A GP for Me
and
In-Patient Care
Program Overviews
April 2013
Revised: April 9, 2013
www.gpscbc.ca
A GP for Me
(or the Attachment Initiative)
www.gpscbc.ca
A GP for Me: Background
• Number of unattached patients in BC uncertain
• Using Canadian Community Health Survey data, it
is estimated:
– 13.8% of British Columbians (~615,000 people) have no
regular family physician; and
– 3.96% (~176,000) are looking for a family physician, but
cannot find one.
www.gpscbc.ca
A GP for Me: Background
• Hollander's BC data indicates better outcomes at
lower costs for patients attached to a FP
• Care through walk-in clinics or Emergency
Departments
– fragmented & expensive
– poorer outcomes
• Lack of access = health inequities
• 2010 Government commitment to provide a family
physician for any BC resident who wants one, by
2015
www.gpscbc.ca
A GP for Me: Goals
• Confirm and strengthen the FP-patient continuous
relationship
• Better support the needs of vulnerable patients
• Enable patients that want a family doctor to find one
• Increase the capacity of the primary health care system
www.gpscbc.ca
A GP for Me: Consultation
• Nearly 400 FPs involved in creation of initiative:
– as members of the GPSC shaping the high-level framework;
– as members of both BCMA and SGP boards of directors, reviewing and
approving the GPSC’s work ;
– as members of the provincial attachment working group from the prototype
communities;
– Approx. 300 physicians tested and implemented the prototype plans across
three communities;
– through workshops to define patient attachment and outline the responsibilities
of both physicians and patients in this relationship; and
– through addressing elements of attachment through CSCs:
•
•
collecting and analyzing data to better understand unattached patient numbers and priority areas
for improving the health of vulnerable populations.
Co-designing community supports with Health Authority Partners
www.gpscbc.ca
A GP for Me: Prototype Results
• Two-year prototype – White Rock/South
Surrey, Prince George, Cowichan Valley
– Approx. 9,400 unattached patients connected to
FPs or primary care clinics
– Many complex patients being served in primary
care clinics and/or through Division of Family
Practice / Health Authority collaborative initiatives
– Currently, patients can find a FP immediately in
White Rock/South Surrey.
www.gpscbc.ca
A GP for Me: Expansion
• Components of Patient Attachment:
1. Practice Fee Supports
2. Divisional Supports
3. Alignment of existing Health Authority, Ministry
and Physician Committee initiatives and
programs
www.gpscbc.ca
A GP for Me: Fee Supports
• Attachment Participation Code G14070:
– Zero-Sum MSP code to indicate commitment
– Once per physician per calendar year
– Submission indicates the FP will:
• provide continuous full service family practice services
• confirm their primary care relationship with their patients
• register with and work with local Division of Family Practice and/or
community to develop community-specific supports as they are
able
– Participation opens access to Attachment fees
www.gpscbc.ca
A GP for Me: Fee Supports
• Attachment Participation Code G14070:
• Submit with “Patient” Identifiers
–
–
–
–
–
PHN#: 9753 035 697
Patient Surname: “Participation”
Patient First Name: “Attachment”
Date of Birth: January 1, 2013
ICD-9 code: 780
www.gpscbc.ca
A GP for Me: Fee Supports
Physician-Patient ‘Compact’:
•As your family doctor I, along with my practice team, agree to:
– Provide you with the best care that I can
– Coordinate any specialty care you may need
– Offer you timely access to care, to the best of my ability
– Maintain an ongoing record of your health
– Keep you updated on any changes to services offered at my clinic
– Communicate with you honestly and openly so we can best address your
health care needs
www.gpscbc.ca
A GP for Me: Fee Supports
Physician-Patient ‘Compact’:
•As my patient I ask that you:
– Seek your health care from me and my team whenever possible
and, in my absence, through my colleague(s), xxxxxx
– Name me as your family doctor if you have to visit an
emergency facility or another provider
– Communicate with me honestly and openly so we can best
address your health care needs
www.gpscbc.ca
A GP for Me: Fee Supports
Physician-Patient ‘Compact’:
•NO need to call in each patient
•Can be done face-to-face, by letter or other communication, or
by posting this standardized ‘Compact’ in office and
examination rooms
•Supportive materials (posters, brochures) are available from
the GPSC website (www.gpscbc.ca)
www.gpscbc.ca
A GP for Me: Fee Supports
• Attachment Fees
1. G14076 GP Attachment Telephone Management fee
2. G14075 GP Attachment Complex Care Management
fee
3. G14077 GP Attachment Patient Conference fee
4. G14074 GP Unattached Complex/High Needs
Patient Attachment fee
5. Non-Complex Unattached Patient Intake (future
incentive)
www.gpscbc.ca
A GP for Me: Fee Supports
1. G14076 GP Attachment Telephone Management Fee
•
•
•
•
•
•
Requires submission of Attachment participation code by FP
$15 per 'visit'
All patients for whom that FP is community MRP
500 per physician per calendar year
Intent is to use to avert need for a visit; in practice, WIC, ER
Requires clinical discussion. NOT for:
• notification of appointments, referrals
• prescription renewals
• May be delegated to another College-certified healthcare professional
• Patients who are eligible for the GP Patient Telephone/e-mail Follow-up
Management fee (G14079) are also eligible for the new Attachment
telephone fee (not on same day)
www.gpscbc.ca
A GP for Me: Fee Supports
2. G14075 GP Attachment Complex Care Management fee
•
•
•
•
Access requires submission of Attachment Participation Code
Includes diagnosis of 'Frailty'
Use Diagnostic Code V15
Canadian Study of Health and Aging Scale; Level 6 & 7
• Moderately Frail: Help is needed with both instrumental and
non-instrumental activities of daily living
• Severely Frail: Completely dependent on others for the
activities of daily living, or terminally ill
• FPs participating in the Attachment initiative still have access to
the original Complex Care incentive (G14033) for qualifying
patients.
FPs choosing not to participate will only have access current FP
complex care dual-diagnosis fee item G14033
www.gpscbc.ca
A GP for Me: Fee Supports
3. G14077 GP Attachment Patient Conference fee
•
•
•
•
•
•
•
•
•
Access requires submission of Attachment Participation Code
Less restrictive; replaces G14015, G14016, G14017
Removes requirement for onsite attendance
Removes need to conference with 2+ other healthcare
professionals
Initiation by facility not required; either side can trigger
Any patient for whom FP is community MRP – no diagnostic
restrictions
Any time either side feels is clinically warranted
$40 per 15 minutes or greater portion thereof
Max 2/calendar day, up to max 18/calendar year per patient
• Non-participants still have access to current fees
www.gpscbc.ca
A GP for Me: Fee Supports
4. G14074 Unattached Complex/High Needs Patient
Attachment fee
•
•
•
•
$200 in addition to visits
providing care for new patients who do not have a FP
Commit to provide ongoing, longitudinal FSFP care for at least one year
Target Populations
•
Complex/high needs populations
»
»
»
»
»
•
Frail in community and in residential care
High needs chronic conditions
Cancer patients
Severe disability
Mental health and substance use
Mother/Baby dyad is counted as one
» May be accepted into longitudinal practice at any time during pregnancy up to
child aged 18 months
• Patient must be referred.
www.gpscbc.ca
A GP for Me: Fee Supports
4. G14074 Unattached Complex/High Needs Patient
Attachment fee (continued)
• Referral Sources
•
•
•
•
•
•
•
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Acute Care: ER and Admitted
Mental Health/Substance Use Workers/Clinics
Home and Community Care
BC Cancer Agency or regional centres
Public Health
Colleagues
Local Division
Patients cannot self-identify
www.gpscbc.ca
A GP for Me: Fee Supports
5. Non-Complex Unattached Patient Intake
• Future incentive
• Lower priority
• Placeholder for future consideration as funding is identified
www.gpscbc.ca
A GP for Me: Divisional Supports
 32 Divisions, including new provincial Rural and Remote Division
 Over 95% of FPs have a Division available
 $40M one-time funding to support the Attachment work of Divisions
 $24M Discretionary MoH support for non-physician expenditures;
 $16M GPSC allocation for physician-related costs
 In areas where there is no Division an alternate mechanism will be
made available
 Allows:
 Engagement with and expansion of membership;
 Assessment of community makeup, local primary care system;
 Collaboration with local HA through the CSC to identify problems,
develop local solutions and provide community-specific supports for
Attachment; and
 Implementation of agreed-upon plan.
 Not to be used for:
 Long term (ongoing) Leases
 Long term (ongoing) Contracts with Allied Health Professionals or Physicians
 Solutions will vary – community-specific
www.gpscbc.ca
Divisional Phases of ‘A GP for Me’
Fee component:
All Family
Practitioners
providing
continuous care
Communication
Introduce and
explain Attachment
www.gpscbc.ca
Access to
portal fees
Tools and
resources to
share
Tools and
resources to
share
Tools and
resources to
share
Division
Component
ASSESS
PLAN
IMPLEMENT
Local
approvals and
provincial
approval
Approval and
funding
Agreement
Dr. informs
Division they have
billed Attachment
participation code
Approval and
funding
Agreement
Divisional Supports: Overview Summary
Pre Planning Phase:
Work with PEL:
Checklist
Plan design
Letter of Intent
Plan to be
reviewed by
Committee
Planning Phase:
($xxx,xxx)
CONTRACT
Data
Analysis
Operation Plan
Approach
Metrics
Plan to be
reviewed by
Committee
Implementation Phase
CONTRACT
ACTIVATE
Year 1
Year 2
Year 3
www.gpscbc.ca
A GP for Me: Alignment of Existing HA,
Ministry and Physician Committee Initiatives
• Programs currently under way:
• Integrated Primary and Community Care Strategy
• NP4BC
• Practice Support Program/Physician Information
Technology Office IT alignment
• Better at Home Program
• Home Health Monitoring
• After-hours Palliative Nursing Services
• Seniors’ Action Plan
• Partnerships with non-governmental organizations
providing patient self-management supports
www.gpscbc.ca
In-Patient Care
Initiative
www.gpscbc.ca
In-Patient Care: Background
• 48% of "MSOC-50" FPs providing In-patient Care
• Attrition of ~3%/Yr FPs leaving in-patient care service delivery
Percentage of community based GPs
80%
70%
60%
50%
40%
30%
20%
10%
0%
www.gpscbc.ca
31%
In-Patient Care: Supports
G14086 GP Assigned In-patient Care Network Initiative:
“Assigned In-patient”: a patient whose family physician has:
•
•
Accepted Most Responsible Physician status for their care while resident in the
community, and
Admitting privileges at the acute care facility in which the patient has been admitted.
The Assigned In-patient Care Network Fee is designed to support the provision of
in-hospital care to ‘Assigned’ inpatients by their own family physicians. This
includes the costs of group/network activities for their shared provision of care
to their Assigned hospital in-patients.
Funding Level:
• $8,400 per annum paid at $2,100 at the beginning of each quarter; and
• Payable in addition to visits.
www.gpscbc.ca
In-Patient Care: Supports
G14086 GP Assigned Inpatient Care Network Initiative
•
•
•
•
For date of service use: April 1, 2013, July 1, 2013, October 1,
2013, January 1, 2014
Billing Schedule: First day of the month, per calendar quarter
Once your registration in the network has been confirmed,
submit fee item G14086 GP Assigned in-patient care network
fee using the demographic patient information on the following
slide. Your location will determine which PHN# to use.
Use Diagnostic Code 780
www.gpscbc.ca
In-Patient Care: Supports
GP Assigned Inpatient Care Network
Participant Location Specific “patient” demographics for billing
Fraser Health Authority:
PHN# 9752 590 548
Patient Surname: Assigned
First Name: FHA
Date of birth: January 1, 2013
Northern Health Authority:
PHN# 9752 590 509
Patient Surname: Assigned
First Name: NHA
Date of birth: January 1, 2013
Vancouver Island Health Authority:
PHN# 9752 590 516
Patient Surname: Assigned
First Name: VIHA
Date of birth: January 1, 2013
www.gpscbc.ca
Interior Health Authority:
PHN# 9752 590 587
Patient Surname: Assigned
First Name: IHA
Date of birth: January 1, 2013
Vancouver Coastal Health Authority:
PHN# 9752 590 523
Patient Surname: Assigned
First Name: CVHA (note first name starts with ‘C’)
Date of birth: January 1, 2013
In-Patient Care: Supports
Eligibility for the Assigned In-patient care Network Incentive:
•
Be a family physician in active practice in B.C.;
•
Have active hospital privileges;
•
Be associated and registered with a minimum of three other network members
(special consideration will be given in those hospital communities with fewer
than four doctors providing inpatient care);
•
Submit a completed Assigned In-patient Care Agreement Form;
•
Submit a completed Assigned In-patient Care Network Registration Form;
•
Co-operate with other members of the network so that one member is always
available to care for patients of the Assigned In-patient Care Network; and
•
Must provide MRP care to at least 24 admitted patients over the course of a
year; networks may average out this number across the number of members.
•
Exemptions can be made through the GPSC In-patient Care working group.
www.gpscbc.ca
In-Patient Care: Supports
Unassigned In-patient Care Network Incentive:
•
“Unassigned In-patient”: a patient whose family physician does not have
admitting privileges in the acute care facility in which the patient has been
admitted
•
Quarterly incentive based on the annual volume of unassigned in-patients
admitted to the acute-care facility, and is available for most hospitals with a
community GP run unassigned inpatient care model
•
Incentive for Unassigned In-patient Care is not available for hospitals which
have a Hospitalist model
•
Payment will be made to participating Divisions of Family Practice, or where
there is no Division or the local Division decides not to provide the oversight, to
the Network group.
Funding Level:
•
Funding varies across hospital sizes from $8,213/qtr to $54,750/qtr.
www.gpscbc.ca
In-Patient Care: Supports
Unassigned In-patient Care Network Incentive:
Funding varies across hospital dependent upon volume of unassigned
Annual Volume
www.gpscbc.ca
Daily payment
Annual Rate
>1,000
$600
$219,000
800-999
$500
$182.500
600-799
$400
$146,000
400-599
$310
$113,150
200-399
$220
$80,300
100-199
$130
$47,450
<100
$90
$32,850
In-Patient Care: Supports
Eligibility for claiming the Unassigned In-patient Care Network Incentive:
•
Be a family physician in active practice in B.C.;
•
Have active hospital privileges;
•
Submit a completed Unassigned In-patient Care Service Verification Form;
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Submit a completed Unassigned In-patient Care Network Registration Form;
•
Also be a member of the Assigned In-patient Care Network unless an exemption
is granted by the Division or the GPSC In-patient Care Working Group as
indicated under the specifics of the Assigned In-patient Care Network Incentive;
and
•
Cooperate with other members of the network so that one member is always
available to care for patients of the unassigned in-patient network.
•
Exemptions can be made through the GPSC In-patient Care working group.
www.gpscbc.ca
In-Patient Care: Supports
G14088 GP Unassigned In-patient Care fee:
•
$150 per patient for MRP care for duration of hospital stay
Eligibility
•
Must be member of a Unassigned In-patient Care Network and/or a Maternity
Network;
•
Payable once per unassigned in-patient per in-hospital admission;
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Payable only to the FP who is the Most Responsible Physician (MRP) for the patient
during the in-hospital admission or is providing shared MRP responsibilities with a
specialist due to a significant medical issue unrelated to the purpose of admission;
•
Payable in addition to the hospital visits for care;
•
Not payable to physicians who are employed by or who are under contract to a
facility and whose duties would otherwise include provision of this care; and
•
Not payable to physicians working under salary, service contract or sessional
arrangements whose duties would otherwise include provision of this care.
•
Exemptions can be made through the GPSC In-patient Care working group.
www.gpscbc.ca
In-Patient Care: Supports
Clinical Service Fee Bonus
– 25% lift to community FP MRP visit fees (13008, 00127)
– Payable to all FPs performing this service
Telephone Visits, Attachment Patient Conference
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expanded conference with healthcare professionals, patients
all patients for whom FP has community MRP responsibility
initiated by either FP or patient/healthcare professional
any time during care as clinically indicated
expanded number per year
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Questions?
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Thank you
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