NP Residency Leadership Meeting Phase Review_CHAS Health
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NP Residency Leadership Meeting Phase Review_CHAS Health
- 1. Nurse Practitioner Residency Program Phase Review July 19, 2016
- 2. Overview • Review of Program Goals • Review of Project Timeline & Research • Milestones Met: Clinical Director Hired • Business Case: Number of Residents • Learning Collaborative • Accreditation • Affiliations/Partnerships with Schools • Looking Ahead • Core Team Recommendations • Action Items 2
- 3. Review of the Program Goals •Retention Rate • Cost within budget, milestones met • Number of applicants/accepted/graduates • Resident satisfaction • Staff involvement in education • No Reduction/Improve Patient Access 3
- 4. Overview of NP Residency •Precepted Continuity Clinic 3 days/week •Specialty Rotations 1 day/week •Didactic Education .5/week •Special Population Project/Community Project? .5/week 4
- 5. Research • Webinar series on "Implementing Post- Graduate Nurse Practitioner” • Attended Northwest Chapter of the National Residency/ Fellowship Consortium • Site Visit to ICHS • Independent Research 5
- 6. Milestone Met: Nurse Practitioner Residency Program Clinical Director • Hired Amy Larson to oversee and implement the Nurse Practitioner Residency Program focusing on providing a comprehensive primary care experience, increasing patient access, improving provider recruitment and retention, and improving clinical outcomes for our patients. • Time Commitment • By September 9th ramped up to at least .10 FTE • Life Cycle Minimum .25 FTE and up to .50 FTE 6
- 7. Evaluating the # of Residents Key Assumptions • Assumes 1200 visits by NP Resident. • $60,000 Salary • Assumes after Month 7 about ½ the preceptor time is needed, for a total of .45 FTE. • A Retained Resident will be up 450 visits vs. new hires and we can save $18,500 in recruitment so retention impacts CHAS favorably by $90K / retained resident • We accounted for lack of credentialing for 3 months. 7
- 8. Other Key Assumptions • There will be a start up period with free exam room space • There is a ramp up period for residents • Retention of at least two residents • Clinic will operate 5 days a week • There will be one additional Provider/Faculty that will be hired and carry a full patient panel • After 3 years the NP Residency Program will be net income positive. • The outlook will not be as positive if we only have two residents or less exam space because it is being used for something else 8
- 9. Evaluating the Financial Feasibility • Assumes a Centralized Residency at Indiana with 3 residents. • The patient impact is an additional 5,000 patient visits and 10,800 prescriptions for the system for 3 residents and faculty. • The operational impact is an additional 3.76 FTE Medical Assistants/MSS, 2.0 FTE Front office support, 0.5 FTE Resident Coordinator, 0.2 FTE Resident Director and 0.45 FTE Preceptor. • Operating Loss / year estimates ($200K). 9
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- 11. Learning Collaborative • The Collaborative will include regular distance learning video-conference sessions and planning and implementation work between sessions. • Access to online benchmarked materials and tools • Technical assistance, training and Coaching from the NCA team • NCA mentors for internal practice coaches • A national network of 15 total FQHCs who will be learning from each other while developing residency programs. 11
- 12. Learning Collaborative • The timeline for implementing our program overlaps well with the timing of the Collaborative. We think that we can achieve our goals at a higher level through participation than we would if we implemented the program independently. • Team of staff members who will participate in each learning collaborative session (11 between September 2016 & June 2017); and weekly team meetings. • Pre-work to be completed before the first Learning Collaborative session in September. 12
- 13. Accreditation (Summary) • It provides external validation of rigor, quality and high standards • Positions the program for potential future federal funds • Multi-track process of developing program and seeking accreditation • Process can take up to 8 months with a 6 month target • Application & Self Study • Self Study is extensive – the process takes time! • Team Effort Needed • A day and a half review on site • Accreditation Standards help develop the program 13
- 17. Pursue Affiliation or Partnership with a School? •Helps with recruiting pipeline •Broader organizational benefits •Could help with Didactics •Could help with Accreditation •Could help with Clinical Preceptors 17
- 18. Looking Ahead (Phase 2 & 3) • Detailed Design of Program Guidelines & Scheduling • Detailed Design of Didactics and Precepting Methodology • Develop Implementation Plan • Partnership or Affiliation with local University? 18
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- 21. Core Team Recommendations • Make best effort to have an initial Cohort of 3 NP Residents • Pursue Provisional Accreditation during first year of program • Hire a Resident and Student Coordinator • Join the Learning Collaborative 21
- 22. Action Items • Phase Review • Formal Approval of Participation in Learning Collaborative • Continue with assumption that the first floor of Indiana will be used for NP Residency Program • The core team is interested in affiliations or partnerships with schools but no action outside of preliminary meetings has occurred. Can leadership kick-start next steps on affiliation or partnerships with schools with high level meetings? 22 Hold No Go Go
Editor's Notes
- Cost within budget, milestones met Number of applicants/accepted/graduates Resident satisfaction Increased Provider Confidence & Competence Move past the “Sink or Swim” Phenomenon that many first year NP’s face going directly into practice. Prepares Residents to work with Vulnerable Populations Retention rate 40-60% of NP’s who do their residency with a CHC sign a contract to practice with the organization the following year Staff involvement in education Learning to Supervise Increasing Skill of Clinical Teaching Improved retention with current providers Increased Patient Access Meets several CHAS Priorities Provider Recruiting & Teaching Partnerships Investments in Training Increased Patient Access Improved Clinical Outcomes There is also a broad impact seen in a commitment to excellence and constant learning throughout the organization.
- CHC model has 1000 lost visits for 1, 2 and 3 residents. Our model is much more conservative.
- CHC model has 1000 lost visits for 1, 2 and 3 residents. Our model is much more conservative.
- Costs are estimated at $75k (low) to $90k (high) per resident. If 2 residents are retained the program runs at a loss, if 3 are retained it is break even. If a clinic is built out at Indiana and all space is utilized, 1 to 1.5 Provider FTE’s could be added. This would utilize staff more fully and with 2 residents retained the program would make modest revenue or conservatively be revenue neutral. If all space is utilized, an estimated additional 11,000 prescriptions would increase profit by $150k-$200k. 2.0 FTE Includes front office/PSC etc.
- CHAS Health has been accepted to participate in the Post-Graduate Residency Learning Collaborative, supported by CHC, Inc. and its Weitzman Institute. This Learning Collaborative, part of CHC’s National Cooperative Agreement on Clinical Workforce Development, will help take our center from a planning to an implementation stage in developing a Post-Graduate Residency Program at your health center. Experts will guide us through this process over a 9-month period, beginning in September 2016. 9 month learning collaborative that will aid in taking health centers from planning to implementation stage for NP residency programs. Timeline for implementing our residency program overlaps well with the timing of the Collaborative By participating, we hope to achieve program goals at a higher level than we would implementing the program independently. Networking nationwide with other FQHC’s working to get a program off the ground, gaining technical assistance, training and coaching will help us be successful.
- Pursue Accreditation? $1,000 for application $10,000 for full Accreditation It provides external validation of rigor, quality and high standards Positions the program for potential future federal funds Multi-track process of developing program and seeking accreditation
- Purpose of Job: Improve the overall health of the communities we serve by providing support services to the nurse practitioner residency clinic as follows: Essential Duties and Responsibilities: Assigns schedules, coordinates clinic staff and ensures smooth daily operations of residency rotations. Assists with scheduling and logistics of didactic training to create effective learning opportunities for residents and staff. Assists with monitoring program measures of success including budgeting to ensure financial viability. Works with clinical director to develop and implement clinical and operational strategies. Creates and maintains documentation related to residency program. Works with appropriate stakeholders to recruit and retain residents. Educates potential and current employees and processes documentation for loan repayment programs. Assists with student rotation coordination and other recruitment tasks as needed. Performs other duties as assigned.