Primary Care System Review: Changing Acuity in Residential Care
An increase in MSP medical audits on physicians prompted the Centre to conduct a review of issues in the delivery of primary care in residential care facilities. Specifically, we examined the impact of a 2002 legislative change (called Priority Access) to understand changes in resident acuity/complexity as well as the impact on physicians and staff. The Centre conducted this study at Providence Health Care in 2003 and in 2004 included Evergreen House in North Vancouver and Haro Park Centre in Vancouver.
Our study concluded that between 2002 and 2003, the proportion of residents with complex needs (EC & IC3) within Vancouver Coastal Health increased by 16%, requiring physicians to visit more frequently and staff to deal with more time-intensive, acutely ill residents. The study highlighted a number of policy areas that require change in order to meet these challenges. One example is a 1981 standard that allows physicians to visit their residents two times per month. In order to be reimbursed for additional visits, physicians must justify the rationale for their resident visit in their billings. We are advocating that this 1981 standard be changed to reflect current realities.