"One Ring-a-dingy:" Small, Rural Practices' Response to Meeting PCPCH Must Pass Standard 1.C.0

September 6, 2016   |  Tags: Blog   |  Tags: Eastern Oregon , PCPCH Standards , Rural , Access
Jill Boyd, MPH, CCRP

Providing comprehensive care for all Sherman County residents is top priority for the Sherman County Medical Clinic in Moro, Oregon.  Not only did Caitlin Blagg, District Administrator, worry about meeting Must Pass Measure 1.C.0, which states that PCPCHs must “provide continuous access to clinical advice by telephone” for Patient Centered Primary Care Home (PCPCH) recognition, she was also concerned how meeting this measure would impact her already busy, single provider and staff.

The concern of meeting this PCPCH Must Pass Measure is continuously echoed throughout Eastern Oregon. In June and July of 2015, Jill Boyd and Paul McGinnis, from the Eastern Oregon Coordinated Care Organization (EOCCO), gathered a group of 11 small, rural clinics to participate on a “brainstorming” call to gain a better understanding of PCPCH standard 1.C.0 and review “best practice”. During this call, clinics shared ideas about how to meet this measure in a way that simultaneously meets the needs of the practice while preventing provider burn-out, is meaningful to the patient and is cost effective. One of the options that fit the bill for Sherman County Medical Clinic was using a third-party vendor.

The Eastern Oregon Call Share Cooperative is Born!
Sherman County Medical Clinic, with assistance from Jill Boyd at the EOCCO, began collaborating with a California-based, third-party nurse advice line called FoneMed. FoneMed uses specially trained and licensed nurses to evaluate patient symptoms, offer medical advice based on the gold-standard Schmitt/Thompson protocols and document encounters in secure systems (meeting PCPCH measure 1.C.1). The total cost of this service, including a flat set up fee of $395, a minimum billing of $395 per month up to 17 calls AND budgeting call volume rate and overages (added rate of $22.50/call when over 17 calls per month) would cost a clinic almost $5200/year (without overages). To budget for overages, FoneMed’s data estimates an average annual call volume for a clinic size of ~2500 active patients to be around 3-6% annually (average call per month=6.25-12.5).  

Due to the yearly base cost of this service, the Sherman County Medical Clinic reached out to the participants from the brainstorming call to determine initial interest in sharing this service that would provide comprehensive, continuous care at a more reasonable price tag.

While partnerships are in the early stages, there is a growing interest in participation.  Currently the Eastern Oregon Call Share Cooperative has two clinic partners, a local administrative liaison with FoneMed (at 0.4% administrative cost for Co-op members) and greatly reduces the cost of using a nurse advice line (52% currently). While clinics participating in the Co-op are responsible for costs accrued from monthly overages, the $395 one time set-up fee is waived, and clinics are only required to pay $100 for a one year commitment to the Co-op.  

For more information and to learn more how your clinic can be part of the Eastern Oregon Call Share Cooperative (or to establish something similar in your area), please contact Jill Boyd at jill.boyd@gobhi.net

Jill Boyd is the Primary Care Transformation Specialist with the Greater Oregon Behavioral Health Inc. (GOBHI) for the Eastern Oregon Coordinated Care Organization (EOCCO).  Based in La Grande, Jill serves as the EOCCO “practice coach,” working with rural and frontier practices on integrating medical home transformation into primary care.  Her areas of focus are on quality improvement, practice workflow, patient engagement and care coordination. Previously, Jill has worked at the Oregon Health Authority’s PCPCH Program and with the Oregon Rural Practice-based Research Network (ORPRN). Jill received her Master of Public Health from the University of Pittsburgh Graduate School Of Public Health. Jill enjoys all the outdoor activities eastern Oregon has to offer, and of course, super heroes.