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

Transcription

1 Hospital Accountability Planning Submission (HAPS) Frequently Asked Questions (FAQ) January 14, 2014

2 Table of Contents INTRODUCTION... 4 GLOSSARY OF TERMS... 4 FREQUENTLY ASKED QUESTIONS AND ANSWERS General When will the HSAA Schedules be distributed? Where are the forms posted? Education & Supporting Documents When will the HAPS Guidelines to 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? Can the HAPS Guidelines be released earlier in future? Planning/ Funding Assumptions How should planning assumptions be made for the various HSFR allocations? When will we receive our FY14/15 funding information, including the mitigation of HBAM? 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 ONA contract for fiscal ? What level of materiality are you expecting? Will the materiality also apply to performance factor on the total margin indicator? Can contact information of finance staff across hospitals be shared H-SAA How long is the HSAA agreement meant for? When will the new reconciled 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? Can you review again the process for extending the current HSAA? Submitting Do the HAPS require Board approval as indicated by a signature prior to submission to the LHIN? 5.2 Why is there only a 4 week period from launch for submission of HAPS? Is there any flexibility on the submission date for HAPS? Will hospitals be required to submit a FY 14/15 HAPS narrative similar to previous years? Without funding information, are Hospitals expected to submit a balanced budget on Feb 14th? QBPs Will the QBP definitions for be released at the same time as the HSAA schedules so we can review our volumes and predict for next year? Without the definitions, we won t be able to forecast or plan for next year accurately What are the 2014/15 QBPs and when will we see information on the financial impact of these procedures? Will inpatient rehabilitation related to QBPs continue to be implemented in 2014/15?

3 6.4 Has Knee Arthroscopy replaced Upper/Lower limb fractures as an Orthopaedic QBP?An October 9, 2013 memo from the ministry identified Orthopaedic QBPs as Upper/ Lower limb fractures and Hip fractures Is there a rehab component associated with the stroke QBP and what is the expected timing for this to be rolled out? Will clarity be provided on "cancer surgery" QBP for next year vis-a-vis the current CSA incremental volumes with CCO, both from the program and funding perspectives? Do we know when small and rural hospitals will receive any documentation as to the impact on funding on the implementation of QBPs for ? What are the expected corridors known today? Indicators When will the 2014/15 Indicators and technical specifications be distributed? Do the technical specifications reference historical indicators and/or rates for each LHIN? Is there any information on when the suggested two new adjusted working capital performance indicators will be implemented? What is the process to determine when, and if, indicators are added or taken away? What if the hospital related MLPA indicators change? Are there going to be targets set on all explanatory indicators? What is the link between the Health System Indicator Initiative (HSII) and Health Quality Ontario(HQO) regarding the quality metrics initiative that was announced in November?

4 Introduction This document contains answers to frequently asked questions (FAQs) related to the 2014/15 Hospital Accountability Planning Submission (HAPS). GLOSSARY OF TERMS HAPS means Hospital Accountability Planning Submission. The HAPS is the planning tool used by hospitals to inform the negotiation of the Hospital Service Accountability Agreement (H-SAA). H-SAA means Hospital Service Accountability Agreement. The H-SAA is the service accountability agreement that the LHINs are required to enter into with the hospitals pursuant to the terms of the Local Health Integration Act (LHSIA). HSFR means Health System Funding Reform. HSFR is comprised of HBAM Funding and QBP Funding. MLPA means Ministry-LHIN Performance Agreement. 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 means The "Self Reporting Initiative". SRI is the self-reporting solution for information collection and sharing among Health Service Providers (HSPs), Local Health Integration Networks (LHINs) and the Ministry of Health and Long-Term Care (the Ministry) and 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 When will the HSAA Schedules be distributed? A: The draft HSAA Schedules will be distributed shortly following this session through your local LHIN. 1.2 Where are the forms posted? I went to our LHIN website and could not find the 2014/15 forms only 2013/14forms but it was noted that the forms were available on SRI since December 11th. A: The 2014/15 forms are available on SRI. They are not available through the LHIN websites. 2. Education & Supporting Documents 2.1 When will the HAPS Guidelines to 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. 2. 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. Some of this information could be captured in the HAPS Narrative, however your local LHIN will provide additional guidance. 2. Can the HAPS Guidelines be released earlier in future? The document is very helpful and provides good material for a framework to follow in developing our budget, however it was released relatively late for this year's HAPS process given the submission is due Feb 14th. 5

6 A: The HAPS process and documentation have reached a mature stage, and we don t expect substantive changes for FY 15/16. The likelihood, therefore, of an earlier release is high. 3. Planning/ Funding Assumptions 3.1 How should planning assumptions be made for the various HSFR allocations? A: The expectation is that hospitals will individually and locally determine reasonable planning assumptions for use in the completion of the 2014/15 HAPS and the H-SAA schedules using information currently available including assumptions for HBAM, Quality Based Procedures and mitigation. T he LHIN will assess these assumptions for reasonableness. Hospitals are encouraged to engage with their peers in the development of assumptions. 3.2 When will we receive our FY14/15 funding information, including the mitigation of HBAM? A: The ministry expects to release funding information along the same timeframe as for FY 13/14, i.e. late Spring. The ministry is on track to post HBAM results with the next couple of months and confirms that there will be mitigation in FY 14/15. Given this reality, hospitals and LHINs are asked at a local level to engage in setting planning target assumptions necessary to develop and populate a HAPS and Schedules. 3.3 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 FY 14/15. In the absence of this information hospitals should individually and locally determine reasonable planning assumptions for use in the completion of the 2014/15 HAPS and the H-SAA schedules using information currently available including assumptions for HBAM, Quality Based Procedures and mitigation. The LHIN will assess these assumptions for reasonableness. 3.4 What are we to assume for the ONA 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. 3.5 What level of materiality are you expecting? 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 H-SAA schedules. 6

7 3.6 Can contact information of finance staff across hospitals be shared in order to perhaps facilitate local discussions regarding assumptions? A: Hospitals and LHINs are encouraged to continue to have regional planning discussions wherever possible. Please contact your local LHIN representative. 4. H-SAA 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. As indicated earlier, the HSAA schedules will be negotiated annually. 4.2 When will the new reconciled consolidated agreement be available? A: The H-SAA Steering Committee has recently decided to issue a one-year extension to the H-SAA while continuing to pursue focused discussions during the months ahead with the goal of jointly developing the H-SAA. 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. 4.4 Can you review again the process for extending the current HSAA? A: LHINs and OHA are currently in discussion regarding the appropriate term for an extension, which will begin on April 1, Further information will be made available once a decision has been made. 5. Submitting 5.1 Do the HAPS require Board approval as indicated by a signature prior to submission to the LHIN? A: In order to meet the timeline for submission, hospitals may submit HAPS without formal Board approval and provide indication of that approval subsequently. Although the HAPS document itself does not require a formal Board sign-off, it is good practice for hospitals to talk to their Boards about it. 5.2 Why is there only a 4 week period from launch for submission of HAPS? We expected a minimum of 6 weeks from the release of forms, schedules and technical Guidelines to submission of the HAPS. 7

8 A: The HAPS process is considered mature at this stage, with minimal change from year to year in the submission requirements. In addition, many hospitals have completed or made substantial progress in their budget deliberations by the end of the 3 rd quarter. The HAPS forms were made available on SRI on December 11, This was communicated to hospitals through H-SAA Communiqué #7 on December 13, Note that board approval of the HAPS is not required prior to submission to the LHIN. 5.3 Is there any flexibility on the submission date for HAPS? Why do hospitals have only until February 14 to submit but LHINs have between February 14 and March 26 for their work? A: The latter period incorporates not only LHIN analysis of hospital submissions but also negotiation of performance indicators between the two parties to the agreement as well as production of the agreement and negotiated schedules. Hospitals should engage in discussion with their local LHIN if they are facing unique circumstances that may result in a later submission of the HAPS. 5.4 Will hospitals be required to submit a FY 14/15 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. 5.5 Without funding information, are Hospitals expected to submit a balanced budget on Feb 14th? A: Yes, hospitals are expected to submit a balanced budget within their HAPS. 6. QBPs 6.1 Will the QBP definitions for be released at the same time as the HSAA schedules so we can review our volumes and predict for next year? Without the definitions, we won t be able to forecast or plan for next year accurately. A: The QBP definitions (i.e. patient inclusion/ exclusion criteria) and the best practices have been encompassed in the Clinical Handbooks for Wave 1 FY 2014/15 QBPs (see next question for a list of Wave 1 QBPs). These Handbooks will be posted on hsimi.on.ca in early February In addition, for ease of reference and to allow for program management including volume planning, the QBP definitions and accompanying SAS codes will be available on the HSIMI website at the same time as well. 8

9 6.2 What are the 2014/15 QBPs and when will we see information on the financial impact of these procedures? A: Further to Memorandum #14, in efforts to streamline the QBP work and the pace of implementation, FY 2014/15 QBPs have been organized by Waves 1 and 2. Wave 1 QBPs were submitted by the Clinical Expert Advisory Groups (Advisory Groups) in November 2013 and include: Tonsillectomy Hyperbilirubinemia (also known as neonatal jaundice) Pneumonia Hip Fracture Hip and Knee Replacement (updated from FY 2012/13) Wave 1 QBPs have been developed and are targeted for roll-out in FY 2014/15. The rollout will encompass clinical implementation with interim pricing as the basis for funding commencing FY 2014/15. Pricing is currently being finalized for these procedures and will be released in Spring Development is currently underway for Wave 2 QBPs. Wave 2 QBPs are scheduled to be submitted by the Advisory Groups in July 2014 and include: Knee Arthroscopy (Upper/ Lower Limb Fractures have been rescheduled for future implementation) Retinal Disease Colposcopy Cancer Surgery Coronary Artery Disease Aortic Valve Replacement Wave 2 QBPs will be developed and are targeted for best practice roll-out in the Q3 FY 2014/15. This roll-out will only encompass clinical implementation in FY 2014/ Will inpatient rehabilitation related to QBPs continue to be implemented in 2014/15? A: Yes, Inpatient rehabilitation for primary unilateral hip replacement and Inpatient rehabilitation for primary unilateral knee replacement will continue to be implemented in 2014/15. Please also see A Has Knee Arthroscopy replaced Upper/Lower limb fractures as an Orthopaedic QBP?An October 9, 2013 memo from the ministry identified Orthopaedic QBPs as Upper/ Lower limb fractures and Hip fractures. A: Yes; Knee Arthroscopy is currently being developed as part of Wave 2 QBP work. Upper/ Lower Limb Fractures have been rescheduled for future implementation. 9

10 6.5 Is there a rehab component associated with the stroke QBP and what is the expected timing for this to be rolled out? A: There is no rehab component at this time for the stroke QBP that was rolled-out in FY 13/14. As we move through the multi-year implementation of the QBPs, additional components of care will be considered under the funding model. For example, the Clinical Advisory Group for Stroke will continue to meet and review the clinical pathways and best practices associated with the Stroke QBP including the rehabilitation care of the patient. These best practices will inform the ministry s future funding decisions. 6.6 Will clarity be provided on "cancer surgery" QBP for next year vis-a-vis the current CSA incremental volumes with CCO, both from the program and funding perspectives? A: Cancer Surgery is currently being developed as part of Wave 2 QBP work. Once the best practices have been developed and recommendations are submitted from the Clinical Expert Advisory Groups/ Cancer Care Ontario, further details will be provided re program management and funding. Initial plans are to start with Prostate Cancer. 6.7 Will Coronary Artery Disease and Aortic Value Replacement QBPs be implemented in 2014/15? A: There are a couple of different streams. The non-cardiac vascular stream has been implemented and will continue in to FY 14/15. Funding allocations for the cardiac stream will not take place until FY 15/16; however, we expect that the clinical handbooks to support those QBPs will be available in the coming months, which will allow hospitals to begin actioning their clinical pathways from those guides. 6.8 Do we know when small and rural hospitals will receive any documentation as to the impact on funding on the implementation of QBPs for ? A: The ministry has been in discussions with small hospitals through the Small Hospitals Work Group regarding the impact of QBP roll-out. The results of discussions to date have determined that small hospitals are not ready to have a QBP funding allocation associated with them. The ministry, however, realizes that this information would be useful and is planning to work with LHINs to develop details regarding what notional pricing may look like for those QBPs that are in the field today. It is anticipated that this process will continue in future years on an information basis. Small hospitals also have access to HBAM results for information purposes. 6.9 What are the expected corridors known today? HBAM, QBP and QBP percentile used for procedures. A: Corridors for HBAM and QBP components are decisions of the Ministry of Health and Long-Term Care and will be communicated once confirmed as part of the HSFR roll-out for 2014/15. 10

11 7. Indicators 7.1 When will the 2014/15 Indicators and technical specifications be distributed? A: The 2014/15 Indicators are included in Schedule C-1, and the Schedules and technical specifications will be distributed to hospitals and/or LHINs shortly following the January 14, 2014 launch event. 7.2 Do the technical specifications reference historical indicators and/or rates for each LHIN? A: Historical information and rates will not be provided, only current indicator information will be provided through the technical specifications. Historical information may be accessed through your local LHIN. 7.3 Is there any information on when the suggested two new adjusted working capital performance indicators will be implemented? A: The H-SAA Steering Committee has agreed to maintain the working capital indicators as explanatory for fiscal 2014/15. Further discussions with respect to the timing for transitioning these indicators to performance indicators will be held with the Ministry of Health and Long Term Care and the H-SAA Steering Committee over the coming year. 7.4 What is the process to determine when, and if, indicators are added or taken away? A: The H-SAA LHIN leads of the Health System Indicator Initiative Advisory Committee (HSII AC) are currently discussing the life cycle of the indicators and engaging the hospital sector in determining a more rigorous process of indicator review. This process is anticipated to be finalized for the 2014/15 H-SAA process. Currently, the H-SAA IWG is using a Logic Model and Indicator Validation Tool as resources to aid in determining indicator alignment to outcomes and technical qualification for indicators to be used. 7.5 What if the hospital related MLPA indicators change? A: The intent is to ensure alignment is maintained between the MLPA and the H-SAA. Any change to the MLPA indicators are then assessed for corresponding change to those set within the H-SAA and a decision is reached to amend the H-SAA at that time or wait for the next H-SAA fiscal year cycle. 7.6 Are there going to be targets set on all explanatory indicators? If so, what guidance will be provided to the LHIN partners and hospitals? A: No. Indicators classified as explanatory do not have targets. Explanatory indicators are mainly used to help inform the LHIN and hospital partners of performance in a certain area of the system. Only indicators classified as performance have targets. It should be noted that a local LHIN and hospital may decide to establish a target for an indicator that is a provincial explanatory indicator but those decisions are left to the local LHIN and hospital. 11

12 7.7 What is the link between the Health System Indicator Initiative (HSII) and Health Quality Ontario(HQO) regarding the quality metrics initiative that was announced in November? A: With HQO s emerging health quality agenda, it is expected that further alignment will be achieved through the HSII Steering Committee, which is LHIN-led but includes representatives from all partners, such as MOHLTC, HQO, health service providers, CIHI, ICES and CCO. In addition, LHINs are engaging with HQO to discuss how to create better alignment with the health system indicator initiative. 12

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