Hospital Accountability Planning Submission (HAPS) Process. Fiscal 2017/18 Financial Leadership Group Update October 2016

Transcription

1 Hospital Accountability Planning Submission (HAPS) Process Fiscal 2017/18 Financial Leadership Group Update October 2016

2 Agenda 1. Context 2. HSAA Organizational Structure 3. Differences between and HAPS Submission Timelines HAPS Guidelines Additional Updates 4. Central East Local Health Integration Network (LHIN) Projected Timelines for Planning for Key Variables 6. Planning Environment Considerations 7. Assumptions 8. Questions

3 Context Planning for 2017/2018 The future HSAA Template Agreement is envisioned to be a multi-year agreement, however a one year extension is recommended for 2017/18. The HAPS and related draft Schedules will cover one fiscal year (FY 2017/18). Information collected through the Hospital Accountability Planning Submission (HAPS) and the Additional Input forms will be used to populate the HSAA Schedules. Both the HAPS forms and the guidelines will be posted on the Central East LHIN website.

4 Context Planning for 2017/2018 The government continues to implement Health System Funding Reform (HSFR), which supports system capacity planning and quality improvement through directly linking funding to patient outcomes. LHINs and the hospitals recognize that HSFR will impact the HSAA process. Hospital funding has become unique to each individual hospital with the roll out of the Health Based Allocation Model and Quality-Based Procedure Funding (QBP) and so across the board planning targets are no longer relevant or possible.

5 Context Planning for 2017/2018 Hospitals are currently engaged in developing budgets to guide operations for fiscal 2017/18 as part of their organization s fiduciary duty, and hospital services will continue to be provided to patients according to the hospital s internal plan and based on the hospital s best assumptions. There is great benefit for hospitals and LHINs to agree on performance expectations within a set of parameters that begins on day one of the fiscal year. The vehicle for this agreement is the HSAA.

6 HSAA Organizational Structure Creating an ownership framework Hospitals (OHA) HSAA Steering Committee LHINs HSAA Planning & Schedules Work Group HSAA Indicator Work Group SRI Reports Work Group

7 Differences between and HAPS Submission Timelines Most Hospitals begin their planning process in September to allow time to implement changes in cost structures. The HSAA planning cycle was revised last year to better reflect change management at the HSP level. The ultimate execution of 2017/18 HSAA is predicated on the HAPS process, which reflects the operational change management process being considered by each individual HSP.

8 Differences between and HAPS Guidelines Updates to the HAPS Guidelines include: timelines for HAPS submission Updated pan-lhin strategic directions Refined list of QBPs Updated Service Delivery Change Form and Sexual Assault and Domestic Violence Treatment Centre Annual Program Report form within HAPS Narrative Similar to last year, a number of documents are embedded within the HAPS Guidelines, including the HAPS Narrative, Revenue Completion Guidelines, an Additional Input Form to capture supplemental details not captured in the HAPS, and instructions on the submission of supplemental forms

9 Differences between and HAPS Submission Timelines A standardized Work plan was endorsed by the LHIN CEOs to provide predictable dates for key deliverables for all future years. For , the HAPS submission is due on Monday November 21 st, The LHINs do not consider the submission on Nov. 21 st to be final as changes usually occur post submission up to January through the LHIN review process. The final HAPS is approved by Hospital Boards in January 2017.

10 HAPS Guidelines Content Review HAPS Guidelines include: Embedded documents which include:

11 HAPS Guidelines HAPS Guidelines include: Revenue Completion Guidelines: Revenue instructions regarding major revenue components. HAPS Additional Input : Supplemental funding detail regarding QBP, Wait Times, One-Time etc.

12 HAPS Guidelines HAPS Narrative which includes the following embedded files: Narrative Completion Guidelines; Service Delivery Change Form any material changes in service delivery should be reflected in the SRI submission and include highlevel notes; Service Delivery Change Process; and Provincial Interest Programs HIV, Sexual Assault and Domestic Violence.

13 Approach for Planning and Implementing Service Changes (Responsibility Matrix) Activity (not necessarily sequential activity) HSP Lead HSP Partners LHIN Notify LHIN of consideration (can be in confidence) R I Carry out Community Engagement for change (see checklist) R S I Approach impacted partners with proposed changes and define potential new model(s) of care for service collaboratively R S I Develop Communication Plan and Key Messages R S Agree Submit Service Delivery Change Form for acceptance (Before implementing proposed change) R I Approve R Responsible S Support I Informed LHIN with work with other LHINs (if impacted) to determine appropriate action to support cross-lhin changes LHIN will notify MOHLTC as appropriate (does not preclude HSP from communicating with MOHLTC) For very sensitive changes a joint meeting with the LHIN is suggested to evaluate and agree to courses of action Background Planning Form Evaluation Summary Appendix

14 LHIN Evaluation of Submissions (Must meet all criteria) 1. All required information submitted: Additional information/evidence may be requested 2. Suggested guidelines adhered to 3. Community Engagement Process Followed 4. No negative impact to other LHIN decisionmaking framework criteria (see reference next slide) Background Planning Form Evaluation Summary Appendix

15 Scope HSAA Current Status Requirements & Scope HSAA HSAA The current extended agreement expires on March. 31, A one year extension agreement will be drafted with no unnecessary changes to indicators for 2017/ Extension Agreement to March 31, 2018 with: Scope: 1 Year extension template (HSAA Working Group). 2017/18 Schedules (HSAA Working Group). HAPS /HSAA notices (from LHIN Legal). Engagement: Distribution of HAPs educational materials (from HAPs Working Group) with LHIN specific obligations and timelines. No webinar and no hospital meetings, except where essential. Engagement through monthly Financial Leadership Group (FLG). Process: 2015/16 Q1/Q2 MSAA schedule refreshes as baseline; HAPS (on SRI). Senior Team Agreement on 2017/18 target methodology. Recommendation: No change to 2016/17 targets. No new LHIN Specific indicators/obligations (with the exception of balanced budget definition). Service Delivery Change Requests (SDCR) to manage exceptions. Risk Template submitted with HAPs.

16 Timelines HSAA Work Back Schedule March 2017 HSPs sign and execute extensions by March 31, Central East LHIN Board receives a report regarding the status of the 2017/18 HSAA schedules refresh and extension agreement, and approves any variances to activity or targets. LHIN CEO and Board Chair Sign agreements and schedules and return to HSPs. February 2017 Review HAPs to ensure balanced budgets and targets. Update to LHIN Board January 2017 Hospital Boards approve HAPs (Jan 1 31). Final board approved HAPS due (Jan. 31). Internal collaboration and negotiations / discussions with HSPs to finalize targets. Engage with FLG on HSAA template (Jan. 13). December 2016 Internal collaboration and negotiations/discussions with HSPs to finalize targets. Balanced Budget or Risk discussions as required LHIN Board receives update and endorses the HSAA Refresh agreement. Delegation of authority is provided to LHIN CEO and Chair. Internal collaboration and negotiations/discussions with HSPs to finalize targets.

17 Timelines HSAA Work Back Schedule November 2016 Hospital Balanced Budget Discussions. FLG Engagement. HAPS due (Nov. 21) (not board approved) ST finalizes any local indicators including the discussion about LHIN Balanced position (inclusive of amortization). Review of risk templates and SDCRs. HAPS review. October 2016 HAPS uploaded to SRI (Oct. 3). Financial Leadership Group Engagement setting common assumptions, update on the process, share timelines (Oct.21). LHIN customizes presentation received from the HAPS Working Group and provides to Hospitals Oct. 21). LHIN HSAA Leads participate in webinar / teleconference hosted by Provincial HAPS Working Group (Sept.28). Refinement and distribution of risk template. Hospital negotiations spreadsheets updated and data collected on all indicators. Legal advice sought on integrations. Q1/Q2 refreshes complete and sent to HSPs (week of Oct 17).

18 Planning for Key Variables HAPS Key variables to consider when completing the HAPS include: Mitigation Strategic planning for a balanced or surplus operating plan; HBAM Market share analysis, actual vs. expected volumes and unit cost; and QBPs Volumes and Case Mix Index (CMI) trending; and Central East LHIN Local Performance Target definition of balanced position

19 Assumptions HAPS Hospitals will individually and locally determine reasonable planning assumptions for use in the completion of the HAPS: Collaboration with the Financial Leadership Group (FLG) including assumptions framework (October 2016). Use information currently available including assumptions for HBAM and Quality Based Procedures, as outlined in the HSFR Forecasting Tool. The LHIN will review assumptions for reasonableness. In some LHINs, the LHIN and hospitals may collectively agree on a common set of assumptions.

20 Assumptions HAPS Central East LHIN proposed formal local definition of a balanced operating position Total Margin - Current definition HSAA technical specifications - Percent by which total corporate (consolidated) revenues exceed or fall short of total corporate (consolidated) expenses, excluding the impact of facility amortization and interest on long-term liabilities, in a given year Central East LHIN Local Performance Target definition- Balanced Operating Position revenue and expenses all sectors including the impact of facility amortization Rationale improves working capital position over time.

21 Questions about the HAPS / HSAA? For any inquiries or assistance please contact one of the following Central East LHIN representatives: Sue Wojdylo Sue.Wojdylo@lhins.on.ca Pauline Rahaman Pauline.Rahaman@lhins.on.ca Emily Van de Klippe Emily.Vandeklippe@lhins.on.ca Irem Ali Irem.Ali@lhins.on.ca

22 Questions??????????????