health center workforce challenges & one solution on alaska’s horizon: hcplrip presentation...
TRANSCRIPT
Health Center Workforce Challenges& One Solution on Alaska’s Horizon:
HCPLRIP
Presentation for the
Association of Tribal Health Directors
February 17, 2009
Goal – Educate & Activate Re:
APCA
CHC model
Workforce Shortage Challenge
CHC Legislative Request
Statewide Legislative Request HCPLRIP2
Alaska Primary Care Association
3
CommunityHealth Centers
CHC Model
Medically underserved communities / populations
Board governed / advised (51% patients) Not-for-profit organizations Local governments Tribal organizations
CHCs are open to all regardless of insurance statusor ability to pay – offer sliding fee scale
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CHC Model
Quality, comprehensiveprimary care
“Primary Care” includes basic Medical care Dental services Behavioral health care
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CHC network in Alaska is statewide 26 CHCs
13 are Tribal CHCs 141 CHC clinic sites
103 are Tribal CHC clinic sites 80,000+ patients 331,000 patient visits 900+ clinic employees
CHC Model
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“…It has been fabulously successful. We have gotten the best treatment we’ve ever gotten in our lives.” -Bob Henrichs, President, Native Village of Eyak
Illanka Community Health Center, Cordova7
13 Tribal CHCs with 103 Sites
Aleutian Pribilof Islands Association 1
Bristol Bay Area Health Corporation 7
Council of Athabascan Tribal Governments 9
Eastern Aleutian Tribes 9
Maniilaq Association 11
Native Village of Eyak 1
Norton Sound Health Corporation 15
Seldovia Village Tribe 2
Southcentral Foundation 2
SouthEast Alaska Regional Health Consortium 11
Tanana Chiefs Conference 5
Yakutat Tlingit Tribe 1
Yukon Kuskokwim Health Corporation 298
CHC Delivery Sites in Alaska
9
78% of Alaskan CHC Patients areLow Income
U.S. Department of Health and Human Services, HRSA. Bureau of Primary Health Care Section 330 Grantees Uniform Data System (UDS) Calendar Year 2007 Data Alaska Rollup Report.
CHC Patient Income Levels
10
Most Alaskan CHC Patients areUninsured or Publicly Insured
U.S. Department of Health and Human Services, HRSA. Bureau of Primary Health Care Section 330 Grantees Uniform Data System (UDS) Calendar Year 2007 Data Alaska Rollup Report.
CHC Patients: Insurance Status
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12
2006 – 2007 CHC Practitioner Numbers
2006
31
48
29
13
2007 Practitioner Type
32 MDs / DOs
48 PAs
32 NPs
16 Dentists
U.S. Department of Health and Human Services, HRSA. Bureau of Primary Health Care Section 330 Grantees Uniform Data System (UDS) Calendar Years 2006 and 2007 Data Alaska Rollup Reports. 13
Lost in Past 3 Years at CHCs (estimated)
# Lost Practitioner Type
28 MDs / DOs
46 PAs
28 NPs
6 Dentists
21 LCSWs
16 Other MLPsAlaska Primary Care Association, Workforce Survey, February 2009. Findings are estimates based on convenient sampling. Contact David Wilson for more information: (907) 929-2739 or [email protected].
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Current Vacancies at CHCs (estimated)
# Vacant Practitioner Type
22 MDs / DOs
20 PAs
26 NPs
6 Dentists
10 LCSWs
12 Other MLPs
Alaska Primary Care Association, Workforce Survey, February 2009. Findings are estimates based on convenient sampling. Contact David Wilson, APCA, for more information: (907) 929-2739 or [email protected].
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High Vacancy Rates Plague CHCs
Alaska CHC physicians 2% of state total
Alaska CHC physician vacancies 10% of state total
2007 UDS Report, HRSA; and Alaska Health Workforce Vacancy Study, 2007, Beth Landon, Alaska Center for Rural Health. 16
Turnover is High / Recruitment is Slow
Practitioner is employed 2 - 4 yrs MD / DO vacancy 9 -12 mos PA vacancy 6 - 9 mos NP vacancy 9 -12 mos LCSW vacancy 18 mos
Alaska Primary Care Association, Workforce Survey, February 2009. Findings are estimates based on convenient sampling. Contact David Wilson, APCA, for more information: (907) 929-2739 or [email protected]
National Shortage:Giant Problem
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The Shortage Problem:Impacting CHCs
2% U.S. medical students choose primary care¹
9% of physicians practice in rural areas – But 20% of the population resides in rural
areas²
150,000 general dentists in practicing in US– But only 14% practice in rural areas²
CHC patients grew 57% from 2000 to 2006³
19¹Journal of the American Medical Association, September 2008. ²DHSS Heath Planning & Systems Development, Robert Sewell. ³HRSA, Bureau of Primary Health Care Section 330 Grantees Uniform Data System Calendar Years 2000-2006.
A Problem thatMust Be Resolved
Incentives elsewhere have stronger pull
Routinely lose candidates
Question of incentives and loan repayment often first question
Alaskan CHCs can’t compete
Alaska can’t compete
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2 Legislative Solutionsto Address Immediate Problem
1. CHCs 2. Statewide
HCPLRIPCHCStateSupport
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CHC State Support
Federal dollars have not kept pace
Cost for uncompensated care is significant
All but a dozen states support CHCs
Wise investment
Nationally, medical expenses for CHC patients are41% lower compared to patients seen elsewhere.22
FY10 CHC State Support Request
Workforce $1.5 million – local recruitment (O) $120,000 – statewide tools (C)
Energy $5.6 million – energy assistance
Senior Access $155,000 – added to $350,000 line item (O) $500,000 – outreach infrastructure (C)
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HCPLRIP
Health Care ProfessionsLoan Repayment & Incentive Program
Shortages are StatewideShortages are Statewide
Estimated VacanciesEstimated Vacancies 10.3% Statewide10.3% Statewide 16.5% Tribal Health Organizations16.5% Tribal Health Organizations 13.9% Behavioral Health13.9% Behavioral Health
29% of all vacancies29% of all vacancies Shortages: all 119 occupations
25 Alaska Health Workforce Vacancy Study, 2007, Beth Landon, Alaska Center for Rural Health.
Shortages are SeriousShortages are Serious
Without intervention, shortage will Without intervention, shortage will become a public health crisis.become a public health crisis.
26 Rod Betit, Alaska State Hospital and Nursing Home Association, discussion at ASHNHA Annual Meeting, Talkeetna, Alaska., Fall 2008.
Tribal / Rural Recruitment is Tough
Remote locations Cost of living Lack of housing Competing salaries Shrinking pool NHSC &IHS loan repayment
issues Lack of state-sponsored
incentives27
Case in Point: Dental Shortage
$35K recruitment cost
Vacancy rate 10% all 15% rural 42% tribal
Average vacancy 19 months
28 Alaska Health Workforce Vacancy Study, 2007, Beth Landon, Alaska Center for Rural Health.
Statewide vacancy rate of 24% (51% tribal)
Average vacancy length is 15 months
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Case in Point: Pharmacist Shortage
Alaska Health Workforce Vacancy Study, 2007, Beth Landon, Alaska Center for Rural Health.
$126K recruitment cost (family medicine)
Vacancy rate 11.7% all 28.4% tribal
Average vacancy 17.8 months
375 FTE shortage 30
Case in Point: Physician Shortage
Occupational GroupsStatewide Estimates
Positions VacanciesVacancy
RateTribal
VacancyAll Occupations 34738 3529 10.2% 16.5%Physicians 1931 226 11.7% 27.1%Professional Nurses 7139 696 9.8% 15.5%CNA/LPN/PCA/HHA 1762 111 6.3% 14.3%Dentist/Pharmacists/ Therapists
2281 404 17.7% 42.9%
Behavioral Health 7450 1033 13.9% 14.5%Allied Health 5523 434 7.9% 17.1%Public Health/Nutrition 189 ND ND 15.2%Managers 2947 160 5.4% 7.6%Health Information/ Reimbursement
4451 253 5.7% 11.3%
Statewide Vacancy Rates
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HCPLRIP Planning Group
Alaska State Hospital & Nursing Home Assoc Alaska Primary Care Association Alaska Native Health Board Alaska Dental Society Alaska Mental Health Trust Authority Alaska Commission on Post-Secondary Education Health Planning & Systems Development (DHSS) Alaska State Medical Association Alaska Pharmacists Association Alaska Native Tribal Health Consortium Alaska Geriatric Education Center (UAA)
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Support for Service Options
Support forService
Loan Repayments
ScholarshipsResident Support
Direct Incentives
Loans forService
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Prospects
Participants
Trained Professionals
AttritionRetirement
Trained Professionals (from Elsewhere)
Active Practitioners
AK HC Workforce____________________________________________________
__
Direct Care____________________________________________________
_
Non-Direct____________________________________________________
__
Possibles
Support-for-Service Programstarget those who are farther along in their careers.
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When Practitioners Make Commitments
22 23 24 25 26 27 28 29 30 31 32 33 34 35
-7 - 6 - 5 - 4 - 3 - 2 - 1 0 1 2 3 4 5 6
Years before and after service begins
Medical School Residency
Schol
arsh
ip P
rogr
ams
&Ser
vice
-Opt
ion
Loan
s
Loan
Rep
aym
ent
Progr
ams
& Dire
ct
Ince
ntiv
e Pro
gram
s
Service Post-Service Retention
Typical Ages
Resid
ency
Sup
port
Progr
ams
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HCPLRIP Program Elements
Program Elements (see handout)
1. Oversight Entity
2. Fiscal Agent
3. Practitioner Eligibility
4. Site Eligibility
5. Payment Details
6. Program Evaluation
7. Resources & Funding
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2 Components: Loan Repayment & Direct Incentives
37
10 Occupations included in HCPLRIP
Tier-1
Dentists Pharmacists Physicians
Tier-2
Dental Hygienists Nurses (RN) Nurse Practitioners Physician Assistants Physical Therapists Psychologists Social Workers38
Payment Details
Placement Types: Regular & Hard-to-Fill Amounts
Tier 1 Up to $35,000/year (Regular)Up to $47,000/year (Hard-to-Fill)
Tier 2Up to $20,000/year (Regular)Up to $27,000/year (Hard-to-Fill)
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Payment Details (cont’d)
3-year period of service
Quarterly payments following service
May re-apply for a 2nd period of service
Lifetime participation cap is 6 years
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Funding & Resources
Employer or community match 0% - 100%
May not offset current or expected provider supports
Proposed funding for FY10
$7.5 million
$7.5 million: 90 participants (9 in each category)
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Even in tough economic times of low oil revenues…
Economic impact of rural physician
Turnover costs
Locums: high cost & discontinuity of care
Pay-offs Costs avoided Continuity of care42
…HCPLRIP is worth the cost.
Questions?
Thank you for inviting the APCA!
We are happy to partner with you as we work together to promote access across Alaska.
Shelley Hughes Government Affairs Director
Alaska Primary Care Association
907-841-163443