Hospital Accountability Planning Submission (HAPS) Frequently Asked Questions (FAQ)

Transcription

1 Hospital Accountability Planning Submission (HAPS) Frequently Asked Questions (FAQ) December 1, 2014

2 TABLE OF CONTENTS INTRODUCTION... 4 GLOSSARY OF TERMS... 4 FREQUENTLY ASKED QUESTIONS AND ANSWERS General Where are the HAPS forms posted? When will the Eforms/HSAA Schedules be distributed? Education & Supporting Documents When will the HAPS Guidelines be available? Will a HAPS User Guide be distributed in addition to the Guidelines? Is there a section in the HAPS that requires partner involvement and joint risk mitigation strategies? Are there any available resources that can facilitate performance dialogue between hospitals and LHINs? Planning / Funding Assumptions How should planning assumptions be made? When will we receive our funding information? How can we complete our HAPS when we do not have our funding letter? What approach can you suggest? How is the Ministry planning for additional funding to hospitals in for inflation and collective agreement increases? Will HBAM results be released in time to use for the funding assumptions? The HSFR impact details do not have global funding details. What approach should we use to budget for global considering we don't have our global information? Can we assume mitigation as a valid assumption for ? The Ministry has developed tools to be used by hospitals to help forecast their HBAM allocations. When will the Ministry update those tools for Rehab, Complex Care and Mental Health Hospitals? Small hospitals received 1% to base funding this year. Can we plan for the same adjustment next year in the HAPS? What are we to assume for the OHA contract for fiscal ? What level of materiality is expected? Will the materiality also apply to performance factor on the total margin indicator? What is the "Materiality Trigger"? Please describe the materiality indicators in greater detail. Are they specific to each hospital? Can contact information of finance staff across hospitals be shared HSAA How long is the HSAA agreement meant for? When will the new consolidated agreement be available? Will the new HSAA template agreement allow for streamlining MSAA into the HSAA for those hospitals that currently have both, therefore eliminating the need for a separate MSAA? Submitting Our hospital's process has been to obtain approval from the Board of the budget before submission to the LHIN. Given the earlier submission time frame this year, will there be opportunity to submit an updated HAPS if changes are required subsequent to Board approval? Our Board approves our budgets in March. If we submit our HAPS as early as January 2015, many changes/revisions may happen until the Board approval in March. Since the quarterly reports reflect a budget column that is based on 2

3 HAPS submission, the actuals that we will be reporting may not make sense because of further budget changes/revisions that we have completed. How are we going to deal with this situation? Are we going to resubmit the HAPS in March so that the proper budget is reflected in the Quarterly reports? Why is there a range for submission dates for the HAPS? Is there any flexibility on the submission date for HAPS? Will hospitals be required to submit a HAPS narrative similar to previous years? Without funding information, are Hospitals expected to submit a balanced budget? Some of the sections in the HAPS narrative may be challenging for a hospital to complete dependent on its circumstances. Is the completion of each of these sections necessary? Can you discuss the narrative that accompanies the submission? What should it contain to be truly useful to the process? QBPs When will the QBP information for be released? With regards to the 2015/16 QBPs, will you provide the technical criteria (i.e., how we can identify our patients for each QBP)? For the new QBPs, what should we assume for the carve-out? Should we assume that the carve-out equals funding for 2015/16? Is there intention to disclose changes to the formulas in advance (e.g., criteria for claw backs for QBPs, change in weights, thinking of wait times)? Also, where can we get the relevant information regarding CMI for QBPs (e.g., peer CMI and calculation to compare to the work book individual CMI)? I m wondering what we can do to compare and contact leaders in QBPs. I m not sure the actual HSP has been identifiable. Will this come out soon? Indicators When will the Schedules and indicators be distributed? Other Why did the Ministry reward long wait time performance for Wait Time volume allocations to the LHINs, but the HSAA performance criteria was shorter wait times? Has the OHA had their legal counsel review the new multi-year HSAA agreement? If so, will comments from the legal counsel by made available by the OHA to its members? Has there been discussion with regards to synchronizing HSAA with QIP targets?

4 INTRODUCTION This document contains answers to frequently asked questions (FAQs) related to the Hospital Accountability Planning Submission (HAPS). GLOSSARY OF TERMS HAPS: Hospital Accountability Planning Submission. The HAPS is the planning tool used by hospitals to inform the negotiation of the Hospital Service Accountability Agreement (HSAA). HSAA: Hospital Service Accountability Agreement. The HSAA is the service accountability agreement that the LHINs are required to enter into with the hospitals pursuant to the terms of the Local Health System Integration Act (LHSIA). HSFR: Health System Funding Reform. HSFR is comprised of Health Based Allocation Methodology (HBAM) Funding and Quality Based Procedures (QBP) Funding. MLPA: Ministry-LHIN Performance Agreement. This is the accountability agreement that is signed between the LHINs and the Minister pursuant to the terms of the LHSIA. Further information can be found in s.18 of the LHSIA. SRI: Self Reporting Initiative. SRI is the self-reporting solution for submission and review of information between Health Service Providers (HSPs) and the Local Health Integration Networks (LHINs) and the Ministry of Health and Long-Term Care (the Ministry). It includes any hardware or software that may be provided to the User for the purpose of using SRI. 4

5 FREQUENTLY ASKED QUESTIONS AND ANSWERS 1. General 1.1 Where are the HAPS forms posted? A: The HAPS forms are available on SRI. A Supplemental Input Form will be used (as in the past) to capture information that is required for the Schedules but not available directly from the HAPS forms. The Supplemental Input Form template will be distributed to the LHINs, who will then post this form on their websites. Hospitals will complete and them to the LHIN at the time of their HAPS submission on SRI. 1.2 When will the Eforms/HSAA Schedules be distributed? A: The HSAA Schedules (Eforms Tool) will be distributed in early December to the LHINs. The Eforms Tool will be used to populate the final Schedules (French and English) from the HAPS and Supplemental Input Forms submissions from the hospitals. Training for the LHINs will occur in early January Only the LHINs will use the Eforms Tool. 2. Education & Supporting Documents 2.1 When will the HAPS Guidelines be available? A: The HAPS Guidelines were distributed in English and French to registrants for this session. These documents will also be posted on the individual LHIN websites. 2.2 Will a HAPS User Guide be distributed in addition to the Guidelines? A: No, there will not be a HAPS User Guide. The HAPS Guidelines contains all relevant information for submitting HAPS. 5

6 2.3 Is there a section in the HAPS that requires partner involvement and joint risk mitigation strategies? A: Please refer to Section (Framework for Making Choices) in the HAPS Guidelines. This information should be captured in the HAPS Narrative (Health Partner Engagement and Risk sections). 2.4 Are there any available resources that can facilitate performance dialogue between hospitals and LHINs? A: The Health Improvement Plan (HIP) Toolkit outlines various concepts and frameworks to assist hospitals with improvement planning, and can provide guidance for performance discussions. Please contact your LHIN for a copy. 3. Planning / Funding Assumptions 3.1 How should planning assumptions be made? A: The expectation is that hospitals will individually and locally determine reasonable planning assumptions for use in the completion of the HAPS and the HSAA schedules using information currently available including assumptions for HBAM and Quality Based Procedures. The LHIN will assess these assumptions for reasonableness. Hospitals are encouraged to engage with their peers in the development of assumptions. In some LHINs, the LHIN and hospitals may collectively agree on a common set of assumptions. It is advised that hospitals and LHINs speak with each other early and often. 3.2 When will we receive our funding information? A: As noted by the Ministry: First, our apology for the delay in the funding letters. This has been a unique year with the election. The ministry endeavors to have the funding letters provided as early as possible in the fiscal year. Having said that, LHINs and hospitals should continue their work on planning targets as per HAPS. 3.3 How can we complete our HAPS when we do not have our funding letter? What approach can you suggest? A: Hospitals can use the HSFR Impact Analysis spreadsheets received in September 2014 as a guide in the interim, as it contains most of the relevant information, making local 6

7 adjustments for known changes in services or costs from that applicable base year. See FAQ 3.5 for further reference with respect to information that may impact 2015/ How is the Ministry planning for additional funding to hospitals in for inflation and collective agreement increases? A: Improving quality and ensuring fiscal sustainability are top priorities for the government. Decisions regarding funding will be part of the 2015 government s budgeting process. 3.5 Will HBAM results be released in time to use for the funding assumptions? A: HBAM results are typically released in February. The ministry is also exploring the feasibility of providing additional HBAM information (e.g., HBAM shares) to help with planning for The HSFR impact details do not have global funding details. What approach should we use to budget for global considering we don't have our global information? A: Hospitals should get in touch with the finance staff at their LHINs as they have preliminary non-hsfr base funding information. 3.7 Can we assume mitigation as a valid assumption for ? A: Mitigation funding for has been shared (see HSFR Impact spreadsheets); mitigation policy for has not been determined. Assumptions about any mitigation for should be made in consultation with the LHIN. 3.8 The Ministry has developed tools to be used by hospitals to help forecast their HBAM allocations. When will the Ministry update those tools for Rehab, Complex Care and Mental Health Hospitals? A: The ministry has developed several tools that can be used to help hospitals understand HBAM and to drill down to HBAM details. However, currently there is no tool that can be used to forecast HBAM. 3.9 Small hospitals received 1% to base funding this year. Can we plan for the same adjustment next year in the HAPS? A: It is not yet known whether the same adjustment will be made for Hospitals should determine reasonable planning assumptions for use in the completion of the HAPS and the HSAA schedules using information currently available. 7

8 3.10 What are we to assume for the OHA contract for fiscal ? A: Hospitals are encouraged to discuss this among their colleagues and OHA representatives as the LHIN and ministry are not parties to that contract. Hospitals should seek broad input into all of their planning assumptions What level of materiality is expected? Will the materiality also apply to performance factor on the total margin indicator? A: Where the HSFR assumptions used in planning are different than actual funding allocations, and these result in the hospital being unable to deliver on a performance commitment, this will trigger a resubmission/renegotiation of the affected HSAA targets What is the "Materiality Trigger"? A: Materiality is assessed on performance indicators and volume targets. Where the HSFR assumptions used in planning are different than actual funding allocations, and these result in the hospital being unable to deliver on a performance commitment, this will trigger a resubmission/renegotiation of the affected HSAA schedules Please describe the materiality indicators in greater detail. Are they specific to each hospital? A: The materiality triggers are the generally the same for each hospital in that the triggers are from the HSAA performance indicators, which are universal. The actual targets and applicable indicators will vary between hospitals, but the general principle not being able to meet a target due to an incorrect assumption is the same for all hospitals Can contact information of finance staff across hospitals be shared? A: Hospitals and LHINs are encouraged to continue to have regional planning discussions wherever possible. Please contact your local LHIN representative. 8

9 4. HSAA 4.1 How long is the HSAA agreement meant for? A: The intention is that the HSAA agreement will be a multi-year agreement established through consultations between the LHINs, hospitals, the OHA and MOHLTC. HSAA schedules will be negotiated annually. 4.2 When will the new consolidated agreement be available? A: The HSAA Steering Committee is continuing to pursue focused discussions with the goal of jointly developing the HSAA. 4.3 Will the new HSAA template agreement allow for streamlining MSAA into the HSAA for those hospitals that currently have both, therefore eliminating the need for a separate MSAA? A: At this time the agreements will continue to be separate due to the differences in language between the agreements relevant to the nature of hospitals. 5. Submitting 5.1 Our hospital's process has been to obtain approval from the Board of the budget before submission to the LHIN. Given the earlier submission time frame this year, will there be opportunity to submit an updated HAPS if changes are required subsequent to Board approval? A: The LHIN will consider any changes made to the HAPS by the hospital board, noting that the hospital board must ultimately approve the HSAA. 5.2 Our Board approves our budgets in March. If we submit our HAPS as early as January 2015, many changes/revisions may happen until the Board approval in March. Since the quarterly reports reflect a budget column that is based on HAPS submission, the actuals that we will be reporting may not make sense because of further budget changes/revisions that we have completed. How are we going to deal with this situation? Are we going to resubmit the HAPS in March so that the proper budget is reflected in the Quarterly reports? 9

10 A: LHIN staff may decide to re-open the HAPS to allow a hospital to update budget lines to populate the quarterly reports with the most recent information. In most cases this should be fine tuning and not wholesale changes given that the first HAPS will be submitted in January and will be used to populate the HSAA agreement schedules. Reopening the HAPS file on SRI would be a decision between the LHIN and the hospital based on the magnitude of the budget revisions and the reasons for the changes. 5.3 Why is there a range for submission dates for the HAPS? A: The HAPS process is considered mature at this stage, with minimal change from year to year in the submission requirements. Therefore, some hospitals will be comfortable with submitting at the earlier end of the range. Other hospitals may be facing some more significant financial challenges and/or other issues, so a later date in the range may be more appropriate. 5.4 Is there any flexibility on the submission date for HAPS? A: A range of submission dates was provided this year to build in flexibility. LHINs will be contacting each hospital to discuss the most appropriate submission date for the hospital s circumstances. 5.5 Will hospitals be required to submit a HAPS narrative similar to previous years? A: Yes, there will continue to be a narrative component. Please refer to the HAPS Guidelines for further detail on the new HAPS Narrative template. 5.6 Without funding information, are Hospitals expected to submit a balanced budget? A: Yes, hospitals are expected to submit a balanced budget within their HAPS. For HAPS purposes, hospitals will need to make assumptions about revenue in consultation with the LHIN. 5.7 Some of the sections in the HAPS narrative may be challenging for a hospital to complete dependent on its circumstances. Is the completion of each of these sections necessary? A: The information provided by the hospitals in the HAPS narrative informs conversations that will occur between hospitals and their LHINs in the analysis of the HAPS and the completion of the HSAA. The information requested provides important insight into the impact of a hospital on the local and provincial health systems. Should hospitals require 10

11 additional clarification or have questions regarding the completion or timing of submission of the HAPS narrative, they are advised to contact their LHINs. 5.8 Can you discuss the narrative that accompanies the submission? What should it contain to be truly useful to the process? A: Brief answers to the questions posed in the narrative will assist the process, specifically: Hospital Performance: Efficiency and Effectiveness o Areas the hospital has identified that require the most improvement with regard to efficiency, effectiveness, and performance o Strategies planned and/or adopted to manage such desired improvements o Where savings will be reinvested, if applicable Service Delivery o Service changes proposed to improve the local health system and/or achieve a balanced budget (with supporting justification) and the expected impact on patients/clients and costs o Describe how health partner engagement will be/has been utilized in determining proposed changes to ensure a sustainable system for the region Choices made to achieve a balanced budget Critical risks to success and mitigation/management plans Risks Key risks and mitigation strategies should include: o Strategic o Clinical o Financial (including working capital) 6. QBPs 6.1 When will the QBP information for be released? A: This has not yet been determined. For HAPS purposes, hospitals should use conservative assumptions reflecting local situations. 11

12 6.2 With regards to the 2015/16 QBPs, will you provide the technical criteria (i.e., how we can identify our patients for each QBP)? A: The technical criteria and definitions will be included in the Clinical Handbooks for 2015/16 QBPs which are targeted for public release in December Stakeholder feedback, as well as the evidence-based QBP framework used for the selection (expert panels, opportunities for quality improvement and the reduction of service variation) have been in place for some time now. We have a helpline regarding the methodology of QBPs as well. 6.3 For the new QBPs, what should we assume for the carve-out? Should we assume that the carve-out equals funding for 2015/16? A: For the newly introduced 2015/16 QBPs, it is most likely that the carve-out methodology will stay the same as in previous years. It should be noted that for newly introduced QBPs, we will not start with a pressure and provincial funding will not exceed provincial carve-out. At a hospital level, carve-out and funding may not be equal. 6.4 Is there intention to disclose changes to the formulas in advance (e.g., criteria for claw backs for QBPs, change in weights, thinking of wait times)? Also, where can we get the relevant information regarding CMI for QBPs (e.g., peer CMI and calculation to compare to the work book individual CMI)? A: The ministry makes every effort to be as transparent as possible in providing changes to the funding formulas as soon as they are available to the sector. CMI information was embedded into the workbooks of the individual hospitals for carve-out and pricing. 6.5 I m wondering what we can do to compare and contact leaders in QBPs. I m not sure the actual HSP has been identifiable. Will this come out soon? A: A multitude of tools and resources have been made available to foster QBP understanding and support implementation: These include, but not limited to: Clinical Handbooks HSF Helpline Success Stories posted on the Ministry website Webcasts, on-line resources on hsimi.on.ca For further information on QBPs and development/ implementation, please contact the HSF helpline. 12

13 Should further information be requested on providers' implementation experiences or QBP development, the Ministry can help facilitate further conversations as needed. However, providers are encouraged to reach out to peers and LHINs to foster peer-topeer knowledge transfer. 7. Indicators 7.1 When will the Schedules and indicators be distributed? A: The Schedules will be available to the LHINs in mid-december. Formal training for the LHINs on the new Eforms will be scheduled for early January Other 8.1 Why did the Ministry reward long wait time performance for Wait Time volume allocations to the LHINs, but the HSAA performance criteria was shorter wait times? A: The Ministry s goal is to ensure that patients have equitable access to health care across all regions of the province. For , some LHINs experiencing challenges in providing care to patients within the provincial access target of 182 days were provided with additional volumes. As part of the QBP planning process, the ministry will work with LHINs to re-assess the approach taken. 8.2 Has the OHA had their legal counsel review the new multi-year HSAA agreement? If so, will comments from the legal counsel by made available by the OHA to its members? A: The OHA and LHIN representatives continue to work toward negotiating a multi-year HSAA agreement. Once an agreement has been reached on the template, OHA will provide a legal review of it to members. 8.3 Has there been discussion with regards to synchronizing HSAA with QIP targets? A: The HSAA Indicator Working Group is working through a process with the MOH and HQO. More information will follow. 13

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