Statement of Work: The project goals are to evaluate the Consolidated Primary Care Clinic (BCPCC) and identify problems and opportunities to make it better. The tasks include to assess the BCPCC through research and data analysis, to report analysis findings on whether the planned clinic is adequate given current constraints, and to identify strengths, weaknesses, opportunities, and recommendations to enhance clinical operations.
Areas of Analysis:
• Literature review: An analysis of the organizations strategic goals, resources and environment are key characteristics that may aid an organization in determining the best model to select for after hours care. Three common industry models are currently in use to provide after hours care: integrated emergency departments and urgent care clinics, stand alone urgent care/after hours primary care clinics, and sole reliance on emergency departments.
• Patient Demand / Beneficiary mix: The primary data used to analyze the patient mix and utilization was from fiscal year 2003 (FY03). In fiscal year 2003 (FY03), the UCC treated a total of 26,203 patients with an average daily workload of 72 patients. The forecasted demand per day for the BCPCC is 33.29 patients. Throughout the entire day, the BCPCC can expect to divert a total 18.24 patients to the emergency room or to the network for civilian care. Under the projected operational model, the BCPCC will have the capacity to see 40 scheduled patients per day or 14,600 patients per year. The current forecasted demand is 33.29 patient per day, or 12,151 patients per year. The clinic can expect to divert 18.24 patients (13.88 of which are TRICARE Standard or TRICARE for Life patients), or 6,658 patients per year, to the ER or network for civilian care. Roughly 6.71 appointment slots are available to see additional TRICARE Prime or a portion of the diverted patients. Should the clinic elect to provide care to 6.71 diverted patients, the total number of diverted patients will decrease to 11.53 patients per day, or 4,208 per year.
• Financial: According to the data presented the to consulting team, the BCPCC is prepared to operate with a staff mix consisting of 9.4 full time equivalents (FTE) at a cost of $250,432. This cost however, does not account for the military salary. When adjusted to include the military salaries, the actual expense for 9.4 FTEs is $644,277. Using the Medical Command approved Automated Staffing Assistance Model (ASAM) and the forcasted and templated patient demand, the consulting group recommends an adjustment to the staffing mix. Based on the projected patient demand of 12,151 patients annually, the staffing mix should be adjusted to 9.8 FTEs. An adjusted staff mix, based off ASAM standards, realigns the staffing in the clinic to increase the overall efficiency of the clinic. Based on templated projection of 14,600 patients annually, the FTE mix should be adjusted to 11.78 FTEs. Again the staff mix is adjusted to reflect ASAM standards. Adjustments to the staff mix will increase the average cost per patient from $164 (with 9.4 FTEs) to $174 (with 9.88 FTEs) and $173 (with 11.78 FTEs) accordingly.
• Process: A number of process issues where noted with the old UCC. They include small signs which confuse patients, the patient check in process in inefficient, and triage is not timely. With the new BCPCC, the initial patient “check-in” process is exactly the same and will not improve the throughput process of determining which patients need care and where they should receive care. This has a potential to cause serious bottlenecks in both the BCPCC and the ER. Determining the eligibility status and the process of diverting patients is also timely, confusing, and will cause significant patient satisfaction issues. Noted areas of concern are: signage, triage, capacity to see non-Prime and TRICARE Plus patients, collaboration/communication between other clinics, and the availability of a health benefits advisor.
Recommendation: Based on the analysis of current industry models and the data from the UCC, the consulting group recommends that MTF implement the stand-alone after hours clinic model for the BCPCC. It is recommended that the clinic adjust its staff mix to 11.78 FTEs to provide adequate staff to efficiently see the templated demand of 14,600 patients annually. This will result in an increased average cost per patient; however, this model and staff mix will help maintain patient satisfaction. With the open appointments, the BCPCC should consider seeing TRICARE Standard and TRICARE for Life patients when possible. The BCPCC should also work to establish protocols for disengaging from non-Prime patients, establish a central appointments system, and review their patient flow in order to streamline patient care. Advantages of implementing a stand-alone model are that: it focuses on primary care for beneficiaries, minimizes wait times for patients, improves patient satisfaction, and it is convenient for patient access. Disadvantages are: low patient volume may jeopardize staff skills, it increases the risk of treating non-TRICARE eligible patients, and it is difficult to maintain continuity of care.