hsfr & cancer surgery program
TRANSCRIPT
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Health System Funding Reform and You
Data accuracy and its importance for the Cancer Surgery Program
Decision Support
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Agenda• Key messages
• Health System Funding Reform (HSFR) overview
• Heath Based Allocation Model (HBAM) and its impact on the Cancer Surgery Program
• Quality-Based Procedures (QBP) and its impact on the Cancer Surgery Program
• Importance of data accuracy for the Cancer Surgery Program
• Introducing the Decision Support Department
• Q & A
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Key Messages• Health System Funding Reform (HSFR) will affect
the funding and clinical operation of the Cancer Surgery Program.
• Data accuracy will help us prepare and anticipate full implementation and revisions of HSFR.
• The Decision Support Department at Trillium Health Partners will provide you with evidence-based, actionable, and clinically-relevant recommendations based on the accurate data your collect.
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Health System Financial Reform (HSFR)
• Moving away from historical-cost based funding system (i.e. global system)
• Heavy reliance on data reported to CIHI
• Two components: 1. Health Based Allocation Model (affects departments with
Inpatient/Ambulatory patients categorized under Neoplasm)
2. Quality-Based Procedures (affects POCUs operating on Cancer Surgeries)
• Will represent 70% of total funding when fully implemented (30% remaining still under global system)
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Health System Financial Reform (HSFR)
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Before HSFR After Complete Implementation
30%
40%
30%
100%
Global System HBAM QBP
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Health Based Allocation Model (HBAM)
• Increase resource utilization efficiency
• Expected weighted case X Expected unit cost = Funding
• Expected weighted case: Uses data from Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS) plus Stats Can population data
• Expected unit cost: data from MIS FC, derived from linear regression of numerous hospitals (regression model not published)
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Financial Implication of HBAM
• Neoplasm Acute Inpatient in 2014: 7,000 (70,000 Acute Inpatients X 10% Neoplasms cases)
• Final HBAM Expected Unit Cost in 2014: $5,500
• Approximate funding: $38.5 M
• Given that expected weighted cases (i.e. patient demographic & grouping) are consistent, 10% excess in actual unit cost compared to expected unit cost will equate to $4 M budget deficit.
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Reaching HBAM Efficiency
1. Proactive in identifying clinical/population trend (i.e. anticipate expected weighted case)
2. Benchmark healthcare supply/overhead utilization (i.e. control actual unit cost)
3. Reduce healthcare supply cost (i.e strategic sourcing)
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Quality-Based Procedures (QBP)
• Aimed to provide better quality of care, improve clinical practice, enhance patient experience, and potential cost-savings
• Influence the amount and method of funding of procedures covered by QBP
• Cluster patients based on related Dx or Tx, and attach an expected cost per procedure assuming hospitals have adopted clinical best-practices
• Number of Procedures X Expected Cost per Procedure = Funding
• Use data from Discharge Abstract Database (DAD) and National Ambulatory Care Reporting System (NACRS) (also used for HBAM)
• Wave two of QBP will include Cancer Surgery for Q3 of 2014-2015
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Financial Implication of QBP
• Number of Cancer Surgeries: approx. 1,200 (Total Day Surgeries in Canada 228,000 X 5.3% Day Surgery marketshare X 10% Neoplasms Surgeries, for Trillium Health Partners in 2014)
• Expected Cost per Procedure: $4,600
• Budget: $5.5 M under QBP
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Financial Implication of QBP• Cancer Care Ontario (CCO) helps the Ministry of Health to
allocate funds through Cancer Surgery Agreements (CSA).
• Each participating hospital have to meet the targets outlined in the CSA.
• Funding from the Cancer Surgery Agreement (CSA) will be gradually transferred to QBP (~20% all cancer surgery funding in Ontario).
• FY15/16, prostate and colorectal cancer will not be part of CSA, a financial implication of $420,000 (prostate and colorectal cancer represent 38% of newly diagnosed cases X $5.5 M X 20% CSA portion).
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Specialties that will be influenced by QBP
• Gastrointestinal: Colon, Rectal, Stomach • Hepatobiliary: liver, biliary, pancreas • Thoracic: Lung, esophagus • Breast Cancer • Thyroid • Genitourinary: kidney, bladder, testis, adrenal gland • Prostate • Gynecology: Endometrium, Cervical, Ovarian, Vulvar • Ophthalmic • Head & Neck • Sarcoma: Bone, Soft Tissue • Neurology: brain, spinal • Skin (including melanoma)
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QBP Metric for Cancer Surgery (Prostate & Colorectal)
Data sourced from Discharge Abstract Database (DAD)13
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Future QBP Metrics• Consult / Pre-treatment Assessment (e.g.
number of pre-op consultations)
• Follow up (e.g. post-op infection rate)
• Data will be sourced from National Ambulatory Care Reporting System (NACRS), Continuing Care Reporting System (CCRS), or National Rehabilitation Reporting System (NRS).
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Reaching QBP Standards1. Early assessment of current clinical practice &
implications of QBP
2. Clinical process remapping according to QBP-identified best-practice guideline
3. Adopt clinical scorecard with the aim of being QBP compliant
4. Facilitate departmental change management
5. Identify and anticipate future QBP quality metrics
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Key to HSFR Implementation Success
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Key to HSFR Implementation Success
• Data
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Key to HSFR Implementation Success
• Data
• Data
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Key to HSFR Implementation Success
• Data
• Data
• More Data!
Yes Captain?
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Data Accuracy & HBAM Efficiency
1. Proactive in identifying clinical/population trend (i.e. anticipate expected weighted case)
• Accurate documentation of NACRS (e.g. patient demographic components, comorbidity) will allow better forecasting of case mix.
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Data Accuracy & HBAM Efficiency
2. Benchmark healthcare supply/overhead utilization (i.e. control actual unit cost)
• Precise and fair (weight-adjusted) benchmarks require accurate MIS FC (e.g. nursing hours), and NACRS (e.g. interventions), and cart (SAP) data.
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Data Accuracy & HBAM Efficiency
3. Reduce healthcare supply cost (i.e strategic sourcing)
• Better contract prices and negotiating position require accurate MIS FC (e.g. product spend per cost centre) and SAP data.
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Data Accuracy & QBP Standards
1. Early assessment of current clinical practice & implications of QBP
2. Clinical process remapping according to QBP-identified best-practice guideline
• Need accurate data to assess current level of QBP compliance and predict post-remapping metrics
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Data Accuracy & QBP Standards
3. Adopt clinical scorecard with the aim of being QBP compliant
4. Facilitate departmental change management
• Accuracy of clinical scorecard depends on the availability and quality of selected metric (e.g. LOS)
• The tractability and continued commitment of change management depends on frequent milestone updates (not necessarily CIHI data)
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Data Accuracy & QBP Standards
5. Identify and anticipate future QBP quality metrics
• Additional metrics will be introduced gradually (e.g. post-op hematoma < 4/1,000 cases). Keeping all QBP related data up-to-date will ensure less time commitment down the road.
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The Bottom-line • Coding must be appropriately assigned to Case
Mix Group/HBAM Impatient Group (CMG/HIG).
• If data is inconsistent, the Cancer Surgery Program will not receive consistent and appropriate level of funding.
• The financial stress ultimately results in patient care quality and safety risks.
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A Little Overwhelming?
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Decision Support to the Rescue
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Decision Support to the Rescue
• Work in conjunction with the clinical team to ensure data accuracy
• Troubleshoot complex cases
• Create easy-to-follow decision support tools based on accurate data
• Decisions recommendations will be easy to implement in clinical practices
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Contact Information• Gary Spenser (Mgr. — Decision Support)
• XXX-XXX-XXXX
• Mary Eleid (Consultant — Decision Support)
• XXX-XXX-XXXX
• Peter Zhang (Sr. Consultant — Decision Support)
• XXX-XXX-XXXX
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Q & A
Decision Support
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References• Ontario Hospital Association (2014). Toolkit to Support the Implementation of
Quality-Based Procedures. • Canadian Cancer Society (2014). Canadian Cancer Statistics. • Ministry of Health and Long-Term Care (2012). Quality-Based Procedure. • Ministry of Health and Long-Term Care (2015). Quality-Based Procedure
Clinical Handbook for Cancer Surgery. • Ministry of Health and Long-Term Care (2013). Online Self-Study, Module 1-6. • Ministry of Health and Long-Term Care (2011). HBAM, Phase 2 Education -
Regional Consultation Session Toronto Central LHIN. • Ministry of Health and Long-Term Care (2013). HBAM 2012-13 Results -
Hospitals. • Ministry of Health and Long-Term Care (2013). HBAM Service Component Tool
2014,V11.
APA format available upon request
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