L-SAA 2013-2016 Indicators An Overview Ernie Jodoin Advisor, - - PowerPoint PPT Presentation

L-SAA 2013-2016 Indicators

An Overview

Ernie Jodoin Advisor, Quality and Risk Management HNHB LHIN January 10-11, 2013

2013-16 L-SAA Performance Framework

Indicators Reflect Select Pan-LHIN System Imperatives:

• Enhancing Coordination and Transitions of Care
• Maintaining Achievements in Access, Accountability & Safety
• Ensuring Sustainable Organizational Health

Local Indicators Reflect HNHB LHIN System Priorities

• Embedding a Culture of Quality – Improving Patient Experience
• Best Practices…Integrating Service Delivery

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Performance

• Are associated with a target and standard and/or performance

benchmark

• Are valid, feasible measures of system performance

Explanatory

• Are complementary indicators – non performance
• Support planning, negotiation or problem-solving at the provincial or

LHIN level

• Data will be provided through existing reporting systems
• Health service providers will not be required to report on these

through SAA reporting requirements.

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Indicator Classifications

Pan LHIN “Ontario” L-SAA Performance Indicators

Pan LHIN System Imperative / Key Result Area Indicators Indicator Classification Enhancing Coordination and Transitions of Care Percent Occupancy/ Long – Stay Utilization Performance Maintaining Achievements in Access, Accountability & Safety Median Wait Time To Placement In LTCH Explanatory Ensuring Sustainable Organizational Health Compliance Status Performance Debt Service Coverage Ratio Explanatory – Year 1 Performance Year 2,3

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Local HNHB LHIN Performance Indicators

HNHB LHIN Priority Indicators Indicator Classification Embedding a Culture of Quality – Improving Patient Experience Development of a Quality Improvement Plan (QIP) in Partnership with the HNHB LHIN Performance Embedding a Culture of Quality – Improving Patient Experience Training in the Health Care Consent Act Performance

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Status of Other Quality Indicators

• Pressure ulcers, bladder control, falls, …
• These quality indicators will not be part of the 2013-2016

L-SAA Performance Framework.

• Will be maintained as part of provincial quality initiatives

across the sector (e.g., HQO).

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Pan LHIN Indicators - Imperative & Objective

Enhancing Coordination and Transitions of Care

• Objective: To Reduce ALC* Days
• Indicator: Percent Occupancy/Long–Stay Utilization
• Status: Performance Indicator

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Enhancing Coordination and Transitions of Care

Percent Occupancy/Long–Stay Utilization (Performance)

• Higher occupancy rates will help alleviate ALC days in

hospitals for those patients waiting for LTC placement.

• This indicator, in conjunction with compliance monitoring,

would provide an indication of a home's viability.

• Considerations include the homes' legislative

requirement and ability to accept referrals from the CCAC and the requirement to maintain 97% occupancy for full funding.

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Pan LHIN Indicators - Imperative & Objective

Maintaining Achievements in Access, Accountability & Safety

• Objective: To Reduce Avoidable Hospital Admissions and

Length of Stay (LOS)

• Indicator: Median Wait Time To Placement In LTC Home
• Status: Explanatory Indicator

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Maintaining Achievements in Access, Accountability & Safety

Median Wait Time To Placement In LTC Home (Explanatory)

• Indicator Rationale (Reduce Admissions/LOS)
• The Work Group supported this indicator as a system level
• indicator. Would help bring partners together to discuss

improvement efforts

• Additional work is underway to explore wait time indicators

that provide increased focus on Long Term Care home activity

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Ensuring Sustainable Organizational Health

• Indicator: Compliance Status
• Status: Performance Indicator
• Indicator: Debt Service Coverage Ratio
• Status: Explanatory Indicator Year 1, Performance Year

2 & 3

Pan LHIN Indicators - Imperative & Objective

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Ensuring Sustainable Organizational Health

Compliance Status (Performance)

• This indicator has been carried forward from the previous

(2010-13) L-SAA Performance Framework.

• In conjunction with Percent Occupancy/Long–Stay

Utilization, it will provide information regarding the home's

• rganizational health and viability.
• The Compliance Status indicator captures activities in 11

key areas (see applicable “Technical Specifications” for detailed listing).

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Ensuring Sustainable Organizational Health

Debt Service Coverage Ratio (Explanatory Year 1, Performance Year 2 & 3)

• Debt service coverage measures the ability to pay
• bligations related to long-term debt principal payments

and interest expense.

• A positive value greater than 1.0 indicates cash flow

greater than current fixed charge payments.

• A positive value less than 1.0 (or a negative value)

indicates cash flow less than current fixed charge payments.

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Technical Specifications

Percent Occupancy/Long–Stay Utilization

Description: Percentage of Long-stay Long-Term Care home beds occupied by clients (adjusted for Long-Term Care homes where bed openings or closings are occurring) in the LHIN/CCAC area on the month-end report date. Effective July 2010, Long-Stay Utilization excludes interim beds. Calculation: Average number of Long-stay Long-Term Care home beds

• ccupied by clients (adjusted for Long-Term Care homes where bed openings
• r closings are occurring) in the LHIN/CCAC area based on three month-end

data. Data Source: OCCM (Occupancy Monitoring Database) Inclusions/Exclusions: Includes: # of Occupied Long Stay beds i.e. Basic beds, Semi-Private beds, and Private beds; Excludes: Occupied Interim beds (effective July 2010 Interim beds are considered short stay beds).

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Percent Occupancy/Long–Stay Utilization Target: Maintain or improve baseline performance. (Baseline rate equal to the average % occupancy achieved by the LTC Home in the calendar year, 2011.) Performance Corridors: If the Performance Target is less than 97.00% then the Lower Corridor = Performance Target less 2.00% in absolute terms; e.g., a performance target

• f 96.50% would have a lower corridor of 94.50%.

If the Performance Target is between 97.00% and 98.00% then the Lower Corridor is 97.00%. If the Performance Target is greater than 98.00% then the Lower Corridor = Performance Target less 1.0% in absolute terms; e.g., a performance target of 98.70% would have a lower corridor of 97.70%.

Technical Specifications

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Examples: Occupancy Performance Targets

LTCH Average Low High LTCH Below 97%

91.2 89.2 93.2

LTCH Below 97%

96.6 94.6 98.6

LTCH Above 97%

97.2 97.0 99.2

LTCH Above 97%

97.8 97.0 99.8

LTCH Above 97%

98.0 97.0 100.0

LTCH Above 97%

98.5 97.5 99.5

LTCH Above 97%

99.0 98.0 100.0

Median Wait Time To Placement In LTC Home Description: This indicator measures the median time that clients in Ontario are waiting for placement in a Long-Term Care (LTC) Home. Median wait time is the point at which half the patients have been placed, and the other half are still waiting. Calculation: Time to Placement (TTP) is calculated as the time from the earlier of LTC Home Application Date or Consent Date until the date of placement. The median TTP is taken for each group (e.g. geography) for which the measure is reported. Data Source: Client Profile Database (CPRO)

Technical Specifications

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Median Wait Time To Placement In LTC Home Inclusions/Exclusions: Includes: All non-crisis clients (priority category 3A, 3B, 4A, 4B from the CPRO) placed from locations other than LTC Homes; Clients placed from hospitals (e.g. acute, rehabilitation, etc.), supportive housing, retirement homes, private homes and other. Excludes: Clients who transferred from one home to another; Clients whose "Admitted from" and/or "Prior Location Code" is unknown are excluded. Baseline Date: Baseline data will not be available until late December 2012 or early January 2013, due to an unavoidable delay in compiling this data.

Technical Specifications

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Compliance Status Description: The Compliance Indicator status of a long-term care home under the LSAA is defined as either: Substantially compliant in key risk areas, or Chronically non-compliant* in one or more key risk areas.

• Calculation. 1. Identify homes that were issued a non compliance with

Order in a key risk area as a result of an inspection in the last quarter;

• 2. Identify if any of the homes from (1) have also had a prior order issued for

the same Legislation/ Regulation; 3. Any homes that satisfy (2) are given a status of ‘Triggered’. Of the remaining homes, those that have had at least

• ne inspection since July 1, 2010 are recorded as ‘Not Triggered’, while the

rest have the status ‘Not Applicable’ 4. Service Area Office Manager(s) review: a) the list of ‘Triggered’ homes to ensure that the second or successive finding of non-compliance was a result of a failure on the part of the licensee to rectify the first finding and b) The overall accuracy of the information in the list.

Technical Specifications

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Compliance Status Data Source: Facility Monitoring Information System (FMIS), MOHLTC Inclusions/Exclusions: Includes: Non compliance in the following key risk areas: Injury that results in Transfer or Admission to Hospital, Medication Incidents, Missing Residents, Environmental Hazards, Infection Control, Alleged/Actual Abuse/Assault, Pressure Ulcers, Presence

• f Daily Physical Restraints, Weight Loss Management,

Continence Care and Bowel Management, Falls and Behavioural Symptoms Affecting Others

Technical Specifications

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Debt Service Coverage Ratio Description: This indicator is applicable to all LTC homes with long-term debt that are operated by either a non-profit or for profit entity. This indicator is not applicable to municipally-

• perated homes, nor those homes operated by entities that

do not hold long-term debt. This indicator is intended to be calculated at the LTC Home level versus at the corporate

• level. In cases where it is not feasible to calculate this

information at the home level, the LTC Home may negotiate with their LHIN(s) to have this indicator calculated using either an aggregation of multiple LTC Homes or a corporate level.

Technical Specifications

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Debt Service Coverage Ratio Calculation: EBITDA = Earnings (Net Surplus) before Interest, Income Taxes, Depreciation, and Amortization/ (Principle Repayments + Interest) Data Source: All information in the numerator will be provided from the OHRS Trial Balance Submission Data Inclusions/Exclusions: Includes: 1. Earnings = LTC Home surplus (deficit) as reported in all fund type 2 and 7 accounts; 2.Interest = Interest paid during the year by the LTC Home on long-term debt; 3. Taxes = Corporate Income Taxes; Depreciation = Amortization OHRS does not differentiate between depreciation and amortization; Excludes:

• 1. Earnings – excluding amortized revenues,; 2.Interest – Excludes interest

paid on short-term debts, overdraft, service charges etc.; 3.Taxes – Excludes all taxes other than corporate income taxes (i.e. sales tax, HST, Payroll tax, EHT etc.); 4. Depreciation – No exclusions

Technical Specifications

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LHIN-Specific Indicators – (Local Indicators)

• LTCH sector to work with the HNHB LHIN in Year 1 to

develop a framework for a future oriented standardized quality improvement plan (QIP) and related risk management process for quality.

• That each LTCH prepare a Board approved QIP for

submission to the HNHB LHIN on or before April 1, 2014.

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LHIN-Specific Indicators – (Local Indicators)

• By end of year 1, 100% of site-specific Administrators

and Senior Nursing Leadership, including Directors of Care and Associate Directors of Care, across all HNHB Long Term Care homes will participate and satisfactorily complete a standardized HNHB training module on their legal obligations in respect to Health Care Consent and Care Planning.

• All new hires will complete the education workshop within

six months of hire date.

Reporting Mechanisms - Data

• Work is underway to identify permanent, sustainable and

secure future location of a L-SAA Performance Dashboard for these indicators.

• Various options currently being explored
• Web-based, accessible
• Will identify protocols and data quality measures to

ensure compliance and consistent reporting

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Thank You!

For further information, please contact: Ernie Jodoin, Advisor, Quality and Risk Management 905-945-4930 ext. 4237 ernie.jodoin@lhins.on.ca

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Questions? Comments?

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