Solutions+poll+from+Dave+Solomon

The top six ideas are listed below in no particular order: 1. One or more LCSW on site at clinic, this is already happening at CHC. (Increases access/capacity) 2. Nurse run clinic for opiates (modeled after the Coumadin/Anti-coag RN run clinics) (Clinic support) 3. Hire more support staff to do panel management (increase capacity, clinic support) 4. Hire more PCP's- physicians or NP's, with the expicit purpose of increasing primary care visits. (increases access/capacity) 5. Administration to hire enough providers and staff to fill 90% of clinic space during the regular 40 hour week, and to articulate a goal for what percentage of clinic space will be filled on evenings and weekends. Administration to publish monthly run charts on all 3 of these measures on the dashboard. 6. Pre-visit preparation for establish care visits. ie a staff member who has time allotted to prepare for patients to be seen for the first time. (Modeled after the PONE nurse and Healthy Start intake process) (increases capacity, clinic support)

More patients mean more revenue for our system which may be able to support some of the above ideas.

We also started the discussion of what areas the medical staff can negotiate in terms of other ways of bringing in more revenue. Negotiable ideas that were discussed:

- Treatment nurse appointment becomes provider short notice add on (system localized at each clinic) PCP's agree that for each clinic, they will, when needed, convert 1 treatment nurse appointment into a quick add on/low acuity appointment

- Locums in non-continuity roles for a short period of time (weeks to months) and as a small percentage of the providers doing clinics (no more than 3% of the providers working in primary care clinics of any type can be locums). Consider locums for: short notice clinics, to do new patient intakes, and/or cover for a doc on extended leave.

- Longer clinic with bigger roster, ie a clinic from 1pm-6pm with 12 to 13 patients instead of 10

- Exchange less panel management pay for decreased roster and decreased panel, e.g. someone doing 5 clinics can have a roster each clinic of 9, with an adjusted panel size based on 18 hours of clinic (90% of 20hours).

- Advertise to patients that we have drop-in appointments available in the CHIP clinic with a maximum of 4 patients total per clinic

- Reduce % of prescheduled continuity appts (fewer PA appts, more routine appt slots) on roster

- Commit to working some number of weekend clinics; for example, 2 weekend clinics per year

- Changing the minimum number of primary care clinics from 3 to 5 including 1 weekend or evening

- 15% of medical staff agree to add one clinic

The group was asked who wants to work on this process and move it forward, and the following four people volunteered to work with Ori on these ideas: Sara Levin, Nishant Shah, Tai Roe and David Solomon. In the future this group will bring priority solutions and negotiables to our administration to help them integrate medical staff priorities into our collective response to the challenge of increasing access and absorbing new patients.

Please vote using the survey link below so that you can collectively prioritize the solutions presented here as well as the negotiables. The voting is anonymous but you MUST put your name so that we can verify that nobody votes twice. (Only I will see the names.) __https://www.surveymonkey.com/s/YN6RDH8__

Sincerely, David Solomon

In attendance at the meeting were: Sarah Mcneil, Will Sheldon, Aneela Ahmed, Jessica Lee, Tai Roe, Melina Beaton, Stephen Merjavy, Danielle Draper, Cinnie Chou, Ken Saffier, Sara Levin, Nishant Shah, Lynn Stromberg, Phyllis Howard, David Solomon, David Brody, Adam Buck, Ann Harvey, Rohan Radhakrishna, Joseph Chavez-Carey, John Lipson, and Medical Staff President Ori Tzvieli

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