Annual Report
2001-2002
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Patient Care
PATIENT CARE
FAMILY MEDICAL CENTER
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FAMILY MEDICAL CENTER CLINICAL SERVICES
NURSING, MEDICAL ASSISTANT, PATIENT SERVICE RESPRESENTATIVE, AND OTHER STAFFING
FMC FINANCIALS
FAMILY MEDICINE INPATIENT SERVICE
QA AND CUSTOMER SERVICE
RESEARCH
Clinical Services within the Department of Family Medicine include ambulatory care services at the Family Medical Center (FMC) and Harborview Medical Center, and the Family Medicine Inpatient Services at the University of Washington Medical Center and Harborview.
Key activities and programs initiated in the last year and those planned for the coming year are described in this report. A revised operating agreement between the UWMC and the Department of Family Medicine was in preparation during this year and implemented at the beginning of the 2002-2003 year.
FAMILY MEDICAL CENTER CLINICAL SERVICES
The Family Medical Center (FMC) provides health care for individuals and families. Services include general and preventive health care of women, men, infants, children and adolescents, as well as pregnancy care and deliveries. Individual providers have specific expertise as well in women's health care, geriatric care, adolescent health care, obstetrics, sports medicine, behavioral health, nutrition, and diabetes care.
Additional services include colposcopy and cryotherapy, sigmoidoscopy, vasectomy, minor surgeries, on-site psychotherapy and counseling, on-site nutritional assessment and counseling, anticoagulation monitoring, ambulatory blood pressure monitoring, and pharmacology consultations by specially trained providers in the clinic. The FMC operates in conjunction with Lab Medicine an on-site laboratory complying with RRC requirements for the discipline. The FMC maintains its own separate medical records. Hours of operation include Tuesday evenings and Saturday mornings. After-hours calls are handled by the Harborview Community Care Line, a nurse triage system.
Physician and Other Professional Staffing
FMC providers in the 2001-2002 year included twelve faculty, two mid-level providers, and eighteen residents, organized into six practice groups. Family Practice residents provide comprehensive care to patients and their families under the supervision of faculty attending physicians. Additional providers include a clinical pharmacist, clinical pharmacy resident, one to two clinical psychologists, a psychiatrist and psychiatry resident, one social worker, and one behavioral science intern.
Provider changes in 2001-2002 included the following:
Provider changes in 2002-2003 will include:
NURSING, MEDICAL ASSISTANT, PATIENT SERVICE RESPRESENTATIVE,
AND OTHER STAFFING
The staffing model in the FMC has included 1 RN 3, 2 RN 2’s, 7 medical assistants, 1 clinical lab tech, 1 clinic manager, 2 patient services representative leads, 5 patient services representatives, 1.5 office assistants in our medical records area, and 0.5 office assistants in billing. The medical records and billing areas are also supported by 1 part-time hourly staff and 1 work-study student.
Changes in staffing in 2001-2002 included:
FMC Visit Volumes
Historical visit volumes are described in the table based on Roosevelt Annual Financial Report data.
The following table, based on data collected at the FMC shows trends in new and established patient visits (note that the totals, if calculated) are slightly different from those listed above):
As one can see from the above table, total FMC volumes, which had been rising through the year 1997-98, have steadily declined since that time. The percent decrease from the peak volumes in 1997-98 through the 2001-2002 year, is about 14% for total volume, 9% for new patient visits, and 14% for established patient visits.
Factors which continue to account for declines in the current year:
While the number of provider sessions available from resident practices each year has remained stable over several years, the number of faculty provider sessions available each year has declined as shown in the table below. It should be emphasized that the providers practicing in the clinic currently complete the number of sessions expected of them each year.
The number of patients seen per clinic session among faculty has averaged 6.3 since 1996. In the last year, productivity among faculty increased to 6.7 visits per session which is the highest achieved since 1998. The average number of visits per session for Physician Assistants has been stable at 5.6 over the last several years. The average number of visits per session by residents has also been stable.
A number of steps are currently being considered as a means of addressing the decline in volumes:
In the last year, facility-side revenues have declined not only because of a decrease in patient volumes but also substantially because of implementation of Facility Only Billing at the UWMC.
Keys to avoiding further problems have included:
In the last year, efforts to improve financial performance have additionally included:
It is anticipated that the implementation of the new FMC Roosevelt Operating Agreement and administrative structure will enable us to more expeditiously address a number of issues affecting clinic volumes, revenues and expenses.
FAMILY MEDICINE INPATIENT SERVICE
The Family Medicine inpatient service continues to be an active and important part of clinical activity, and includes adult inpatient, maternity and neonatal care.
The adult admissions in 2001-2002 was 293. This number only includes adult admissions. Obstetrical admissions are counted separately. Newborn admissions are not reported by CDS as part of Family Medicine Admissions.
In the last year, the total number of Family Medicine patients on L & D was 182, but because 22 resulted in C-sections by Obstetrics, the total number of deliveries was 160. The source of this data is the Perinatal Database.
Obstetrical deliveries for the period 1995-1999 are from Patient Load Summaries. These reports are no longer produced and were known to under report Obstetrical deliveries. For example, in 1998-99 the Patient Load Summary reported 120 deliveries; however, when we latter obtained data from the Perinatal data base the number was closer to 150. The Obstetrical data for the 1999 to the present year is from the Perinatal database.
The sources of deliveries in the prior two years is show below. Comparable data is not yet available for the year 2001-2002.
In addition to monthly medical staff case reviews and discussions and bimonthly Cost-QA rounds, the following QA projects developed in the prior year were continued. Several relate to policies and procedures aimed at improving patient access.
Customer Service and QA projects initiated or completed in the reporting year included:
Specific Customer Service and QA projects for the coming year include:
The clinic continues to be an active site for clinical studies conducted by our own faculty and by faculty outside of the Department of Family Medicine.
All studies which solicit participation of our providers or patients continue to be reviewed by our Research Oversight Committee. Committee members include Tom Cartmill, Sharon Dobie, Allan Ellsworth (Chair), Joanne Hudson, Judy Pawells, Bill Neighbor, Catherine Cooper, Coreen Reddoch, Tom Taylor, Larry Mauksch (psychiatry related projects). The purpose of the committee is to assure that studies are appropriate to our clinic, do not interfere substantially with clinic flow, do not inappropriately use clinic resources, and, when appropriate, involve one of our faculty as an investigator. Additionally, the committee tries to assure that there are not too many studies being conducted in the clinic at one time.
Studies in the FMC completed in the last year included:
Studies in progress in the FMC include:
Studies currently under consideration for our participation include:
UNIVERSITY OF WASHINGTON PHYSICIANS NETWORK
The University of Washington Physicians Network is the community based clinical arm of the primary care program at the UW Academic Medical Center. The network, now in its sixth year of operation, manages eight large primary clinics in King County. Working through the University of Washington Physicians and with the cooperation of the Departments of Family Medicine, Medicine, and Pediatrics, UWPN employs approximately 65 providers. Half of these providers are family physicians who are board certified and residency trained family physicians; all are clinical faculty of the UW Department of Family Medicine. These physicians serve as part of Department’s community based faculty, assisting in a number of different ways, including medical student teaching, resident teaching, inpatient call coverage and attending, and physician assistant teaching. The family physicians in the UW Physicians Network also participate in Department-based research projects.
In FY 2002, the UWPN clinics had 221,000 patient visits. In addition, the Network saw over 25,000 new patients and referred over 25,000 patients to colleagues in the UW Academic Medical Center for their specialty care. The UW Physicians Network provides a full service, primary care, community based network of neighborhood clinics for the Academic Medical Center. These clinics provide access for a large number of King County patients. The Network currently has 107,000 active patients, or about 6% of the King County primary care market. The Network finished FY 2002 favorable to the five year business plan budget, under which it is operating.
During FY2002 the UWPN physicians became much more productive. Almost half of the UWPN providers are now seeing more than the Medical Group Management Association 50th percentile of patients. This markedly increased level of productivity was accomplished while actually increasing patient satisfaction levels. Additionally, the amount of teaching and research at UWPN clinics, much of it done in conjunction with the Department of Family Medicine, increased.
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