Power point buisness in clinical practice

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Strategic Plan: Community Health Clinic Phoenix Urban Native Center

Baylor University DNP Program

Urban Health Clinic

OVERVIEW: URBAN HEALTH CLINIC (UHC)  Native American Non-profit Organization

 Mission: Provide free patient-centered healthcare services to low-income Native Americans (American Indians and Alaska Native) located within the metropolitan area of Phoenix, Arizona. The clinic serves over 50 primary appointments daily, 15 sick/emergency visits daily and over 1,500 patients yearly.

 Services: Offer a variety of comprehensive medical assistance across the lifespan of an individual. Our services are available from infants to elderly adults and include specialty care for urban Native Americans. The services are delivered by culturally competent providers with sensitivity to all we serve daily. Services include primary medical care, wellness visit, prenatal care, minor dental care, behavior health, other available services.

 The staff consists of physicians, advanced practice nurses, dentists, registered nurses (RNs), medical & dental assistants and other medical personnel.

 Urban Health Clinic is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Federal Tort Claims Act (FTCA) Public Health Service organization under 42 U.S.C. 233(g)-(n).

 Location: 1908 Ivy Lane Phoenix, AZ 82005

 UHC is an Equal Opportunity Employer.

Urban Health Clinic

Overview: Services

Urban Health Clinic

 Primary Care: Prevention, Treatment, & Education

 Chronic Management: Diabetes, Obesity and Hypertension

 Annual physical exam for men & women; School physicals

 Dental visits: Preventative & Basic care

 Prenatal and Wellness visits

 Pregnancy testing & Prenatal lab work, Prenatal care, Labor and Delivery care & classes, Post Partum Care, Case management, Home Visiting Program referral for Native American families with children under 5, living off reservations in Maricopa County.

 Mammograms, Well Women exam with pap smears & WIC referrals.

 Pediatric Services  Wellness & Sick care visits, Immunizations and flu shots, Newborn care, and Chronic disease

care such as Allergies, Asthma, Diabetes

 Behavior Health  Substance Abuse education & treatment, Behavioral and Developmental Assessments, &

Integrated Behavioral Health (IBH) program

Management & Health Workforce

 Required Roles:

 Chief Operating Officer (CPO)

 Chief Medical Director (CMD)

 Chief of Human Resources (CHR)

 Medical Team

 Physicians: 2

 Family Nurse Practitioners: 2

 Certified Nurse Midwives: 2 (1 new addition- CNM Jolley)

 Dentists: 1 Dental Assistants(Assts): 1

 RNs: 4 Nursing Assts: 2

 Social Workers: 1

 Behavior Health Counselors: 1

 Auxiliary Team

 X-ray Tech: 2

 Lab Techs: 3

 Administrative Assts: 1

 Human Resources (HR) Techs: 1

 Drivers: 2 (I FTE, 1 PT)

 Basic contracts are provided to Physicians, APRNs, and Dentists. The arrangements only include salary, reason for hire (services to perform), probation period, and credentialing requirements.

 Credentialing must be maintained per issuing state or licensing board and reviewed by HR annually. Proof of certification must be provided within 30 days of hire.

Urban Health Clinic

Health Center Requirements  Grantees have various requirements they must met to received funding. Each

funding instrument may differ depending on the agency and type of health center requested.

 Here are the funding instrument requirements for UHC, as a grantee, must follow:

 be located in specific geographic areas,

 have an established fee schedule that meets certain requirements (depending on type of center and/or population),

 have appropriate governance,

 offer specific health services,

 meet certain reporting and quality assurance requirements,

 and license providers and seek accreditation (Heisler, 2017).

 These requirements apply to activities that are within the scope of Public Health Service Act (PHSA) Section 330 grant, but do not apply to other activities. Health Resource Services Administration (HRSA) is required to determine whether health center grantees meet these requirements (Heisler, 2017).

Urban Health Clinic

Financials: Federal Funding  HRSA’s Bureau of Primary Healthcare (BHPC) Grant

 UHC was awarded a federal grant of 5.5 million over five years ($1.1M yearly). Currently, in 2nd year of this funding cycle. This grant is UHC’s second five-year grant award after completing their first grant in good standing. The CPO oversees all aspects of UHC and ensures compliance.

 Funding is provided yearly as long as the health center remains compliant. HRSA’s Compliance Manual is the definitive publication that all federal health centers must follow in order to continue to receive funding.

 Annual site visit must occur to inspect health center and ensure compliance is met. Federal staffers will review The Joint Commission (TJC) standards, credentials of the staff, and any other requirements.

 Due to the vulnerable Native population served at the clinic, funding allow free services to all patients without payments.

 UHC plans to continue providing services in the Phoenix area and reapply at the beginning of the 5th year of this cycle for a new federal grant to expand services. UHC’s CPO is reviewing state funding opportunities, in an effort, to expand services, increase staff, and provide additional reserves to sustain the clinic.

Urban Health Clinic

Financials: Operational Budget

 Staffing: ~54 percent allocated to salaries & benefits

 Supplies: ~10 percent: medical, dental, and administrative

 Referral Services: ~6 percent: outside services, specialty care

 Transportation costs: 5 percent: gas & maintenance of vehicles

 Equipment/maintenance costs: 6 percent: medical, dental, radiology, & lab

 Utilities costs: 2 percent (building is paid in full; only utilities)

 Training/education: 5 percent: staff and patient education

 Administrative Cost: 12 percent: IT costs, expansion costs, staff insurance, reserve cash for unaccounted expenses, membership fees, etc. (Operational numbers are listed on Appendix 1)

Urban Health Clinic

APRN’s Protocols: FNPs & CNMs  All APRNs are presented a general contract that is provided to all medical staff. The contract,

as all, includes a six month probation period.

 Newly certified APRNs are assigned to work with an experienced nurse on staff that has been employed with the Health Center at least 2 years.

 CNMs staff the prenatal clinic and manages a daily schedule of patients for various services. FNPs work in the primary clinic and see patients on a daily schedule as well.

 All APRNs must be licensed to practice in Arizona and do not require a collaborative agreement per the State Board of Nursing in Arizona. APRNs must upkeep their licenses and remain in good standing as part of their employment contact with the health center.

 CNM & FNPs work daily with Physicians and other APRNs on complicated cases to provide the best outcome for their patients.

 The CMD evaluates the entire medical team at the end of their probation period, then annually based on their standard protocol. APRNs, along with the CMD, created APRN & RN standard operating procedures (SOPs) and protocols based on the TJC standards and are the guidebooks for the nursing staff.

 All APRNs, along with all staff members, at UHC must take part in federal site visits that reviews the UHC’s overall performance based on preset requirements listed in the HRSA’s Compliance Manual (examples are listed on the Appendix 2).

Urban Health Clinic

Health Center Staff Benefits  Although staff salaries are not as high as larger hospitals or private practice,

the staff received other benefits and advantages for working at UHC.

 Benefits include, but are not limited to:

 Health centers, which are located in medically underserved areas, are also automatically designated as health professional shortage areas (HPSAs) and are therefore eligible for National Health Service Corps (NHSC) providers status (Heisler, 2017). They have the opportunity to received scholarships for additional education, tuition reimbursement, and other federal benefits.

 UHC is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Federal Tort Claims Act (FTCA) Public Health Service organization under 42 U.S.C. 233(g)-(n). This Act covers medical providers and malpractice insurance is an option but highly recommended. This opportunity decreases malpractice costs for providers.

Urban Health Clinic

APPENDIX 1: Operation Budget  $594,000 Staffing

 $110,000 Supplies

 $66,000 Referral Services

 $55,000 Transportation

 $88,000 Equipment/Maintenance

 $22,000 Utilities

 $55,000 Training/Education

 $110,000 Administrative

 $1,100,000 estimated annual budget

**In the first month of the 4th quarter, an evaluation occurs to determine any remaining monies. Any remaining monies is allocated to staff benefits & training, equipment & maintenance, and IT upgrades as required.** Urban Health Clinic

APPENDIX 2: SITE VISITS REQUIREMENTS The Health Center Program Site Visit Protocol (SVP) is the tool for assessing compliance with Health Center Program requirements during operational site visits (OSVs) and look-alike initial designation site visits. The SVP is designed to provide HRSA the information necessary to perform its oversight responsibilities using a standard and transparent methodology that aligns with the Health Center Program Compliance Manual (Compliance Manual).

 Download the entire SVP or download specific SVP sections:

 Introduction

 Needs Assessment

 Required and Additional Health Services

 Clinical Staffing

 Accessible Locations and Hours of Operation

 Coverage for Medical Emergencies During and After Hours

 Continuity of Care and Hospital Admitting

 Conflict of Interest

 Collaborative Relationships

 Financial Management and Accounting Systems

 Billing and Collections