Hospital Service Accountability

Agreements:

Schedules & IndicatorsFiscal 2018/19

Presented in Fall 2017

Agenda

1. Context

2. H-SAA Organizational Structure

3. Changes to H-SAA Schedules for 2018-19

4. H-SAA Indicator Work Group

5. Updates to Provincial H-SAA Indicator Slate

6. Next Steps

7. Questions

8. Appendix A: H-SAA Indicator Work Group Membership

9. Appendix B: H-SAA Planning & Schedules Work Group Membership

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Context

H-SAA Schedules and Indicators

• The H-SAA Template Agreement is envisioned to 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.

• This presentation will focus on the status of the schedules and provincial indicators for 2018/19.

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H-SAA Organizational Structure

Creating an ownership framework

Hospitals

(OHA)H-SAA Steering Committee

H-SAA Planning & Schedules

Work Group

SRI Reports Work Group

H-SAA Indicator

Work Group

LHINs

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H-SAA Organizational Structure

Creating an ownership framework

• The H-SAA Indicators Work Group is co-led by Elizabeth Salvaterra, Pan-LHIN Lead, Patients First LHIN Renewal, and Imtiaz Daniel, Director, Financial Analytics and System Performance, Ontario Hospital Association.

• The H-SAA Planning & Schedules Work Group is led by Jeff Kwan, Vice President, Financial Health & Accountability at North Simcoe Muskoka LHIN.

• See Appendices A and B for membership lists pertaining to the Indicator Work Group and Planning & Schedules Work Group, respectively.

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Changes to H-SAA Schedules for 2018-19

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Schedule A (Funding Allocation) • Under Quality Based Procedures (Section 2), the list of QBPs has

been updated to reflect the addition of Stroke Endovascular Treatment and the removal of Neonatal Jaundice

• Under Wait Time Strategy Services (Section 3), a column for Incremental Base funding has been added

Changes to H-SAA Schedules for 2018-19

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Schedule C2 (Service Volumes)• Technical specifications have been updated to reflect HIG

methodology:• Complex Continuing Care Weighted Patient Days• Day Surgery Weighted Cases• Emergency Department Weighted Cases• Total Inpatient Acute Weighted Cases; and • Inpatient Mental Health Weighted Days

• Most of these indicators are already on Schedule C2. The only new addition for 2018-19 is Inpatient Mental Health Weighted Patient Days.

• New technical specifications are also available for:• Forensic Bed Inventory• Stroke Endovascular Treatment (new QBP for 2017-18)

• The H-SAA Indicators Work Group (IWG) is comprised of representation from involved hospital, LHIN and MOHLTC leaders with backgrounds in program delivery, performance improvement and finance.

• The IWG made minimal changes this cycle, with consideration for further, ongoing discussion regarding Patients First work and its potential impact on the H-SAA indicators in 2019/20.

• The core deliverables of the H-SAA Indicators Work Group were to:

• Review current indicators to ensure continued alignment with pan-LHIN system imperatives

• Update technical specifications and target setting guidelines as required

• Develop other communication and education materials as needed

H-SAA Indicator Work Group

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• Several changes will be introduced to the provincial H-SAA indicator slate for 2018/19.

• Emergency Department (ED) indicators:

• For greater alignment with the provincial Pay For Results program, it was recommended that the ED indicators be updated. Resulting changes are:

• Renaming “90th Percentile ED Length of Stay for Minor/Uncomplicated Patients to “90th Percentile ED Length of Stay for Non-Admitted Low Acuity Patients [CTAS IV-V]” and maintaining it as a performance indicator

• Aligning “90th Percentile ED Length of Stay for Non-Admitted High Acuity Patients [CTAS I-III]” (identical to Pay for Results indicator) as a performance indicator and removing “90th Percentile Emergency Department (ED) Length of Stay for Complex Patients”

• Adding “90th Percentile Time to Disposition Decision (Admitted Patients)” as an explanatory indicator

Updates to Provincial H-SAA Indicator Slate

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• In summary, performance indicators for 2018/19 will be:• 90th Percentile ED Length of Stay for Non-Admitted High Acuity Patients [CTAS I-III]• 90th Percentile ED Length of Stay for Non-Admitted Low Acuity Patients [CTAS IV-V]• Percent of Priority 2, 3 and 4 Cases Completed within Access Targets for Hip

Replacements • Percent of Priority 2, 3 and 4 Cases Completed within Access Targets for Knee

Replacements

• Percent of Priority 2, 3 and 4 Cases Completed within Access Targets for MRI

• Percent of Priority 2, 3 and 4 Cases Completed within Access Targets for CT scans

• Rate of Hospital Acquired Cases of Clostridium Difficile Infections

• Readmissions to Own Facility Within 30 Days for Selected HBAM Inpatient Grouper (HIG) Conditions

• Current Ratio

• Total Margin (all sector)

• ALC Rate

Updates to Provincial H-SAA Indicator Slate

Performance Indicators

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• Explanatory indicators for 2018/19 will be:• 90th Percentile Time to Disposition Decision (Admitted Patients)

• Percent of Stroke/TIA Patients Admitted to a Stroke Unit During Their Inpatient

Stay

• Hospital Standardized Mortality Ratio

• Rate of Ventilator-Associated Pneumonia

• Rate of Central Line Infection

• Rate of Hospital Acquired Cases of Methicillin Resistant Staphylococcus Aureus

• Percent of Priority 2, 3 and 4 Cases Completed within Access Targets for Cancer

Surgery

• Percent of Priority 2, 3 and 4 Cases Completed within Access Targets for Cardiac

By-Pass Surgery

• Percent of Priority 2, 3 and 4 Cases Completed within Access Targets for Cataract

Surgery

• Total Margin (Hospital Sector Only)

• Adjusted Working Funds / Total Revenue %

Explanatory Indicators

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• Percentage of ALC Days

• Repeat Unscheduled Emergency Visits within 30 days for Mental Health

Conditions

• Repeat Unscheduled Emergency Visits within 30 days for Substance

Abuse Conditions

Explanatory Indicators (cont’d)

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Next Steps

• The H-SAA IWG will:

• Liaise with external stakeholder groups as necessary to enhance understanding of, and continually improve upon, proposed and existing indicators for next cycle (2019/20)

• Assess indicator set to ensure ideal alignment of hospital performance and accountabilities to system outcomes

• The H-SAA P&S WG will:

• Discuss members’ feedback about the HAPS and schedules materials and processes, and discuss any improvements for the following year

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Questions?

Please contact your local LHIN.

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Appendix A: Indicator Work Group

Membership

Sector Organization Individual, Title

LHIN Patients First LHIN Renewal Elizabeth Salvaterra, Pan-LHIN Lead (Co-Chair)

OHA Ontario Hospital Association Imtiaz Daniel, Director, Financial Analytics and System Performance (Co-Chair)

Hospital Grey Bruce Health Services Martin Mazza, VP Corporate & Diagnostic Services, Chief Financial Officer

Hospital Joseph Brant Hospital Cheryl Williams, VP Patient Care Services and Chief Nurse Executive

Hospital Sunnybrook Health Sciences Centre Darren Gerson, Senior Director, Decision Support

Hospital St. Joseph’s Healthcare Hamilton Jane Loncke, Director, Clinical Programs

MOHLTC Ministry of Health and Long-Term Care Nam Bains, Manager, Health Analytics Branch

MOHLTC Ministry of Health and Long-Term Care Lauren Churcher, Senior Health Analyst, Health Analytics Branch

MOHLTC Ministry of Health and Long-Term Care Thomas Custers, Manager, Quality Performance & Evaluation

MOHLTC Ministry of Health and Long-Term Care Domenic Della Ventura, Team Lead, LHIN Liaison Branch

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Indicator Work Group Membership (cont’d)

Sector Organization Individual, Title

MOHLTC Ministry of Health and Long-Term Care Minh Huot, Team Lead (A)

MOHLTC Ministry of Health and Long-Term Care Leanne Lindsay, Senior Program Consultant (A)

HQO Health Quality Ontario Gail Dobell, Director

LHIN Central East LHIN Marilee Suter, Director, Decision Support

LHIN Champlain LHIN Paul Caines, Senior Accountability Specialist

LHIN Hamilton Niagara Haldimand Brant LHIN Iwona Bielska, Advisor

LHIN Toronto Central LHIN Erin Scholl, Senior Consultant

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Appendix B: H-SAA Planning & Schedules Work Group

Membership

Sector Organization Individual, Title

LHIN NSM LHIN Jeff Kwan, Vice President, Financial Health & Accountability (Chair)

Hospital Collingwood General & Marine Hospital Michael Lacroix, Vice President, Corporate Services & CFO

Hospital Quinte Health Care Brad Harrington, Vice President and Chief Financial Officer

Hospital St. Michael’s Hospital Tomi Nieminen, Deputy Chief Financial Officer

Hospital Trillium Health Partners Carol Vinette-Hancharyk, Director, Financial Strategy & Deputy Chief Financial Officer

MOHLTC Ministry of Health and Long-Term Care Minh Huot, Team Lead (A)

MOHLTC Ministry of Health and Long-Term Care Leanne Lindsay, Senior Program Consultant (A)

OHA Ontario Hospital Association Imtiaz Daniel, Director, Financial Analytics and System Performance

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Planning & Schedules Work Group Membership (cont’d)

Sector Organization Individual, Title

LHIN C LHIN Ronald Eng, Senior Business Analyst

LHIN C LHIN Kelvin Luk, Senior Analyst

LHIN SW LHIN Scott Chambers, Manager

LHIN MH LHIN Jeanny Lau, Lead

LHIN MH LHIN Andrew Wahab, Senior Lead, Funding and Allocation

LHIN NE LHIN Marc Demers, Controller / Corporate Services Manager

LHIN NW LHIN Kevin Holder, Senior Consultant

LHIN TC LHIN Erin Scholl, Senior Consultant

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