TO: Mayor and Commissioners
FROM: Duane D'Andrea, Human Resources Director
THROUGH: Neal de Jesus, Interim City Manager
DATE: December 10, 2019
Title
REQUEST FOR ADDITIONAL STAFFING EMPLOYEE HEALTH AND WELLNESS CENTER
Body
Recommended Action:
Recommendation
Motion to Approve additional staffing for the Employee Health and Wellness Center.
Body
Background:
Since 2012, the City’s Employee Health and Wellness Center has provided primary and urgent care services for active employees and retirees and their dependents who are enrolled in one of the City’s medical plans.
On May 1, 2017 the Employee Health and Wellness Center (Center) expanded business hours from 32.5 to 42.5 weekly to accommodate the increase in participation by employees, retirees and their enrolled dependents.
Since this schedule change, the Center has experienced continued increase in participation as shown in this table:
|
|
2017 |
2018 |
2019 through 09/30/2019 |
2019 Projected |
|
Number of Center Visits |
4,082 |
4,473 |
3,515 |
4,684 |
|
Number of patients |
1,396 |
1,331 |
1,198 |
1,608 |
The size of the Center staff has stayed the same since it opened in 2012. The current staff of one part-time Physician, one part-time Nurse Practitioner, and two full-time Receptionist/Nurses is insufficient to support the increased number of patients and visits and provide a high level of service. The City consulted with Concentra to determine the staffing changes needed at the Center to help alleviate wait times, increase physician availability and continue to meet the City’s customer service expectations. We are requesting approval to amend the agreement with Concentra to add a full-time Medical Assistant/Receptionist, increase the physician hours from the current thirty-six (36) to forty (40) hours per week and add a part-time dietitian at ten (10) hours per week.
Center Physician
Increasing the hours of the physician from the current thirty-six (36) to forty (40) will provide employees and their dependents with flexibility and access to additional appointment hours, helping support current patient scheduling requests. These additional hours would also help employees and their dependents who are currently utilizing other health and urgent care centers.
Medical Assistant
The addition of a medical assistant provide support to the Center nursing staff and physician and nurse-practitioner when two providers are scheduling appointment simultaneously, particularly during Police and Fire annual physicals when the current Center nursing staff is needed to conduct laboratory and physical testing.
Responsibilities for the Medical Assistant would include patient triage, phlebotomy, immunization administration, perform laboratory tests and EKGs, place and analyze TB tests, provide office coverage for staff time off, such as sick days, vacation, and training, patient scheduling, including scheduling appointments to specialists and imaging centers. This individual would provide the needed clerical and nursing support to guarantee telephone coverage, staffing presence at reception, and physician assistance. Additionally, staffing a Medical Assistant/Receptionist would help to reduce wait times, allow expedited services as the nurses would be dedicated to patient care and provide the high-quality customer service the Center is expected to provide.
Dietitian
Currently diabetes and obesity are the second and third high claim cost condition based on the City’s claims data with UnitedHealthcare, with diabetes the number one cost driver of the medical plan’s pharmacy benefit. Based on 2018 clinical data for patients receiving care at the Center 56.2% have high blood pressure, 37.2% have high cholesterol and 16.9% are diabetic.
It is important to note, those diagnosed with obesity and diabetes (either both or one) routinely are diagnosed with both high blood pressure and/or high cholesterol.
The addition of a part-time dietitian would help patients manage adverse risk factors for obesity, diabetes, high blood pressure, high cholesterol and other chronic health conditions by providing one on one nutritional counseling and chronic condition management, provide on-site guidance for diabetic care and healthy eating potions for weight loss and heart health. Assisting the patient to modify behavior for better control of chronic conditions and ultimately assist in decreasing the number of chronic conditions, especially obesity and diabetic conditions. Currently this counseling is provided by the physician at a high hourly cost and a loss of time with patients requiring care.
The funding for this increase in staffing has already been approved in the 2019/2020 budget.
FINANCIAL DEPARTMENT REVIEW
The total expenses for the Center in fiscal year 2018/2019 was $928,901. The proposed agreement with Concentra for fiscal year 2019/2020 is $1,142,872, which includes the contractual three (3) percent annual increase, the projected increase in prescription drug costs and the proposed staffing increase.
The proposed staffing increase will result in an additional annual cost of $126,769.31, which has been included in the FY 2019/20 budget. An individual breakdown of these additional charges is provided in this table:
|
Position |
Current Hours |
Current Cost |
Increased Hours |
Increased Cost |
|
Physician |
36 |
$331,283.76 |
4 |
$36,809.31 |
|
Medical Assitant |
0 |
0 |
40 |
$64,480.00 |
|
Nutritionist |
0 |
0 |
10 |
$25,480.00 |
|
Total Annual Cost Increase |
|
|
|
$126,769.31 |
City Attorney Review:
Approved as to form and legal sufficiency.
Funding Source/Financial Impact:
Funding is available from Risk Management Account Number 551-17-020-513-34.90.