NPLCA Meeting Minutes – October 9th, 2019

Facilitator:                         Jennifer Clement

Recorder:                           Sue Tobin

Pre-Reading:                  None

Item 1.0 Roll- Call: (completed re: CHAT window)

2.0 Review Minutes

Discussion:  Minutes of last meeting were sent out as attachment so that NPLCA members and non-members could view. Also posted on NPLCA microsite.  The executive would like to apologize for the delay in getting minutes out and posted.  

3.0 Introduction of New NPLCA Meeting Format

Discussion:  

The NPLCA executive has learned:

• Meetings are difficult to stay engaged in through voice only communication
• Need more opportunity for NPLCs to share information/expertise with other NPLCS so that we are not becoming silos within our own organization
• NPLCA membership needs easy access to relevant information

Suggestions for change:

• Zoom with camera on and Power Point Presentation
• NPLCA Rounds:  Opportunity for all NPLCs to share experience and relevant information to other NPLCs such as OHT progress and Media Clips
• Subcommittee Development

4.0 NPLCA Priorities 2019-2020

Discussion:

The NPLCA Executive met on September 18 2019 to review our strategic plan, the workplan, and determine our priorities for 2019-2020 given the changing landscape of healthcare. The workplan is posted on the NPLCA microsite.  Our priorities are as follows:

4.1 Data Standardization:  As discussed at our September meeting, problem list standardization needs to be a priority from an individual and association perspective.  IDC-10 codes are preferred, but IDC-9 or ENCODES can also work individually if IDC-10 can not be completed by November 30 2019.   The importance of this work in relation to the Ontario Health Team development can not be overstated.  The codes are necessary for our data to be connected to ICES; the data base used by the Ministry of Health for health resource planning.  It is also necessary in order to complete Health Economic Analysis similar to that which was completed by the OMA. Problem list codes are the foundational building block for demonstrating our value to funders and stakeholders.  There are currently 5 clinics who have completed their problem list coding.   There is variation in challenges and progress at the other clinics.  These include:

• Using IDC-9 codes – how do we migrate to IDC-10?
• feeling that the work is not doable
• concern that the codes are too specific
• not having access to the ICD-10 coding summary sheet

Suggestions were provided to those clinics struggling to get the work done.  These include:

• engaging your administrative and nursing staff to split the work
• discuss challenges with your QIIMS
• Recognize that the work is essential to OHT development and problem list coding is the easiest way to accomplish this and will save lots of additional leg work when OHT applications are submitted (doing the work upfront).

4.2 PCAM Project

Discussion: Stephanie Skopyk (DurhamCMHA NPLC) explained how the PCAM can demonstrate a measure of complexity for NPLC patents.   The four areas assessed include:

• Health & Wellbeing
• Social Environment
• Health Literacy & Communication
• Service Coordination

The use of the PCAM in NPLCs ins currently under ethics review.  A small number of NPLCs have offered to be early adopters of the PCAM.  All NPLCs will be eventually participating in PCAM in collaboration with their QIIMs.   Some clinics are already collecting this information in a different format.  The issue of the PCAM being on paper was discussed.  There are currently challenges with the format and deliver of the PCAM tool when an attempt is made to transition the document to EMR.  This issue may be resolved in the future.

4.3 Enrollment to the NP

Discussion: The NPLCA has met with Michelle Acorn, CNO to discuss the importance of enrollment to the NP.  The NPLCA and NPAO have also sent letters to the Ministry of Health to support enrollment to NPs.  The letters outline the following limitations of the current rostering system:

• Patients are currently only rostered to physicians which is tethered to OHIP billings
• The MOH’s intended use of rostering to facilitate funding for attributable populations for OHTs will result in accurate health resource planning by excluding NPs and NPLCs
• NPs are the MRP for an estimated 120,000 Ontarians representing up to 10 those persons considered “unattached” in our province, therefore skewing statistics used for population health planning, spending and health care needs, creating inaccuracy in heath human resource requirements
• Rostering eliminates the ability to comparatively analyze different provider groups and models
• Rostering limits access to patient information, leading to patient safety concerns
• There is risk to those providers who have rostered patients to whom they are not providing care for

The letter also outlines the benefits of enrolling patients to the NP:

• Allows for the collection of “Big Data” at the ministry level
• Allows for comparative analysis of the NPLC model of care with other primary care delivery models
• Facilitates identification of NPLC patients in population attribution of Ontario Health Team funds
• Improves patient safety and reduces litigation risk
• Directly reduces the number of Ontarians considered ‘unattached’

The Membership discussed the difference between being enrolled to the NP versus being enrolled to the clinic.  The NPLCA executive and some member clinics participated in a discussion that explained how enrolling patients to the clinic does not facilitate the ability to collect and share the amount and quality of data that can be collected through NP enrollment.  Direct enrollment to the NP also allows for practice reports to be generated, for communication about each patient being shared among systems (such as diagnostic reports, medications prescribed, etc.), and supports the direction that digital health is moving in Ontario. The NPAO representative (Claudia) shared that NP enrollment is very close to becoming a reality.

4.4 Building Relationships with Stakeholders

Discussion:  The NPCLA, as an associate member of the NPAO, has cultivated a positive relationship with the MOH and Ministry representatives.  the result of this relationship is the inclusion of NPLCs when speaking about primary care models (CHCs, FHTs, NPLCs). The MOH is also using inclusive language such as “physicians and Nurse Practitioners”, or “primary care providers”. 

The MOH recognizes the NPLCA as the association that represents NPLCs in the province. However, there is some confusion created as a result of NPLCs being members of other associations who also state they represent NPLCs.  The NPLCA is working on establishing common ground with other associations while preserving what is unique about our models, namely being NP/clinical leadership. We also recognize the value in belonging to other associations such as specific population support, EMR discounts, leadership support and, communities of practice.  The NPLCA is small and can not offer what larger associations do, however the NPLCA is investigating opportunities to partner with other associations so that our membership can benefit from these resources.

With trust as the foundation, the NPLCA is carefully examining historical, current and evolving relationships that have resulted in true collaboration and will keep us in high regard with the MOH 

4.5 Incentives for NPLCs

Discussion: in 2019-2020 the NPLCA will focus on acquiring EMR discounts for our members.   The NPLCA executive is also in talks with the Canadian Pharmacist Association to acquire a discount on RxTx. NPAO is offering a 5% discount for NPs who work in an NPLC where all the NPs are members of NPAO.  Beginning in 2020, the NPLCA will look at group benefits and examine what other associations are offering their members.  NPLCA members suggested looking at group legal services for NPLCs and LTD for staff.

5.0 NPAO Update

Discussion: Claudia Mariano advised members that an NPLC scoping review had been completed in the spring of 2019 and was almost ready for distribution.  A new collaborative group has been formed to look at developing a vision of team-based primary care. The group includes NPAO, NPLCA, AFTHO and the Alliance.  Claudia reminded members about the 5% discount on NPAO membership (4.5) and encouraged sending her stories or media clips that can be shared through the NPLCA and NPAO social media networks.

6.0 Ontario Health Team Progress

Discussion:  10 NPLCs are currently involved in OHT full application:

The RISE resources were referenced as a source of reference for NPLCs involved in OHT development 

Advise and suggestions shared by clinics involved in OHT development included:

• Participating in meetings has increased understanding and support for NPLC model
• Having a primary care engagement session that has an outside facilitator helps to prevent bulldozing and monopolizing of discussions
• Having problem list coded data available from the NPLC is vital to supplementing what the MOH has provided for attribution of resources; in North Muskoka they were able to pull some data when patients used OHIP-billed services within the local health care system (specialists, hospital).
• Signing on to an OTH agreement means you are committed to moving forward with the application and are not committing to sharing of HR or any other resource.  Signing on is necessary to be included in decision making.

7.0 Media Clips

Discussion:  In preparation for NP week, many NPLCs are participating or hosting events to highlight NPLC work. 

8.0 Issues Brought Forward & Subcommittee Opportunities

8.1 NPLC Conference 2020

Discussion:  the NPLCA annual conference will take place in Thunder Bay from June 7-9 2020 at the Delta.   More details to follow

8.2 EMR Discount

See 4.5

8.3 Policy & Procedure Sharing and Standardization:

Discussion:  There has been an increase in requests for examples of policies and procedures from clinics recently

8.4 NP Orientation

Discussion:  there has been a request for access to an NP orientation package that can be shared with other NPLCs

8.5 Legal Service

Discussion:   With an increased need for legal services associated with the OHT development and a decrease in operational budgets, a question was asked as to how many clinics use Miller-Thompson, a large legal firm specializing in health law.  Only one clinic (Ingersoll) indicated they used this firm.  Other clinics use local firms. Some have legal service contracts (retainers).  Some clinics access legal assistance as needed.  There was a general interest in securing one legal service for all of the clinics.

8.6 Supply Chain (additional agenda item)

Discussion:  The idea of developing a supply chain for the NPLCs and for OHTs was brought forward. 

8.7 Group Benefits

Refer to 4. 4 and 4.5

Adjourned 12:00

Next Meeting (NPLCA members only)

November 13 2019

10:30-12:00 via ZOOM (please enable your cameras)