Hospital Accountability Planning Submission 2013-2014

Education Session February 1, 2013

Agenda

1. Context 2. Alignment 3. H-SAA Organization 4. Structure 5. Guiding Principles 6. H-SAA Schedules Naming Convention

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Agenda

7. Summary of Changes to Guidelines, Forms and draft Schedules for 2013-2014

8. Approach to Setting Planning Targets for 2013/14

9. Guidance for Report Submissions Process 10.H-SAA Indicators 11.Timelines 12.Questions

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Context Planning for 2013-2014

The H-SAA Template Agreement will be a multi-year agreement established through consultative stakeholder meetings between the LHINs, hospitals, the OHA and MOHLTC. The Schedules content will be negotiated annually.

Information collected through the Hospital Accountability Planning Submission (HAPS) will be used to populate the H-SAA Schedules. Both the HAPS forms and the guidelines have been refreshed.

The HAPS and related draft Schedules are being launched today and will cover one fiscal year fiscal - 2013/14.

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Context Planning for 2013-2014

The government is implementing an evidence-based funding model through its Health System Funding Reform (HSFR) and LHINs and the hospitals recognize that health system funding reform (HSFR) will impact the H-SAA process.

Hospital funding has become unique to each individual hospital with the roll out of the Health Based Allocation Model and Quality Based Funding (QBP) and so “across the board” planning targets are no longer relevant or possible.

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Context Planning for 2013-2014

Hospitals are currently engaged in developing budgets to guide operations for fiscal 2013/14 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.

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Alignment with Health System Priorities Achieving the greatest efficiency

MOHLTC: Minister’s Action Plan

LHINs: Pan-LHIN Health System Imperatives

H-SAA

Keeping people healthy Faster access to family health care Right care, right time, right place

Leading with quality & safety Strengthening and enhancing access to primary care Enhancing coordination and transitions of care for targeted populations Holding the gains

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Advancement of pan-LHIN health system imperatives Advancement of /alignment with the LHIN’s IHSP Advancement of/alignment with the Minister’s Action Plan

H-SAA Organization

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LHIN CEOs

H-SAA Steering Committee

Co-Chairs: Paul Huras, CEO, SE LHIN Bill MacLeod, CEO, MH LHIN Marian Walsh, CEO Bridgepoint

H-SAA Planning & Schedules Work Group

WG Co-Lead: Sherry Kennedy, SE LHIN

WG Co-Lead: May Chang, Trillium

H-SAA Communications Work Group

WG Co-Lead: Louise Biggar, LHINC WG Co-Lead: Anthony Dale, OHA

H-SAA Indicators Work Group

WG Lead: Mark Brintnell, SE LHIN

OHA

Structure Creating an ownership framework

As in previous years, the H-SAA Steering Committee was established to provide oversight and guidance to the current year’s consultation process.

The H-SAA Planning & Schedules Work Group was co-led by Sherry Kennedy, Chief Operating Officer of the South East LHIN, and May Chang, Vice President of Finance, Risk, Chief Financial Officer and Queensway Health Centre Lead of Trillium Health Partners.

Based on the H-SAA Steering Committee’s planning assumptions, the core deliverables of the H-SAA Planning & Schedules Work Group were to: prepare draft schedules and related planning submission documents, prepare a data access plan and produce related education materials.

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HSAA Planning & Schedules Work Group Team Membership

Co-Chairs: Sherry Kennedy (L) and May Chang (H)

Members:

Chris Sulway (L) David Couch (H) Scott Chambers (L) Paul Chatelain (H) Eric Partington (L) Tomi Nieminen (OHA) & (H) Kevin Holder (L) Mark Agius (LHINC) Derek Bodden (L) Rosalind Tarrant (L) Technical Support: Mike McClelland (L), Sarah Davis (L) Testing Hospitals and LHINs: Trillium Health Partners, Sunnybrook Hospital, St. Michael’s Hospital, Manitoulin Health Centre, Toronto LHIN, North East LHIN, and South East LHIN L = LHIN H = Hospital OHA = Ontario Hospital Association LHINC = LHIN Collaborative

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Guiding Principles Developing the HAPS materials

The deliverables of the Planning & Schedules Work Group were set with three guiding principles in mind:

1. Practicality. Develop easy to use and understand products that reflect our current reality.

2. Emphasis on local vs. provincial for planning targets, performance indictor targets and other health system changes.

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Guiding Principles Developing the HAPS materials

3. Partnership Approach. Hospitals and LHIN should talk early and often in order to develop a mutually acceptable HSAA within the requisite timeline.

4. Ensure alignment. All core HAPS materials (Guidelines, Forms and Schedules), should align with one another. The Work Group will also strive for enhanced functionality whereby one form/schedule may be pre-populated by another where appropriate.

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Summary of Changes Primary differences between the 2012/13 and 2013/14 HAPS

The Schedules have been reconfigured and renamed to cluster key elements. A handy reference tool follows on the next slide.

The HAPS Guidelines have been streamlined, updated to reflect HSFR, and updated to reflect a new approach to determining planning targets.

The HAPS forms have been refreshed to reflect HSFR and there has been general “housekeeping” to ensure alignment among materials and correction of previously noted errors. A “Main Menu” page has been added with links to the forms and schedules to improve navigation, and provider information is now entered only once.

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Summary of Changes Primary differences between the 2012/13 and 2013/14 HAPS

The draft Schedules have been added to the HAPs forms and Service Volumes (Schedule C2) are now linked to the HAPs input forms.

The hospital will be required to input historical data this year as it cannot be pre-populated in the current version of the HAPS forms. This will be done automatically in future versions.

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H-SAA Schedules Naming Convention NEW! 2013/14

Schedule Title Description Formerly 2012/13

Schedule A Funding Allocation Reflects the hospital’s best assumptions

with respect to planning targets for each relevant category of revenue

C

B Reporting Obligations Lists various reporting obligations and relevant timelines

A

C1 Performance Indicators Reflects recommendations of the Provincial Performance Indicator Committee, approved by the HSAA Steering Committee

E

C2 Service Volumes Similar to prior years. Language updated D

C3 Local Indicators LHIN Specific

Standard template for locally negotiated indicators and obligations

E.1

C4 Post Construction Operating Plan Targeted Funding and Volume

Awaiting MOHLTC feedback

F

D Declaration of Compliance NEW N/A

E Project Funding Agreement Template

To be completed as/if required. N/A

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HAPS Guidelines Main differences between the 2012/13 and 2013/14

Reorganized/reordered some content to improve flow.

Streamlined content to remove duplication and commentary that was no longer necessary due to the maturation of the HAPS process over the years.

Updated the language to reflect HSFR, to reference more recent key documents, and added some minor clarification to wording to reflect feedback from the field and improve understanding.

Incorporated the new approach to setting planning targets.

Note: If a hospital is proposing a change in services, the previous requirements for notification and discussion with the LHIN remain the same.

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HAPS Forms Main differences between the 2012/13 and 2013/14

HSAA schedules A, C1, C2, C3, C4 now included as tabs and where possible have been linked to other HAPS tabs.

New tab to capture Quality Based Procedure (QBPs) volumes.

New tab to capture Chronic Kidney Disease (CKD) data (pulled from previous Provincial Programs tab).

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HAPS Forms Main differences between the 2012/13 and 2013/14

Option to add the hospital’s legal name where it is different from the hospital name in common use.

“Main Menu” page added with links to the forms and schedules to improve navigation.

Numerous changes to update terminology and better align to current reporting requirements.

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Draft H-SAA Schedules Main differences between the 2012/13 and 2013/14

Schedule A (formally Schedule C): updated to reflect HSFR and reorganized and some change in nomenclature for certain revenue categories.

Schedule C2 (formally Schedule D): terminology updated and some line items reordered. Definitions/inclusions/exclusions are noted within the Technical Specifications document.

Schedule C1 (formally Schedule E): no new performance indicators at this time.

Schedule C4 (formally F): no changes, awaiting information from MOHLTC.

Schedule C3 (formally Schedule E3): template now consistent with other schedules, content remains to be negotiated locally.

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Approach to Setting Planning Targets NEW! Premise: 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 in question.

Context: Actual funding allocations are not available until well into any fiscal year and so setting planning target assumptions are necessary to develop and populate a HAPS and Schedules.

Development Principles:

Work in partnership Reflect local reality Build on existing/current hospital budget efforts Manage mutual risk

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Approach to Setting Planning Targets NEW! Actual funding allocations are not available until well into any fiscal year and so setting planning target assumptions are necessary to develop and populate a HAPS and Schedules. The HSAA Steering Committee has confirmed that the following is a practical and reasonable approach to this reality:

Leveraging and aligning with internal hospital budget processes: Hospitals will locally determine their best estimates for planning assumptions for global, HBAM, QBP, etc. (including an assumption for mitigation where applicable) for use in completing the HAPS and related schedules for 2013/14 using their current knowledge.

Focus on reasonability: LHINS will review and discuss these assumptions with hospitals within their region and assess the proposed planning targets for reasonableness.

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Approach to Setting Planning Targets NEW! Mitigating the risk: In order to mitigate the risk to hospitals and LHINs

that actual funding will be different than planning targets used to populate the Schedules of an H-SAA, a materiality “trigger” will be incorporated in the H-SAA template.

Materiality assessed on performance indicators and volume targets: In the event that actual funding allocations are different than the planning targets AND this difference directly results in a hospital being unable to deliver on an H-SAA performance indicator or volume target then this will trigger a renegotiation/resubmission of the affected component of an H-SAA Schedule.

Detailed language and process guidance to follow: Note that the H-SAA Steering Committee has approved this approach and has requested the development of appropriate language for inclusion in the H-SAA template as well as process guidance for the field.

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HAPS Report Submissions: Process Guidance for LHINS and Hospitals

1. LHINs will upload the HAPS forms, Guidelines and a short User Guide to their website for download by hospitals.

2. LHINs will organize a pre-HAPs meeting(s) with their hospitals to discuss:

Where to find forms on their website To understand each hospitals’ planning target assumptions

and to determine reasonableness of same To communicate and discuss LHIN expectations with

respect to volume targets and performance indicator targets (directional and/or specific as appropriate for the local context)

To communicate the local LHIN HAPS submission process e.g.. o a central email or specific person, etc.

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HAPS Report Submissions: Process Guidance for LHINs and Hospitals

3. Given the short time available between launch date and H-SAA

completion date, it is strongly recommended that LHINs and hospitals take advantage of the pre-HAPS meetings to negotiate content in advance of or during the HAPS submission and Schedule population – a parallel vs. linear process.

4. LHIN’s will subsequently upload completed forms (final version only) to the MOHLTC DON site. This will enable subsequent population into SRI.

Location and process to be provided at a later date

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H-SAA Indicators Update for 2013/14 Changes and Process

Volume Indicators:

There are 4 volume indicators added for 13/14 under “Specialized Hospital Services” : HIV Out patient Clinics, Cleft Palate, Sexual Assault

Clinic and Cochlear Implants (only apply to hospitals who offer these services)

Tracking only volume, no performance targets Explanatory Indicators

There are 2 additional indicators currently under discussion in the “Organizational Health” domain: Adjusted Working Funds Adjusted Working Funds over Total Revenue

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H-SAA Indicators Update for 2013/14 Changes and Process

Technical specifications and target setting guidelines will be distributed through the 13/14 Technical Specification Document

Indicator Life Cycle

With regards to future HSAAs, the LHINs and the hospitals are continuing to discuss the appropriate addition and removal of indicators from the HSAA indicator list as the agreements and the system continue to evolve

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Timelines Completing the 2013/14 HAPS

Projected Timelines

January 21 2013/14 HAPS materials education session.

January-March

Local H-SAA consultations between LHINs and hospitals to finalize H-SAA for Board sign-off . Note that a parallel vs. a linear process is recommended to enable completion of signed H-SAAs by March 31, 2013.

March 1 Completed HAPS submissions are due to the LHINs.

March 31 New H-SAAs signed . All board approved H-SAAs are due to the LHINs by March 31, 2013

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Questions? Discussion?

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