The Impact of Activity Based Funding on the Patient and Family's Journey to

Transitional Care: A Hospital and Client Perspective!

Amanda Humphreys, Transition Care Central Coordinator, North Metro Health Services, Perth WA

Mary Joyce, HOD, Social Work Dept, Sir Charles Gairdner Hospital, Perth, WA

Aims

• The state of play of the health system in WA: introducing an ABF model

• Impact on Transition Care in Metro WA, for the health services and the client group

Perth, Western Australia

Sir Charles Gairdner Hospital - in the land of West Oz

Activity Based Funding

• What is it?

• A way of funding health services, based on the work they perform

! Improve efficiency

! Gain transparency

! Improve patient care

Activity Based Funding

• History

• Agreement by Council of Australian Governments (COAG) in 2008, to move to a nationally consistent approach to ABF

• Phased introduction commenced 2012/13

Activity Based Funding���

– in 20 words or less ! ���• On discharge hospital coders review the

client’s medical record and determine which Diagnostic Related Group (DRG) applies

• Each DRG has a weighting, which is multiplied by the State Efficient Price to determine the payment the hospital receives from the commonwealth

Activity Based Funding - example

• 86 year admitted post fall, daughter unable to manage at home due to mother’s deteriorating cognition, wandering

• Hospital stay was 29 days, TC ready at day 23

Activity Based Funding - example

• DRG code for this patient was B78A – “an intracranial injury with co-morbidities and complications”

• This code stipulates a stay of between 3 to 30 days and a weighting of 2.8203

• Hospital payment is 2.8203 x the State Efficient Price $5,325 = $15,018

Activity Based Funding - example

• The cost for the 29 day admission was approximately 29 x $1,464 = $42,456

• Unfunded cost to hospital = $27,438

• Break even point where cost equals payment is 10.25 days

Activity Based Funding - Data

• November 2013 – 24 patients discharged from Sir Charles Gairdner Hospital to TC

• Unfunded cost to hospital approximately $550,000

Transition Care in Perth

Who are our ���clients ?

• 265 clients of SCGH were discharged to Transitional Care in 2013

•  (1903 discharged to TCP across North Metro)

• Restorative pathway 47%

• Residential care pathway 53%

How was the journey to TCP?

• What does this mean for the clients?

• Small sample

• From the hospital system to TCP

• Qualitative questions for client and carers after transfer to TCP

The human face

• Introducing some of our clients........

Systemic perspective

• Macro and micro view: need to view system as a whole

• Balance needs of both clients and hospital services

• economic imperatives = cost cutting

• other system changes: aged care reform, changes to TC

Impact for clients on this journey

• TCP clients identified as expensive to the health system

• Increased overt and covert pressure on patients and families to accept sub-optimal out of home care

• Changed care practices in the hospital environment?

Conclusion • Neither client or carer felt care was

compromised or overt pressure to discharge

• However, evidence of stress on the client and carer

• Clients and carers aware of limited hospital beds

• The future....