Physician Recruitment and Retention for Charity Care

1. Physician Recruitment and Retention for Charity Care Tennessee Charitable Care Network May 8, 2017 Rae Young Bond

2. The Project Access Model • Project Access is a system of health care for low-income uninsured patients that organizes physician volunteers to provide care -- often in their offices -- before health conditions reach a crisis…and the ER. • A partnership between physicians, medical societies, multiple health centers, and hospitals • In collaboration with hospitals, health agencies, and community leaders.

3. Functions of Project Access • Develops and maintains physician, hospital, and other provider networks • Provides care coordination • Utilizes a state-of-the-art software system that manages referrals and tracks and reports “claims” submitted by providers of charity care

4. Functions of Project Access • Enforces/monitors client eligibility and is time-limited (Chattanooga – 150% of poverty; Knoxville - 200% of poverty • Charity care is not “free” – the cost is being a good healthcare citizen • Keeping appointments – on time • Taking meds • Following directions • Doing your part to achieve wellness • Breach of contract by the patient results in loss of access to network services

5. How Does Project Access Work? • Patients receive an ID card that has their eligibility dates and contact info for PA. • Partners set us up in their systems as if we were a payer. They send us claims info and then write the charges off to charity. • We provide each partner with a Provider Manual that clearly explains the process.

6. How Does Project Access Work? • Potential patients are screened for eligibility at a partner health center or by the Project Access office. • Participating physicians also can refer qualified patients to Project Access (so they can have access to needed tests and procedures).

7. Why Do Hospitals Participate? • Lower ER Use and Intervention Before Situations are a Crisis. Over time, volunteer programs can decrease ER utilization because patients are treated earlier in more cost-effective ways. • A Cost-effective Approach to Care. There is an increase in the number of uninsured patients with access to care, without an increase in overall per capita costs. • Single Entity to Coordinate Services. Most hospitals have appreciated having a single coordinator for these services, rather than working with multiple referral sources.

8. Program Results Hamilton County(2004- present) • Amount of Donated Care: $155 million • Patients: 15,840 Monthly: 550-650 • 900 volunteers serve 14 health centers Knoxville Area (2005-present) • Amount of Donated Care: $185 million • Patients: 22,000 Monthly: 935 (includes # enrolled in primary care) • 1,100 volunteers; serving 9 health centers

9. Program Results Nashville (2005-present) • Amount of Donated Care (specialty care only): $35.98 million • Patients: 4,874 Monthly: 154 • 1,087 volunteers Serve 23 health centers • Appalachian Mountain (2008-present) • Amount of Donated Care: $53.5 million • Total Patients: 5,092 Monthly: 300 • 500 volunteers Serve 7 health centers

10. Hamilton County Project Access Uninsured Population in Hamilton County Volunteers in Medicine Physician Offices Multiple smaller clinics Erlanger FQHCs Memorial Clinics Homeless Health Clinic Health Dept. Clinics Rehab Services Lab Services Hospital Services 900+ Volunteer Physicians Pharmacy Assistance Durable Medical Supplies Mental Health Social Services Siskin Hospital Rehab South Primary Care Medical Specialties Erlanger Hospitals Memorial Hospitals Parkridge Hospitals Kindred Hospital

11. Access to Specialty Care Increases Primary Care Capacity

12. More BCMS Results • The per capita cost of free care in the community has been reduced. • Timely access to care allows earlier, less costly medical intervention. • Avoidable repeat visits to the county health department have been reduced; the department sees 50% more primary care patients, but the number of patient visits has remained constant.

13. More BCMS Results • Nearly doubled number of patients with regular source of care • The amount of charity care provided by doctors and hospitals is documented • Businesses benefit because absenteeism is down (13% in one study) and productivity is up (25% by self-report)

14. Why Physicians Supported PA • It engages more people in providing charity care. Charity care is equitably distributed between volunteer physicians. • It makes it easier to access tests and treatment for your current charity patients. They can refer existing patients who are eligible. They count toward your annual commitment and PA helps them access other Project Access services. • Positive Impact on Patient Health, with Accountability. Patient need is verified, and the program reinforces patient responsibility.

15. Why Physicians Supported PA • Positive Recognition of Medical Profession. Project Access increases recognition of the physician role in promoting community health and caring for the needy. • Documented Results. Project Access tracks the value of care actually provided by key participants. • The Right Thing to Do.

16. Why do People Volunteer? • Help Those in Need • Give Hope to Others (or Share Your Faith, or Follow a Spiritual Calling) • To be Adventurous • To Save Lives • Sense of Professional Responsibility • Keep Active in Retirement • Learn

17. Why do Doctors Volunteer? • Doctors became doctors to care for patients. • A number of great doctors are retiring earlier than expected because: • The regulatory climate has changed things they loved about medicine. • They HATE EMRs, especially if their practice has gone through more than one version. • Volunteering at a charity clinic can help restore their first love!

18. Understand Your (Organization’s) Value • Understand the value your program brings to the community, to individuals, and to volunteers. This helps articulate message. • Consider the mission and values of the individuals you are trying to recruit. • How does your mission align with theirs?

19. Tailoring Your Messages • Think about your messaging in recruitment and tailor it to the needs and interests of the individual/organization you are trying to recruit. • Faith-Based institution/individual? Appeal to their spirit vision and values. • Competitors? Remind them their competitors are supporting your program.

20. Physician Recruitment • The most effective recruitment is done physician to physician. • Consider creating a physician recruitment team with respected physician leaders. • Consider recently retired physicians who are still fully licensed. • To the extent possible, create processes that model their regular practice and/or referral patterns.

21. Volunteer Physician Licenses in TN • Special Volunteer License • Inactive Volunteer License (Inactive Pro Bono Practice) • Recently retired physicians are seldom ready to retire completely • They maintain relationships with physicians still in practice

22. Medical Liability • Some physicians are concerned about liability protections (even though PA programs have had no lawsuits). • Tennessee has passed the Volunteer Health Care Services Act which provides significant liability protection for physicians when treating patients without charge through a coordinated healthcare program such as Project Access or at an indigent care clinic.

23. Volunter Health Care Services Act • Encourages physician to provide services in remote/rural areas that are underserved or to at-risk, low-income populations. • The physician must work for a sponsoring organization that has registered with the TDOH and coordinates the voluntary health care services. • The physician receives NO compensation for care.

24. Things Physicians May Ask • Describe your Financial Screening Process. • Can you do appointment reminders? • Consider a patient responsibility contract that outlines patient responsibilities. • Project Access handles it when patients need to be discharged (only 120 patients in 12 years)

25. Things Physicians May Ask • Reciprocity: Can specialists refer their uninsured specialty care patients back to you when they are ready to be discharged but need primary care? • Can you help them access laboratory, hospital, and other specialty services (anesthesiology, pathology, etc.).

26. Things Physicians May Ask How many patients will they see? How long is their commitment? We reinforce that participation in Project Access is voluntary and they can change their commitment at any time.

27. Ask Volunteers What THEY Need • Make it EASY to volunteer.

28. Maintaining Volunteers • Provide appropriate support for your volunteer physicians (aide, scribe, etc.). • Communicate clearly and in advance about scheduling. If they are available on a standard day once a month, take advantage of that. • Acknowledge the actual cost for a physician to be away from his/her own office. • Share your successes. Tell your story.

29. Say Thank You • Year-end feature story in HealthScope magazine, with a list of all participating volunteer physicians and APNs • Holiday “card” or thank you letter • Patient stories! • Thank you notes from patients (we supply the cards) • Periodic news stories about volunteer physicians. • Inexpensive box of chocolate pretzels or cookies to the practices in December

34. “Many hands make light work.” “Statistics are people with the tears wiped away.”