Nurse Practitioner Residency Program

Phase ReviewJuly 19, 2016

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

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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

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

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Research

•Webinar series on "Implementing Post-Graduate Nurse Practitioner”

• Attended Northwest Chapter of the National Residency/ Fellowship Consortium

• Site Visit to ICHS

• Independent Research

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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

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Evaluating the # of ResidentsKey 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.

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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

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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).

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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.

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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

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

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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

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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?

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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

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?

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Hold

No Go

Go