Hospital Service Accountability Agreement (HSAA): Education Session. Frequently Asked Questions (FAQ)

Transcription

1 Hospital Service Accountability Agreement (HSAA): Education Session Frequently Asked Questions (FAQ) February 2016

2 TABLE OF CONTENTS INTRODUCTION... 3 GLOSSARY OF TERMS Education & Supporting Documents Are there any available resources that can facilitate performance dialogue between hospitals and LHINs? Planning / Funding Assumptions How should planning assumptions be made? When will we receive our funding information? Small hospitals received 1% to base funding last year. Can we plan for the same adjustment next year in the HAPS? What level of materiality is expected? Will the materiality also apply to performance factor on the total margin indicator? What is the "Materiality Trigger"? Can contact information of finance staff across hospitals be shared? We ve already submitted our HAPS to the LHIN. Will we need to refresh our HAPS when the new HSAA is finalized? When will the new funding formula results be available? Service Accountability Agreements (SAAs) How long is the HSAA agreement meant for? Will the existing HSAA agreement be extended? When will the new consolidated agreement be available? Will the new HSAA template agreement allow for community programs to carry forward surpluses into next year? Will the new HSAA template agreement allow for streamlining the MSAA and/or LSAA into the HSAA for those hospitals that currently have both, therefore eliminating the need for a separate MSAA and/or LSAA? The wording used in the current HSAA is far less restrictive that the wording used in the current MSAA and LSAA. Can we expect the proposed new consolidated agreement to be more reflective of the current HSAA or the current MSAA or LSAA? Can the Steering Committee issue a draft version of the MHSAA template so that the field can begin to prepare? Some HSPs have SAAs with more than one LHIN. Will the MHSAA template consolidate multi-lhin SAAs into one agreement? Will the MSAA be extended to June 2016 as well? Indicators What is the difference between performance indicators and explanatory indicators? For the readmission indicator, are we measuring readmissions for the same diagnosis to our own facility or for any diagnosis to our own facility? The HQO technical specifications for readmission still look at all readmissions to any facility. How do you propose we consider this discrepancy in QIP target setting? Are there any concerns that the CIHI Discharge Abstract Database (DAD) no longer requires readmission to own facility as a mandatory field to capture? Are hospitals expected to calculate the risk adjusted readmission rates? If so, will technical specs be provided to assist with this calculation? Are the readmission performance indicators risk adjusted? How will hospital targets be set? Why have we excluded the 90th percentile ED LOS for Admitted Patients as a performance indicator? It is difficult for hospitals to reach some of the ED targets (e.g. ED LOS targets for complex patients). Is anything being done to address this?

3 INTRODUCTION This document contains answers to frequently asked questions (FAQs) related to the February 3, Hospital Service Accountability Agreement (HSAA) education webcast. GLOSSARY OF TERMS HAPS: Hospital Accountability Planning Submission. The HAPS is the planning tool used by hospitals to inform the negotiation of the Hospital Service Accountability Agreement (HSAA). HSAA: Hospital Service Accountability Agreement. The HSAA is the service accountability agreement that the LHINs are required to enter into with the hospitals pursuant to the terms of the Local Health System Integration Act (LHSIA). MSAA: Multi-Sector Service Accountability Agreement. The MSAA is the service accountability agreement that the LHINs are required to enter into with community agencies pursuant to the terms of the Local Health System Integration Act (LHSIA). LSAA: Long-Term Care Home Service Accountability Agreement. The LSAA is the service accountability agreement that the LHINs are required to enter into with Long-Term Care Homes pursuant to the terms of the Local Health System Integration Act (LHSIA). HSFR: Health System Funding Reform. HSFR is comprised of Health Based Allocation Methodology (HBAM) Funding and Quality Based Procedures (QBP) Funding. MLAA: Ministry-LHIN Accountability Agreement. The purpose of the accountability agreement is to set out the mutual understandings between the MoHLTC and the LHIN of their respective performance obligations for the stated period. It is an accountability agreement for the purposes of section 18 of the LHSIA. SRI: Self Reporting Initiative. SRI is the self-reporting solution for submission and review of information between Health Service Providers (HSPs) and the Local Health Integration Networks (LHINs) and the Ministry of Health and Long-Term Care (the Ministry). It includes any hardware or software that may be provided to the User for the purpose of using SRI. Eforms Tool: The HSAA Eforms is an Excel model that enables LHINs to populate and create the Accountability Schedules for the HSAA for each of their providers. 3

4 FREQUENTLY ASKED QUESTIONS AND ANSWERS 1. Education & Supporting Documents 1.1 Are there any available resources that can facilitate performance dialogue between hospitals and LHINs? A: The Health Improvement Plan (HIP) Toolkit outlines various concepts and frameworks to assist hospitals with improvement planning, and can provide guidance for performance discussions. Please contact your LHIN for a copy. 2. Planning / Funding Assumptions 2.1 How should planning assumptions be made? A: The expectation is that hospitals will individually and locally determine reasonable planning assumptions for use in the completion of the HAPS and the HSAA Schedules using information currently available ; including assumptions for HBAM and Quality Based Procedures. The LHIN will assess these assumptions for reasonableness. Hospitals are encouraged to engage with their peers in the development of assumptions. In some LHINs, the LHIN and hospitals may collectively agree on a common set of assumptions. 2.2 When will we receive our funding information? A: This has not yet been determined. Hospitals and LHINs should engage in setting planning assumptions necessary to develop and populate the HAPS and Schedules. 2.3 Small hospitals received 1% to base funding last year. Can we plan for the same adjustment next year in the HAPS? A: It is not yet known whether the same adjustment will be made for Hospitals should determine reasonable planning assumptions for use in the completion of the HAPS and the HSAA Schedules using information currently available. 2.4 What level of materiality is expected? Will the materiality also apply to performance factor on the total margin indicator? A: Where the HSFR assumptions used in planning are different than actual funding allocations, and these result in the hospital being unable to deliver on a performance commitment, this will trigger a resubmission/renegotiation of the affected HSAA targets. 4

5 2.5 What is the "Materiality Trigger"? A: Materiality is assessed on performance indicators and volume targets. Where the HSFR assumptions used in planning are different than actual funding allocations, and these result in the hospital being unable to deliver on a performance commitment, this will trigger a resubmission/re-negotiation of the affected HSAA Schedules. The materiality triggers are generally the same for each hospital in that the triggers are from the HSAA performance indicators, which are universal. The actual targets and applicable indicators will vary between hospitals, but the general principle not being able to meet a target due to an incorrect assumption is the same for all hospitals. 2.6 Can contact information of finance staff across hospitals be shared? A: Hospitals and LHINs are encouraged to continue to have regional planning discussions wherever possible. Please contact your local LHIN representative. 2.7 We ve already submitted our HAPS to the LHIN. Will we need to refresh our HAPS when the new HSAA is finalized? A: No, the intent is that the HAPS submission will apply to the new HSAA template agreement. 2.8 When will the new funding formula results be available? A: There are two stages to this process. The first stage is the release of the actual and expected weighted cases and the second stage is the HBAM shares construct. There are currently ongoing discussions between the MoHLTC and related Advisory Committees and Work Groups to finalize this process. Two webcasts through the OHA have been scheduled to address funding. Details regarding registration will be forthcoming. 3. Service Accountability Agreements (SAAs) 3.1 How long is the HSAA agreement meant for? A: The intention is that the HSAA agreement will be a multi-year agreement established through consultations between the LHINs, hospitals, the OHA and MoHLTC. HSAA Schedules will be negotiated annually. 5

6 3.2 Will the existing HSAA agreement be extended? A: Yes. The LHIN Boards have agreed to extend the current HSAA Agreement for at least 3 months until June 30, When will the new consolidated agreement be available? A: The HSAA Steering Committee is continuing to pursue focused discussions with the goal of jointly developing a new three year HSAA template agreement to take effect July 1, Will the new HSAA template agreement allow for community programs to carry forward surpluses into the following year? A: No, at this time community surpluses cannot be carried forward. Any un-used funds will be recovered by the Ministry of Finance on an annual basis. 3.5 Will the new HSAA template agreement allow for streamlining the MSAA and/or LSAA into the HSAA for those hospitals that currently have both, therefore eliminating the need for a separate MSAA and/or LSAA? A: The intent is to work towards a Multi-purpose HSAA (MHSAA) template, to reflect not only hospital services, but also either community or long term care services or both. Sector-specific terms and conditions would likely reside in separate Schedules. 3.6 The wording used in the current HSAA is far less restrictive that the wording used in the current MSAA and LSAA. Can we expect the proposed new consolidated agreement to be more reflective of the current HSAA or the current MSAA or LSAA? A: The HSAA Steering Committee is still in the process of developing the MHSAA template. It is expected that in areas where there is duplication between the current HSAA and MSAA or LSAA, the language in the current HSAA would prevail. However, this has not been finalized. It is also expected that the template will include some provisions specific to the current MSAA and LSAA. 3.7 Can the Steering Committee issue a draft version of the MHSAA template so that the field can begin to prepare? A: The Steering Committee is working diligently to finalize the MHSAA template. However, they are currently still in the negotiations stage of this process so it is not possible to share a draft at this time. A draft will be shared as early as possible. 3.8 Some HSPs have SAAs with more than one LHIN. Will the MHSAA template consolidate multi- LHIN SAAs into one agreement? A: No, similar to the Multi-home LSAA, the MHSAA will be LHIN-specific. 6

7 3.9 Will the MSAA be extended to June 2016 as well? A: No, the current MSAA is valid until March 31, The MSAA process is currently separate from the HSAA process. Once the MHSAA template is finalized, a process to move hospitals from their current MSAA and/or LSAA to the new template will be considered. 4. Indicators 4.1 What is the difference between performance indicators and explanatory indicators? A: Performance indicators are included in Service Accountability Agreements (SAAs) and may trigger consequences under the agreement. They are associated with a target and corridor, or at minimum, have a benchmark. Explanatory indicators are complementary to the performance indicators and support planning, negotiation or problem solving at the provincial or LHIN levels. As these indicators have data that may be provided through existing reporting systems, health service providers will not be required to report on them through SAA reporting requirements. 4.2 For the readmission indicator, are we measuring readmissions for the same diagnosis to our own facility or for any diagnosis to our own facility? A: The readmission indicator measures readmission for any diagnosis to your facility. 4.3 The HQO technical specifications for readmission still look at all readmissions to any facility. How do you propose we consider this discrepancy in QIP target setting? A: While QIPs and SAAs are both important to the health system, they are distinct mechanisms with different purposes. Please note that in the HSAA Target Setting Guidelines, which will be made available shortly, it is recommended that hospitals work locally with their LHINs to review historical performance and any other local, relevant factors prior to setting targets. 4.4 Are there any concerns that the CIHI Discharge Abstract Database (DAD) no longer requires readmission to own facility as a mandatory field to capture? A: No concerns regarding this have been raised through the Indicator Work Group (IWG). 7

8 4.5 Are hospitals expected to calculate the risk adjusted readmission rates? If so, will technical specs be provided to assist with this calculation? A: The Ministry will be calculating the risk-adjusted rate for Readmissions to own Facility within 30 Days for Selected HBAM Inpatient Grouper (HIG) Conditions. Technical specifications will be provided as well. 4.6 Are the readmission performance indicators risk adjusted? A: Yes, the performance indicator Readmissions to own Facility within 30 Days for Selected HBAM Inpatient Grouper (HIG) Conditions will be calculated with a risk adjustment. 4.7 How will hospital targets be set? A: Hospitals and LHINs are encouraged to set targets through discussions about local, relevant factors, as well as through review of historical performance. A Target Setting Guideline, which is updated and distributed to the hospitals every year, can also be reviewed for guidance prior to and during these local discussions. 4.8 Why have we excluded the 90th percentile ED LOS for Admitted Patients as a performance indicator? A: This indicator has not been excluded; rather it has been rolled up into the new ED LOS performance indicators, which looks at complex and minor/uncomplicated patients. 4.9 It is difficult for hospitals to reach some of the ED targets (e.g. ED LOS targets for complex patients). Is anything being done to address this? A: Rather than making adjustments to the specific targets, the MoHLTC and LHINs are putting effort into investigating what resources are needed in order to enable hospitals to meet these targets. 8