Health System Funding Reform and You

Data accuracy and its importance for the Cancer Surgery Program

Decision Support

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

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

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?

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

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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