Presentation Transcript

1. NSW FUNDING REFORM2012/13

   HETI NSW Prevocational Medical Education Forum 10 August 2012 ABF Taskforce
2. National Health Reform - Objectives National reform objectives Improve patient access Ensure sustainability of funding Improve the transparency of public hospital funding Nationally consistent ABF methodology ABF objectives Mechanisms to reward good practice and support quality initiatives Explicit relationship between funds allocated and services provided Stronger focus on outputs, outcomes and quality Encourage clinicians and managers to identify variations in costs and practices
3. What is ABF? A method by which health services are funded for what they do, not who they are A means of transparently identifying funding allocation A tool to identify where to ask questions: right model of care? correct allocation of resources? quality? The means by which communities, clinicians, managers and government can identify the right services
4. What ABF is not Not … uncapped funding source for additional work fixed Commonwealth funding till 2014 Not …monthly payment for work performed No… goose, no golden egg No… more money from the State
5. NSW ABF Scope Public hospital services in hospital, home, community, or purchased by a public hospital Activity in scope: acute admitted, ED and non-admitted >= 3,500 cost weighted separations 2009/10 sets threshold for ED and Non-admitted Interim Funding Model: sub and non acute and mental health
6. Block Funding Block Funded Hospitals (<3,500 cost weighted separations) Teaching, Training & Research Population Health Primary Health Residential Aged Care
7. State Price Principles Keep system safe and operating Transparency Explicit relationship between funds / activity / deliverables Incentives Reasonableness State Price = $4,471 per national weighted activity unit (NWAU) Applies to Acute, ED and Non Admitted* LHDS/SHNs funded at lower of LHD/SHN projected average cost or State Price
8. 2012/13 ABF Funding by LHD/SHN
9. Sample Budget Allocation 2012/13 (Schedule C Part 1)
10. NWAU – National Weighted Activity Unit The NWAU is the ‘currency’ used to express the price weights for all services funded on an activity basis. Does not replace classifications that are used to describe activity (such as AR-DRGs, URGs, UDGs) and serves a different purpose to these classifications an NWAU allows for direct comparison, transferability and net funding NWAU for all public hospital services are arrayed along one continuous scale e.g. ED and Non Admitted relative to Acute inpatient (1 NWAU = $4,471) URG 3 Adm T1, Injury 0.3313 NWAU; $1,481 Tier 2 Clinic, 10.10 Renal Dialysis 0.1324 NWAU; $592 DRG L61Z, Haemodialysis 0.1324 NWAU; $592
11. Adjustments Private patients (service adjustment - DRG basis and accommodation adjustment) Specialist paediatric hospitals - DRG basis +/- Aboriginality +5% (applies to acute, ED and non admitted) Rural/remoteness (applies to acute, ED and non admitted) Outer regional +8.7% Remote +15.3% Very remote +19.4%
12. Information & Resource Kit Practical Guide Funding Guidelines Conditions of Subsidy Performance Framework KPI Definitions http://internal.health.nsw.gov.au/communications/funding_reform/resources.html
13. Ministry & ABF Taskforce Next Steps Data quality and timeliness IT systems → Coder training and workforce - expansion of training positions and scholarships for tertiary studies → Cost Accounting Guidelines → Research and Innovation Grants → Monitoring and reporting ABF reporting tool → NWAU patient level data to LHDs → Inclusion of NWAUs in HIE data warehouse → Enhanced performance reports →
14. Ministry & ABF Taskforce Next Steps (cont’d) Budget alignment ABF Based Schedule C  Budget tool  Clinical engagement/buy-in Communication and education → Communications toolkit  ABF education module (HETI) → Pro-active planning Research and Innovation Grants → Inform development of classifications for subacute and mental health ABF → Purchasing Framework → Inform development of 2013/14 NEP and State Price →
15. LHD/SHN Next Steps: Counting Counting and reporting all services provided Improve medical record documentation Daily progress notes Discharge summary completed at time of discharge Information systems Documented business rules Clinician education
16. LHD/SHN Next Steps: Classification/Coding Ensure service provided is coded to correct category within classification Compliance with standards Coding workforce Coding audits Quality review Financial coding – general ledger
17. LHD/SHN Next Steps: Costing Upgrading costing software and feeder systems Costing workforce, costing and accounting data quality, compliance with standards and auditing Review cost centre information for alignment with service profile Clinician and cost centre manager engagement and education
18. Clinical Documentation to Funding Clinicians document diagnoses and procedures in the medical record Clinical Documentation Documentation translated into alphanumeric ICD-10-AM codes Clinical Coding Codes/Age/Discharge status used to assign AR-DRGs. Computer software used (Encoder) DRG Assignment Assigned to each AR-DRG. Based on previous costing studies, which inform the average value of treating a patient Cost Weights Price weights X price used to allocate funds to each LHD Funding
19. Counting & Coding to Costing
20. Clinical and Performance Review Increased focus on evidence based and benchmarked clinician utilisation of resources such as tests, drugs, patient days etc What is best clinical practice and who is doing it? Are length of stay and cost variations between peers explainable and justified? Performance Target setting – communication, accountability Strive to control unplanned readmissions & ambulatory sensitive conditions Manage waiting lists to benchmark Improved management of length of stay