Fiscal and Operating Plan - Peterborough Regional … and...Fiscal and Operating Plan March 26, 2014...

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Fiscal and Operating Plan March 26, 2014

Confidential and Draft

To March 27, 2014 @ 1pm

www.prhc.on.ca

Overview

• PRHC 2013/14 in Review

• Healthcare Environment 2014/15

• Framework for Plan 2014/15

• Plan 2014/15

• Risk Mitigation

• Summary

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PRHC 2013/14 in Review

Balanced Budget while:

$5.1 million for Debt Service and Working

Capital Remedy

Met Working Capital Remedy $11.4 million requirements

Earned $3 million through additional volumes

Post Construction Operating Plan funding

Sustained and Improved Quality (QIP)

Sustained and Improved Access

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PRHC 2013/14 in Review

IT Planning for Electronic Patient Record

Challenges

Quality

• Infectious disease prevention & antibiotic use

Access • Length of Stay

• Reducing Readmission Rates

• Patient flow and bed surge capacity

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• Health System Funding Reform – continues

• Performance and efficiency cannot slip

• Pace of funding change implementation is not

aligned with pace of system change

• Data is the new currency

• Accuracy, timeliness of data critical

• Alignment of the continuum of services

• Pressure for integration

Healthcare Environment 2014/15

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• Volume and market share must be managed in real

time

• Health System Funding Reform (HSFR) requires

length of stay reduction

• ALC relatively constant

• Quality Improvement Plans linked to H SAA

• Labour contract settlements

• Outbreaks / sentinel events ~ unplanned


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PRHC needs to be strategic,

precise, nimble in our decision

making, implementation and

execution

Strategies to enable timely

clinical change required by

HSFR


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Framework for Plan 2014/15

• Principles as approved and SOAPEER

criteria

• Economic and Workload Assumptions

– No funding increase

– Compensation: frozen or per agreements ONA, OPSEU Para, OPSEU Clerical under negotiation

– Volumes and activity maintained and modest

growth only with specific confirmed funding

– Other expenses: not increased

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Non Negotiable Performance

Requirements for 2014/15

• Principles

• Balanced Budget

• Debt Obligations $2.8 million

• Working Capital Remedy $2.6 million

• IT Renewal

• HSAA embedded targets

• Capital Equipment Renewal

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Non Negotiable Performance

Requirements for 2014/15

• Supports Quality Improvement Plan

• Length of Stay Reduction

• Ongoing Performance Gains

• Staffing Ratios and models to Match Patient Care

Needs

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Enablers 2014/15

• Continued Development of Best Practice

Care Pathways and Order Sets

• Ambulatory Care Services

• Cooperation with Community Partners

• Standard Work (LEAN)

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2014/15 Overview

• Staff mix changes

• Bed Realignments

• Increased funded volumes

• Efficiency gains

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2014-15 2013-14 Incr (decr) Incr 2013-14 Incr (decr) Incr

Annual Annual Budget vs (decr) Projected Budget vs (decr)

Budget Budget Budget YE at Q3 Projected YE

Revenue

CELHIN Global 94,933 94,933 0 94,933 -

CELHIN HBAM 64,356 64,356 (0) 64,356 -

CELHIN QBP 15,656 16,779 (1,123) -6.7% 18,059 (2,403) -13.3%

PCOP 6,363 - 6,363 3,000 3,363 112.1%

CCO QBP 17,041 15,782 1,259 8.0% 15,682 1,359 8.7%

One-time Funding 5,583 5,453 130 2.4% 7,546 (1,963) -26.0%

Subtotal CELHIN Funding 203,931 197,302 6,629 203,576 355

Patient Accomodations and Co-Payments 8,062 8,397 (335) -4.0% 7,897 165 2.1%

Recoveries and Misc. Revenue 8,512 8,581 (69) -0.8% 8,581 (69) -0.8%

NDFP Recovery 4,531 4,634 (103) -2.2% 4,562 (31) -0.7%

Amortization of Grants/Donations 5,500 5,500 - 5,500 (0) 0.0%

Total Revenue 230,537 224,414 6,123 2.7% 230,117 420 0.2%

Peterborough Regional Health Centre

Plan2014/15

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Expenditures 26.5% 25.3% 25.6% 23.6%

Salaries & Wages 116,854 114,750 2,104 1.8% 115,550 1,304 1.1%

Benefits 30,940 29,002 1,938 6.7% 29,581 1,359 4.6%

Employee Future Benefit Costs 2,420 1,150 1,270 110.4% 1,620 800 49.4%

Medical Stipends 1,508 2,018 (510) -25.3% 1,662 (154) -9.3%

Medical/Surgical Supplies 18,327 18,129 198 1.1% 17,629 698 4.0%

Drugs & Medical Gases 6,118 6,364 (246) -3.9% 6,364 (246) -3.9%

NDFP Drugs 5,149 5,148 1 0.0% 5,184 (35) -0.7%

Supplies and Other 30,334 28,750 1,584 5.5% 30,400 (66) -0.2%

Interest 1,974 2,250 (276) -12.3% 2,120 (146) -6.9%

Bad Debts 300 165 135 81.8% 255 46 17.9%

Amortization of Equipment 8,577 8,580 (3) 0.0% 8,580 (3) 0.0%

Total Expenditures 222,499 216,306 6,193 2.9% 218,944 3,555 1.6%


Plan2014/15

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Medical Fees

Revenue (ER Services, On Call Coverage, OHIP) 20,065 18,417 1,648 19,417 648

Medical Fees 22,607 21,425 1,182 22,425 182

Net Medical Fees (2,543) (3,008) 465 -15.5% (3,008) 465 -15.5%

Net Costs Specialty Funding & Other Vote Programs (65) - (65) (350) -

Net Surplus from Hospital Operations 5,430 5,100 330 7,815 66

2.1% 2.0% -0.1% -0.4%

Amortization of Grant/Donations Non-Sharable 5,519 5,519 - 5,519 460

Depreciation of Capital Non-Sharable (6,519) (6,519) - (6,519) (543)

- -

Net Surplus/(Deficit) 4,430 4,100 330 6,815 (17)

FTE's 1,621 1,621 - 1,611 -


Plan2014/15

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Source & Application of Funds

2014/15 Plan 2013/14

Forecast

Sources In ‘000’s In ‘000’s

Surplus from operations 5,430 7,815

Depreciation-net 3,077 3,080

Foundation –equipment* 1,000 1,100

Total 9,507 11,995

Application of Funds

Debt Repayment 2,800 2,600

Working Capital Repayment 2,600 2,500

Business Case Investment 507 500

Equipment Renewal * 1,700 2,500

IT/EHR 1,900 1,500

Total 9,507 9,600

NET 0 2,395

* Excludes specific campaign or projects

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Funded Volumes

Plan 2014/15 Plan 2013/14

Inpatient Weighted Cases 23,200* 21,200 9.4%

Out Patient Visits 135,000* 130,000 3.9%

*Additional Volumes Funded through PCOP

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People Implications

Although minimal overall impact on employment levels (FTEs) ~

ongoing refinements in staffing mix, patient care focus, inpatient-

outpatient models are to continue based on:

– Best practice

– Quality Based Funding

– Government investment in community-based care

• Minimize impact through attrition and redeployment strategies (Leaves, retirements, departures, transfers)

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What will change in 2014/15…..

Surgical Services

Closure of 4 Orthopedic beds Monday – Friday

– Based on surgical utilization

Closure of 2 Surgical Constant Care beds

– Based on patient care needs reducing to 6 beds

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Medicine

• Bed realignment to better meet patient needs and

to improve quality of care and efficiencies

• Overall 4 bed reduction

– Length of stay reduction

• Creation of Transitional Unit (Alternative Level of

Care) 60 bed unit for Patients ready to be discharged from acute

No longer acute care patients

Staffing mix changes to align with patient care needs

Improve efficiencies – matching cost to funding

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Palliative Care

– Realignment of 5 beds to meet acute care needs &

length of stay benchmarks

Consistent with new hospital function program level

– CE LHIN has made significant investment in

community based services including CCAC Palliative

Care Service

Integrated Stroke Unit

– Considered best practice

– Realignment of 6 acute care beds

– Acute care and Rehabilitation in the Unit

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Geriatric Assessment Intervention Network

(GAIN)

– New funding for Outreach Program

Support frail seniors in their homes

Care team includes, Occupational Therapists,

Social Workers, Nurse Practioner and Speech

Language Pathologist.

Paediatric Services

Regional Level IIB Neonatal Intensive Care

requirements

Outpatient services volumes increase

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Diagnostic Assessment Program

– Cross program implementation – Oncology, Surgery, Women’s Health, Diagnostics

Renal

– Implementation of Transition Unit – Support Patients in Independent Dialysis

Rehabilitation – Shift outpatient to inpatient – focusing on stroke, hands and

orthopaedic

– Supports Ministry shift and funding support to

outpatient physiotherapy in the community


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Inpatient Beds

Budget Forecast Budget

2014/15 2013/14 2013/14

Beds

Medicine 160 173 164

Intensive Care 24 24 24

Surgery 56 62 60

Paediatric 8 8 8

Neonatal Intensive Care 10 10 10

Obstetrics 14 14 14

Mental Health 27 27 27

Complex Continuing Care 28 28 28

Rehabilitation 42 42 42

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IT

Electronic Health Record

– Planning

– Readiness Assessment

– Change Management


Leveraging E-records to Advance Patient Safety

LEAP

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What are our risks …..

• Revenues

– HSFR actual funding

• Expenses

– Timely response to revenue changes

• Monitoring Quality and Safety Indicators

– Outcomes

– Access

• Monitoring Staff and Physician Satisfaction

• Political Climate

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Risk Mitigation ……

• Stakeholder Engagement - Strong

Communication Plan

– Staff and Physicians

– Foundation

– Public

– CE LHIN and Government

– Community Partners

• Change Management - Strategy

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Balanced Approach while meeting obligations for

debt repayment and working capital requirements

Supporting…..

• Best Practices

• Responding to HSFR

• Sensitivity to HR implications

• Alignment with Strategic Plan

• Strong Partnerships

In Summary 2014/15

www.prhc.on.ca 29

1. Quality and safety standards maintained or improved

2. Alignment with strategic plan

3. Promote strategic direction of a High Performance Culture

4. Alignment with LHIN IHSP and MOHLTC priorities

5. Alignment with SOAPEER

6. Responsible and accountable budgeting practices

7. Budget within available resources – impact of HSFR

8. Specific budgets within funding allocation for providing services

9. Services must operated within specific funding envelopes – HBAM, QBP

10. Volume funded targets achieved – no claw backs

Principles

www.prhc.on.ca 30

11. Repayment of working capital deficit - Remedy meet year two commitment for 2014/15 ~ $2.5 million

13. Strategic investments to support strategic directions, information technology, and efficiencies

14. New Hospital Capital Debt repayment must be made for 2014/15 ~$2.7 million

15. Benchmarking used to identify savings and performance targets

16. Focus on core business

17. Maximize efficiency opportunities, elimination of waste

18. Continue to implement efficient staffing mix that enables maximum scope of practice standards

Principles

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SOAPEER

31

Safety: Avoids errors and injuries to patients and staff from the care that is

intended to help.

Outcome: Provides services based on evidence to all who could benefit, and

refrains from providing services to those not likely to benefit.

Access: Maintains capacity, ensures timely access to care and reduces waits

for both those who receive and those who give care

Patient

Experience: Provides patient and family focused care that is in line with our

ethical framework.

Efficiency: Avoids waste, including waste of equipment, supplies, ideas, time

and energy.

Effectiveness: Provides appropriate service and care that aims to meet quality,

performance and productivity targets.

Risk: Considers all aspects of possible harm arising

from an action and ensures a risk mitigation

strategy is in place.

Fiscal and Operating Plan - Peterborough Regional … and...Fiscal and Operating Plan March 26, 2014...

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