How to Tame your (SNAP) Dragon

1. How to Tame your (SNAP) Dragon

2. NSW Experience • NSW began implementation of a SNAP data collection in the late 1990s • The purpose was to develop a funding model based on the SNAP data collected • Thecollection incorporated all the elements currently necessary for classifying episodes to an AN-SNAP class • The AROC and PCOC data elements were incorporated into the collection • 59 hospitals in NSW collect SNAP data

3. How did we create a “SNAP Dragon”? Step 1 • The scope of the data collection was “designated” units • Designated units were defined as having: • at least 4 beds • A distinct physical location • At least 80% of the activity in the unit is sub acute Step 2 • No state wide funding model implemented

4. How did we create a “SNAP Dragon”? Outcome • If the data was not clinically meaningful to a service they did not collect it e.g. services for whom sub and non activity was not core business • Increase in focus on LOS/RSI in acute care meant that for some services a service category change may have been viewed as a quick and easy way to end the acute episode Service category change but no SNAP data

5. Why did anyone continue to collect data? • Clinical usefulness of data • Expected length of stay • Expected functional improvement • Benchmarking • AROC • PCOC • Some AHS/LHDs did use SNAP to monitor quality, activity levels and/or fund sub and non acute services • The ever present promise that “one day…..”

6. Enter the Dragon

7. From 2008-2009 the total sub acute bed days in NSW and the bed days for which SNAP data was collected remained relatively stable From 2009 the total SNAP days in the state grew From 2010-2012 the number of “SNAPPed” days remained stable Therefore the proportion of “SNAPPed” bed days was not changing over time

8. Enter the Dragon Tamer-ABF

9. ABF • The introduction of ABF gives us an opportunity to shine a light on SNAP activity • All NSW services providing sub acute care, that are in scope for ABF, will need to be able classify SNAP activity • Will that be a SNAP class or just at the care type level?

10. Why at SNAP class level? • Participation in the data collection is advantageous to SNAP services • NSW SNAP data collection is a rich source of information that can be used for • Measurement of clinical outcomes • Evaluation of service effectiveness • Review of individual patient progress. • Care type level data does not allow us to fully understand the clinical or resource utilisation characteristics

11. How do we avoid creating baby dragons? NSW lessons learned 1. Policies • New national care type definitions • State based or national care type policies • Regular review of and audit against policies

12. How do we avoid creating baby dragons? NSW lessons learned 2.Incentives • Consider development of models that incentivize the collection of SNAP Data • NSW Interim SNAP funding model • Differential amounts paid for SNAPPedvs non SNAPPed – weight or price • Needs to be a meaningful difference • Ultimately “retire” the concept of “ungrouped” or “non designated” activity • Incorporate into classification or “delete”

13. How do we avoid creating baby dragons? NSW lessons learned 3. Support Clinicians • Provide training in clinical assessment tools • FIM train the trainer • Easily accessible education resources • A range of resources on intranet • IT system development that serves multiple purposes • Clinical information • ABF information • Benchmarking data • Reporting that is clinically meaningful as well as ABF appropriate

18. Is it working?

19. Summary • Collecting SNAP data is only the first step • Ensure policy reflects appropriate clinical care and the data we want to receive • Integrate performance reporting with benchmarking • Clinically meaningful