Burnaby Patient Medical Home for Priority Populations

Primary Care Providers working in Community Health Clinics generally have patient attachment targets that are reduced in order to best support priority populations. As the Burnaby PPC does not currently have CHC status there is not reduced patient panel sizes. CHCs also have ongoing funding for a Director level role within their funding envelope, the Burnaby PPC has one year funded for a Director level role. The CHC application would include the request for an ongoing funded position.

Primary Care Providers and Allied Health Clinicians have their own clinical liability and malpractice coverage inclusive of patient care. The not-for-profit operating the Burnaby PPC would still need to obtain insurance for the clinic space inclusive of: General Liability, Business Property Insurance, and Business Interruption Insurance (optional).

The concept of a Patient Medical Home (PMH) is not new and has been used in the BC context since 2016. The PMH at the Edmonds Centre for Healthy Communities is a completely new clinic. It would be the responsibility of the not-for-profit to operate this new clinic.

No, this would not be accurate. The clinic’s primary focus is on providing longitudinal family practice care to the four priority populations. There may be an aspect of care that provides episodic (walk-in) care, but the model’s main concept is patient attachment to the clinic, emphasizing having a regular health care team or provider for ongoing primary care needs.

Referrals originate from a central attachment waitlist for Burnaby (currently held by the Division, which will merge with the provincial Health Connect Registry) serving as the initial point for identifying individuals in need of services. Multiple agencies also assist in adding people to this attachment list, creating a comprehensive process to connect individuals with the clinic’s services.

The clinic’s services will be open to Burnaby residents on the attachment waitlist if they fall into one of the four specified populations.

The eligibility for internationally educated nurses enrolled in bridging programs would be determined based on the specific requirements of the clinic and the nursing education they require.

There is an open area within the clinic designated for group education sessions, which could potentially be used for health literacy education.

The HR manager, clinic director, allied health staff, and nursing staff will be employed by the not-for-profit operator(s) handling these hiring processes. 

Family physicians and nurse practitioners will work as contractors. They will sign two agreements: one with Fraser Health for payment and another with the clinic (the not-for-profit) specifying their obligations, working hours, job scope, and the financial support they provide to the clinic’s operations. 

The money to pay Nurse Practitioners (NPs) and Family Physicians (FPs) doesn’t flow through the clinic. Instead, the clinic receives a component of the money they earn, known as the overhead component. Their base pay, which is equivalent to a salary, is paid directly to them.

The FPs are typically contracted for their hours and send invoices to Fraser Health for the hours they’ve worked. Fraser Health then pays them directly. The overhead component, which is revenue for the clinic, can be handled in two common ways, and the specific arrangement may vary and needs to be confirmed.

PCC Clinical SC pertains to the PMH clinic.

The clinical steering committee will include representation from the entity (clinic) and family doctors within the network in Burnaby.

The entity is responsible for administrative management of the clinic, while doctors play a significant role in ensuring its clinical effectiveness. They work collaboratively to oversee the clinic and its integration with other components of the CfHC.

The Interim Federal Health Program (IFHP) primarily relates to billing for government-sponsored refugees. While it’s possible for the clinic to register for IFHP for billing services for such refugees without MSP coverage, IFHP itself wouldn’t be part of the clinical steering committee.

In the RFQ template, we didn’t specifically ask for a detailed budget for each staff member. We provided a cost breakdown based on equivalent salaries in the health sector. The revenue side of the budget is relatively fixed because it aligns with the funding structure from the ministry.

As of now, physician assistants are not available in primary care practice, but it may change in the future.

The clinic’s operating hours have not been established yet. The decision on hours will be made collaboratively with the successful non-profit organization, considering the specific needs of the populations being served.

If by “satellite clinics” you mean outreach services that use the PMH as home base, yes, the clinic will provide outreach services.

If by satellite clinics you mean additional medical clinic locations, this would require PCN SC approval and be dependent on funding availability and approval. These are not currently in scope.

You would follow the same rules as any other clinic. Only those who need to access a specific patient’s records should have access to them. Access to medical records should be limited to the individuals providing care for the patient in question.

There will be an evaluation component (refer to RFQ guidelines document for discussion of the annual report). We could collaborate on a more frequent evaluation schedule if desired.

The reporting requirements for financial and HR aspects will be necessary due to the funding structure involving the Ministry of Health.

The Edmonds CfHC consists of three key components: 

1. The Allied Health Hub, operated by Fraser Health and BDFP, is fully operational and will continue that way. 
2. The Patient Medical Home (PMH) for priority populations will be run by an NGO in partnership with Family Doctors, creating a medical clinic. 
3. There’s an Edmonds UPCC operated by family practice on behalf of the community 

The funding is not a global allocation. The funding is broken down as follows:

• FP and NP positions
• Allied Health and Nursing positions
• Non-clinical staff positions
• Other operating costs

Revenue:

• The funding structure is not global; it involves targeted amounts for specific positions.
• Overhead or revenue includes a 15% addition to the salary of Allied Health positions.
• Estimated total overhead/revenue is approximately $645,000.
• Funding for Family Physician/Nurse Practitioner (FP/NP) contracts is not listed as it’s assumed that the health authority will directly fund these positions.
• Funding is provided for Allied Health and Nursing staff, and the clinic is responsible for their payroll.
• Direct funding from the Ministry of Health for targeted positions, such as Clinic Director, HR Manager, and Office Manager.
• PCN distribution funding is meant to address potential shortfalls in operating funds and is contingent on PCN overhead.

Expenses:

• The estimated cost of nursing and allied health staff is expected to match the funding for non-clinical staff, such as MOAs and support services.
• Lease costs are assumed to be covered by the health authority, with no cost passed on to the clinic.
• Other operating costs, such as equipment, supplies, EMR costs, internet, and phone costs, are estimated to be related to clinic operations.
• These expense estimates are based on real practice and represent typical clinic costs.

The Edmonds Urgent Primary Care Centre (UPCC) is essential for the community, as it mainly specializes in offering urgent care services during evenings and weekends. Its services benefit both individuals who have primary care doctors and need after-hours care, as well as unattached patients seeking urgent medical attention. This facility plays a vital role in meeting the health care needs of the community, with a particular focus on unattached patients, and is a fundamental component of our health care services.

Nurse Practitioners (NPs) would follow the same contracting model as physicians. They would be contracted, and they would also sign a Practice Agreement. 

The health authority is overseeing the contract, but they are not responsible for managing the connection or interaction between the family physician, the NP, and the clinic. 

The estimates in the funding table are based on salaries of equivalent positions in a unionized environment. Therefore, the salaries in your unionized setting should align reasonably well with these estimates, and significant discrepancies are not expected.

For nursing positions, the wage rates are determined based on the BCGU (British Columbia General Employees’ Union). The wage rates are generally standardized in line with ministry guidelines across different service offerings within the Primary Care Networks (PCN).