PHYSICIAN AND MID-LEVEL RECRUITMENT AND TRAINING

Identifying Project and Provider Information: Category 1: Increase Training of
Primary Care Workforce; Project Option 1.2.2: Increase the number of primary care
providers (i.e., physicians, residents, nurse practitioners, physician assistants) and
other clinicians/staff (such as health coaches and community health
workers/promotoras); 094109802.1.4; HCA Las Palmas Del Sol (094109802).

Project Description: This project will increase recruitment and training of
physicians and support staff including nurse practitioners and physician assistants.
Recruitment will entail creative strategies for attracting the needed practitioners to
the El Paso community. Training will entail partnering with educational institutions in
the area to increase the hands-on training for physicians and medical support staff.
We have an ongoing mission to draw talented, qualified physicians and support staff
to our facility. We have actively engaged in marketing and incentive strategies to
recruit physicians into our community. In addition to current efforts, we continue to
seek and develop innovative ways to attract physicians to El Paso. This project will
improve our ability to retain and recruit physicians. We are in need of at least 60
positions within our community (including 25 Internal Medicine, 18 Family Practice,
and 15 Pediatricians). In order to hire and retain these key personnel, we plan to
recruit or employ them within a five-year period. We will develop a plan for adding
additional incentives to the recruitment and retention efforts, and implement
strategies we have identified. We can offer tuition assistance nursing students who
are in the nurse practitioner program if they commit to working for HCA Las Palmas
Del Sol. It is our intention to provide physician resident rotations at our facility in
cooperation with Texas Tech, so that their residents may experience treating
patients in a private hospital setting. This will serve a dual purpose: area physicians
will receive additional training, and we will have the opportunity to recruit them to
stay at our El Paso facilities.

Challenges include: obtaining the staff and space to accommodate training
programs; implementing collaborations with education facilities; targeting
practitioners willing to work in primary care and live in El Paso; offering competitive
recruitment packages.

Starting Point/Baseline: As of December 2011, our medical staff complement for
HCA Las Palmas Del Sol is 282. This consists of 148 Internal Medicine, 88
Pediatricians, 46 Family Practice, and various others. Las Palmas Del Sol has seven
employed nurse practitioners and zero physician assistants. Currently we offer
income guarantees to physician recruits, including relocation and start-up support.

Rationale: El Paso, Texas has a growing shortage of primary care doctors and
nurses due to the needs of an aging population, a decline in the number of medical
students choosing primary care, and thousands of aging baby boomers who are
doctors and nurses looking towards retirement. The shortage of primary care
workforce providers is a critical problem that we have the opportunity to begin
addressing under this waiver.
El Paso also has a shortage of bilingual Nurse Practitioners. Recruitment of Nurse
Practitioners outside of El Paso has proven difficult because most of these
candidates do not speak both English and Spanish. It is crucial to support our local
nurse practitioner programs within the community so that we retain sufficient human
capital that will have the necessary skill sets to provide the primary care needed for
our community.
It is difficult to recruit and hire primary care physicians. We are in need of at least 60
positions within our community (including 25 Internal Medicine, 18 Family Practice,
and 15 Pediatricians). The shortage of primary care providers has contributed to
increased wait times in hospitals, community clinics, and other care settings. Nearly
one-third of the El Paso community is uninsured or underinsured; many of these
patients utilize the community emergency departments for primary care. This results
in high-cost, fragmented healthcare delivery. Expanding the primary care workforce
will increase access and capacity and help create an organized structure of primary
care providers, clinicians, and staff. Moreover, this expansion will strengthen an
integrated health care system and play a key role in implementing disease
management programs. The extended primary care workforce will also be trained to
operate in patient‐centered medical homes. A greater focus on primary care will be
crucial to the success of an integrated health care system. In summary, the goal for
this project is to train more workforce members to serve as primary care providers,
clinicians, and staff in order to address the substantial primary care workforce
shortage, increase access, care for the aging and uninsured population, and update
training programs to include more organized care delivery models.

Related Category 3 Outcome Measure(s): OD-6: Patient Satisfaction; IT-6.1:
Percent improvement over baseline of patient satisfaction scores; (094109802.3.4).

Relationship to Other Projects: This project is part of LPDS’s larger plans to
expand and develop primary care and specialty care services, while improving
access to care and containing the costs of care. . Specifically, this project will
complement LPDS’s Psychiatric Telemedicine project (094109802.1.1) and
Outpatient Women’s Imaging Services Expansion project (094109802.1.2); each of
these projects is intended to increase access to important health care services for
patient populations with an identified need and an identified lack of timely access.
Furthermore, this project will complement the Outpatient Women’s Imaging Services
Expansion project in developing and expanding a robust community-wide network of
primary care services in El Paso.

Relationship to Other Performing Providers’ Projects in the RHP: TBD

Plan for Learning Collaborative: TBD

Project Valuation: $7,237,994. The valuation of each LPDS project takes into
account the transformational impact of the project, the population served by the
project (both number of people and complexity of patient needs), the alignment of
the project with community needs, and the magnitude of costs avoided or reduced
by the project. In particular, this project has been valued based on the crucial role
that primary care providers play in effectively and efficiently providing quality health
care services to a community, and the need for such primary care providers in El
Paso.
094109802.1.4
1.2.2.X
HCA Las Palmas Del Sol
094109802.3.4
IT-6.1
Related Category 3
Outcome Measure(s):
Year 2
(10/1/2012 – 9/30/2013)
Milestone 1: Establish baseline for
metrics P-2.1 and I-11.1.
Metric 1: Establish baseline for future
years.
Milestone 1 Estimated Incentive
Payment: $1,770,157
1.2.2
PHYSICIAN AND MID-LEVEL RECRUITMENT AND TRAINING
094109802
Percent improvement over baseline of patient satisfaction scores
Year 3
(10/1/2013 – 9/30/2014)
Milestone 2 [P-2]: Expand primary
care training for primary care
providers, including physicians,
physician assistants, nurse
practitioners, registered nurses,
certified midwives, case managers,
pharmacists, and/or dentists.
Metric 1 [P-2.1]: Expand the primary
care residency, mid-level provider
(physician assistants and nurse
practitioners), and/or other
clinician/staff (e.g., health coaches,
community health
workers/promotoras) training
programs and/or rotations.
Baseline/Goal: Begin operating
new training programs.
Data Source: Training program
documentation.
Year 4
(10/1/2014 – 9/30/2015)
Year 5
(10/1/2015 – 9/30/2016)
Milestone 3 [I-11]: Increase primary
care training and/or rotations.
Milestone 4 [I-11]: Increase primary care
training and/or rotations.
Metric 1 [I-11.1]: Increase the number
of primary care residents and/or
trainees, as measured by percent
change of class size over baseline.
Demonstrate improvement over prior
reporting period.
Baseline/Goal: Increase of 4 over
DY 2 baseline.
Data Source: Documented
enrollment by class by year in
primary care training program.
Metric 1 [I-11.1]: Increase the number of
primary care residents and/or trainees, as
measured by percent change of class size
over baseline. Demonstrate improvement
over prior reporting period.
Baseline/Goal: Increase of 2 over DY 4.
Data Source: Documented enrollment by
class by year in primary care training
program.
Milestone 4 Estimated Incentive Payment:
$1,599,932
Milestone 3 Estimated Incentive
Payment: $1,936,760
Milestone 2 Estimated Incentive
Payment: $1,931,146
Year 2 Estimated Milestone Bundle
Amount: $1,770,157
Year 3 Estimated Milestone Bundle
Amount: $1,931,146
Year 4 Estimated Milestone Bundle
Amount: $1,936,760
TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4-YEAR PERIOD: $7,237,994
91311
Year 5 Estimated Milestone Bundle Amount:
$1,599,932