Report re- Walden-CAN-Health Services Task Force Feb.28/06 Meeting with Dr. Chris McKibbon, Lead Physician -City of Lakes- Family Health Team

Report re- Walden-CAN, Health Services Task Force Feb.28 Meeting with Dr.McKibbon :
1:30pm,former offices of Town of Walden - Details re- Concept & Status of proposed City of Lakes- Family Health Team
Present: Jim-Vice-Chair, Gwen-Secretary, Brent, Paul, Art, Forbes Absent: Richard, Darwin
Guest: Dr.Chris McKibbon, Chief of Staff SRH, Lead Physician, City of Lakes –Family Health Team (COL-FHT)

Introductory Comments: The model of FHT is part of broader scheme involving provincial engagements; part of proposals & policies developed to respond to health care needs of under serviced communities; when call came from province for submissions re- FHT, there were none from Sudbury; a group of physicians got together & I wrote the proposal- therefore named ‘lead’ physician; leadership will evolve over the years & the role of FHT will facilitate leadership.

Part I- Detailed Summary- using 7 Charts - prepared by Dr, McKibbon

Chart 1- Development of Primary Health Care Models:

Over last 10 yrs.
The crisis in primary health care for small communities has led to move from Solo Practices to Group/Family Health Group (LMC) to models offering alternative plans of funding

Feb/March/05 call for proposals for Family Health Teams came:
1. SRH + NOM + City + LMC explored possibility re- making an Expression of Interest; examined demographics & decided to submit group proposal

2. At that time LMC elected not to be a part & wanted to submit own proposal

3. 220 Expressions of Interest were submitted; 50 were chosen
4. The LMC proposal was not successful
5. But in the City of Lakes FHT proposal -a Walden Site was included

At present, still working on conception of COL-FHT

1. Urban FHT is an easy sell; the outlying FHTs are harder sell
2. Must begin by setting up outlying FHT
3. 2 Family Physicians in Val Caron have expressed interest- will be 1st FHT Site

Chart 2- Fee For Service Finances:

a. As a business, FDs must earn sufficient monies to cover overheads + other expenses; income is directly related to 100 different Codes/prices for services provided x number of patients seen
b. The actual ‘case-mix’ (healthy vs multiple illnesses) will impact earnings/time spent/ # of patients seen

Chart 3- Capitated Methods of Payment:

a. The % of capitation ranges from: 10% - Family Health Group( LMC); 60% - FHT; 80% Northern Group Funded Plan & Community Sponsored Contract to 100% - Community Health Centre
b. Offers a broad range of choices for FDs & communities

Chart 4-Blended Capitation Payment re- FHT:

a. FHT: 60% capitation + 40% other services ie. Preventative Medical Care (lots for women; less for men)
b. Special Premiums – care of mentally ill, hospital services etc
c. THAS- Telephone Health Advisory Services- calls directly to FD in FHT
d. New Patient Bonuses
e. Access Bonuses… could also be penalties...if patient can’t access FD & has to go to Sudbury for service
f. Capitation Amount is $120 -$122 per : ave. from babies to elderly - $106 + 22% towards degree of access
g. Shadow Billing = 10%; computer tracking of all services/monitor & evaluate

Chart 5- Funding Model for FHT:

a. All monies come to FHN( Corp) & are dispersed to Team

b. Rostered Capitation + Access Bonus + CME + Grp Mgmt. + Preventative care + Enrollment $$ + Shadow Billing @ 10% + Special Premiums + New Patient Bonus + THAS @ 24K
+ Out of Scope FFS = Total Revenue Inputs to Corp.

c. All salaries & other expenses paid by Corp : NP + Nurses + office assistants + Dieticians + Pharmacists + others

d. The FHT Group decides the methods & role of the entity
e. Other participation opportunities are possible:

I. The City could be a partner:
a. Municipal buildings could be renovated to house FHT; owned by taxpayers/deadweight if underutilized
b. Could provide range of services for population in general vs individual health care services
c. Allows municipalities across the province- who want to provide lease of perpetuity of use as long as for health care- to do it
d. Not part of City mandate to repair private buildings

II NOM could be a partner:
a. NOM needs FDs to help train residents
b. If FD is seeing 50/60 patients per day- not time to teach medical students
c. FHT could help train medical students
d. Those FDs teaching @ NOM only want to work 1 or 2 days per week- could be part of FHT
e. Need to be able to watch student taking a family history; video tape- could be part of FHT model

Chart 6- Proposed Structure of City of Lakes –FHT ( COL-FHT):

a. COL-FHT Operational Council + Walden COL-FHT + Rayside COL-FHT + Pioneer Manor COL-FHT + Valley East COL-FHT + New COL-FHT

b. Managers of our own property vs delegating to others
c. Operational Council will look over whole practice common to all: payroll system, computer information system, full-time CAO, lease ( who holds it) Insurance/Liability etc
d. Collaborative decision re- form it takes- could be Charitable Foundation
e. Requires balance & collaboration & being in touch with community needs

Chart 7- Governance Model:

Joint Executive Committee + Clinical Council + Administrative Council + Community Advisory Panel
Major changes re- re-numeration/ownership/partnerships/allied health providers etc

Other comments re- status of FHT:

a. Actual expressions of interest by health care providers is in constant flux – from 19 FDs up to 40 and shrink back – keeps changing throughout the process
b. Some FDs think that is they wait it will be a Fee For Service model- it’s not going to happen
c. COL-FHT is 6 months behind schedule at present time

Other questions answered:

1. Will Bill 36 re- Local Health Integration Networks (LHIN) affect FHTs?

Bill 36 won’t impede anything.

2. Describe the Interim Plan for Walden…until the COL-FHT is up & running

There can be no interim plan if LMC is not interested in FHT model
Cannot be competitive with LMC

3. What % of FD in Sudbury are over 40 vs under 40? How does this impact health care services?

a. It’s an aging population of Family Doctors
b.Cutbacks in 90’s in enrollment meant that cadre never came along
c. numbers fell behind Medical Schools decided they wanted older/mature applicants (like myself); this impacted the average age of FDs
c. Changing from 1-2 yr Family Residency decreased numbers too
d. Feminization of profession- great but brought drawbacks-
e. In 2005 match- 70+% acceptance into Family Med. Residency were women; 25% difference in services; see less patients
f. Older FDs tend to see more patients; Dr,Koop is a 1.4 FD equivalent
g. New FDs see less

4. How can Walden-CAN help with the process…in the broadest sense?

a. Find out what the people of Walden want
b. In the FHT model- Sponsorship without ownership won’t work
c. Community Input is very important
d. Possibly could be participation in the administrative structure

5. Is this FHT model based on the hospital going out to the community?

a.In a building such as this,( former Town of Walden offices) necessary renovations could permit other services to be provided for the community on Site; costs less to renovate than for a new building @ $300 per sq. ft
b. Could include: consulting services, X-ray equipment, dialysis care, minor surgery, endoscopy, chemo clinic etc…anchored in Primary Care
c. SRH could provide: full-time recruiter, chartered accountants, info technology, diagnostic services, access to hospital records/tests
d. Could be FDs + NP + other services depending on community need/input

Final Comments by Dr. McKibbon:
a. I am not in charge of the FHT…just submitted the proposal (named as ‘lead’ physician)
b. I'm a facilitator re-group sponsorship of City of Lakes –FHT: Dr. McKibbon + SRH + City
c. One of doctors at LMC could be the lead physician here at Walden-FHT site
d. Walden must have ownership in the process .