Long-Term Clinical Service Plan Impacts for 2016/17. October 2015

Transcription

1 Long-Term Clinical Service Plan Impacts for 2016/17 October

2 Purpose 1. Ensure common understanding of what is driving change Health System Funding Reform, QHC cost structure issues 2. Share significant proposed changes Clinical service distribution across QHC hospitals 2016/17 operating plan 3. Answer questions 2

3 HSFR Future & Current State Past Future (Current) State Global 30% (56%) Global 100% 4? year transition Quality Based Procedures (QBPs) 30% (15%) Health Based Allocation Methodology (HBAM) 40% (29%) Patient Focused Funding 3

4 Quality Based Procedure Funding 4

5 HBAM Funding Hospitals lose funding if: Actual costs are higher than expected costs Hospitals gain funding if: Actual costs are lower than expected costs 5

6 Implications for 16/17 All services, direct clinical care, indirect clinical care and administrative areas must perform at least at median cost in comparison to the rest of the province Must remove at least $11.5M in expenses for 2016/17 $7 million in non clinical, $4.5 million in direct care savings In future years, will need to find efficiencies to: Fund inflation Meet changing expected costs Adjust for any further volume decreases Health Care Tomorrow Hospital Services project will be important to finding efficiencies for future years by working more closely with 6 other hospitals in this LHIN

7 Process to Find Opportunities for 2016/17 Director led planning team identified opportunities based on: Community engagement to define top health care priorities Recommendations of the Brighton/Quinte West Health Services Advisory Committee Input from physicians and staff Internal analysis and benchmarking QHC against high performing hospitals External input from the Hay Group 7

8 QHC Long-Term Clinical Service Planning 8

9 Overall Summary of Feedback My local health care system should provide: 1. Family care providers who: Provide system navigation and equitable access to services Help keep people healthy through health promotion and maintenance 3. Efficient access to specialist services With adequate transportation options A sustainable, local system of care that can create healthy communities and is: Patient centered High quality Timely 2. Local access to: 24 hour emergency services Inpatient beds Basic diagnostic services Home and community care services 4. Effective coordination of services and communication between providers

10 QHC Hospital System Distribution of Services Primary Care Hospitals Regional Secondary Hospital QHC Prince Edward County Memorial Hospital QHC North Hastings Hospital QHC Belleville General Hospital Core Primary Care Services: Emergency Room (24 hour) Acute Inpatient beds Appropriate basic diagnostics and clinics QHC Trenton Memorial Hospital Each with Protected Core Services: Emergency Room (24 hour) Acute Inpatient beds Supported by: Appropriate basic diagnostics for ER and inpatients Ambulatory clinics appropriate for hospital-based delivery and based on local need Regional Services: Obstetrics/Pediatrics ICU Surgery Internal Medicine Oncology Clinic Mental Health inpatient/outpatient Inpatient Rehab and Rehab Day Children s Treatment Centre Supported by advanced diagnostics: -MRI -CT - Cardiopulmonary - Bone mineral density - Nuclear medicine - Lab - Interventional radiology

11 QHC North Hastings Hospital Emergency room (24 hour) Acute inpatient beds Basic diagnostics: - X-ray, ultrasound - Cardiopulmonary, ECG, holter - Point-of-care lab Ambulatory clinics (e.g., mental health services) Efficient access to BGH specialist services 11

12 QHC Prince Edward County Memorial Hospital: Near Future Low risk regional endoscopy services Emergency room (24 hour) Acute inpatient beds - General, acute care for elderly Basic diagnostics: - X-ray, ultrasound - Point-of-care lab Ambulatory clinics (e.g., mental health services) Efficient access to BGH specialist services 12

13 QHC Prince Edward County Memorial Hospital: Evolving to a Integrated Future Vision A range of integrated health care services wrapped around the patient co-located in a new health care campus 13

14 QHC Trenton Memorial Hospital: Near Future Emergency room (24 hour) Acute inpatient beds Basic diagnostics: - X-ray, ultrasound - Cardiopulmonary, holter, ECG, pulmonary function testing - Point-of-care lab Ambulatory clinics (e.g., mental health services) Some Regional Services: Complex Continuing Care Cataracts, cystoscopy Minor surgery Ambulatory clinics (e.g., breast assessment) CT Scan Efficient access to BGH specialist services 14

15 Evolving to a Future Vision of Integration and Co-Location with Enhanced Primary Care Services Trenton Health Centre Hospital Services ER Inpatient Beds Diagnostics Ambulatory and surgical services Primary Care Services FHT CHC Physician offices Health assessments Health promotion Chronic disease management (e.g., medication management, foot care, mental health, pain clinic, etc.) Support Services CCAC Hospice Mental Health Private Physio, X-Ray, Lab Procedures/Clinics Etc. As Proposed by the Brighton/Quinte West Health 15 System Advisory Committee

16 QHC Belleville General Hospital Primary Care Hospital Emergency room (24 hour) Primary care beds Basic diagnostics (x-ray, ultrasound) Clinics Regional Specialist Services Obstetrics/Pediatrics ICU Surgery Internal Medicine Advanced Diagnostics - MRI, CT - Cardiopulmonary - Nuclear medicine - Bone mineral density - Mammography - Interventional radiology - Lab Oncology Clinic Mental Health inpatient and outpatient Inpatient Rehab and Rehab Day Children s Treatment Centre 16

17 2016/17 Operating Plan Implications 17

18 Process to Find Financial Savings 1. Admin/Support Areas Ensure all areas are meeting provincial benchmarks 2. Program Efficiencies Staff number and skills mix Alignment of inpatient beds Utilization of tests, drugs and supplies 3. Service Consolidation Consolidation/ movement of services across sites to ensure efficient delivery of high quality care 4. Service Reduction Ambulatory care services not related to hospital core services Optimizing service hours

19 Impact in 2016/17 Proposed Continued implementation of the Interprofessional Patient Care Teams Realignment of inpatient beds to maximize quality and efficiency, maintaining the overall number Move 2400 day surgery cases to BGH operating rooms Cataracts, cystoscopy and surgical clinics would remain at TMH Consolidation of surgery reduces overhead costs associated with MDRD, equipment, supply chain, environmental service, imaging and laboratory 19

20 Impact for 2016/17 Proposed Work with Hotel Dieu Hospital to provide the Pain Clinic services HDH offers evidence based multidisciplinary program Recently received funding to expand this program More focussed services for Rehab Day Hospital Stroke, neurology, pulmonary Ensure appropriate utilization of tests and supplies Optimizing hours, booking and wait times in diagnostic areas 20

21 Non Clinical/Back Office Changes Changes in almost every department to ensure we are at least meeting median benchmark performance compared to other hospitals Examples: Information Systems Materials management Hospitality, portering, Resource Centre Plant maintenance Security Patient registration Health records 21 Administrative areas

22 Next Steps Education/Gather Input Oct. 6 30: Community/staff/physician education on long term vision and opportunity to provide input on proposed changes (to inform implementation planning) Approval and Implementation Mid Nov: Board review, QHC staff planning begins April 2016 Implementation 22

23 Questions & Answers 23