Long-Term Clinical Service Plan Impacts for 2016/17 October 2015 1 - - PowerPoint PPT Presentation

Long-Term Clinical Service Plan Impacts for 2016/17

October 2015

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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

Purpose

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HSFR – Future & Current State

Global 100%

4?‐year transition Global 30% (56%) Quality Based Procedures (QBPs) 30% (15%) Health Based Allocation Methodology (HBAM) 40% (29%)

Past Future (Current) State Patient Focused Funding

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Quality Based Procedure Funding

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HBAM Funding

Hospitals lose funding if: Hospitals gain funding if:

Actual costs are higher than expected costs Actual costs are lower than expected costs

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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

• ther hospitals in this LHIN

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• 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

Process to Find Opportunities for 2016/17

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QHC Long-Term Clinical Service Planning

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• 1. Family care providers who:

 Provide system navigation and equitable access to services  Help keep people healthy through health promotion and maintenance

• 2. Local access to:

 24 hour emergency services  Inpatient beds  Basic diagnostic services  Home and community care services A sustainable, local system of care that can create healthy communities and is: Patient‐centered High quality Timely

• 3. Efficient access to

specialist services

• With adequate

transportation options

• 4. Effective coordination of

services and communication between providers

Overall Summary of Feedback

My local health care system should provide:

QHC Hospital System – Distribution of Services

Primary Care Hospitals Regional Secondary 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 Core Primary Care Services:

• Emergency Room (24 hour)
• Acute Inpatient beds
• Appropriate basic diagnostics and clinics

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

QHC Belleville General Hospital QHC Prince Edward County Memorial Hospital QHC North Hastings Hospital QHC Trenton Memorial Hospital

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

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QHC Prince Edward County Memorial Hospital: Near Future

• 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 Low risk regional endoscopy services

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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

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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) Efficient access to BGH specialist services Some Regional Services:

• Complex Continuing Care
• Cataracts, cystoscopy
• Minor surgery
• Ambulatory clinics (e.g.,

breast assessment)

• CT Scan

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Evolving to a Future Vision of Integration and Co-Location with Enhanced Primary Care Services

Support Services

CCAC Hospice Mental Health Private Physio, X-Ray, Lab Procedures/Clinics Etc.

Primary Care Services FHT CHC Hospital Services

ER Inpatient Beds Diagnostics Ambulatory and surgical services Physician offices Health assessments Health promotion Chronic disease management (e.g., medication management, foot care, mental health, pain clinic, etc.) As Proposed by the Brighton/Quinte West Health System Advisory Committee

Trenton Health Centre

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QHC Belleville General Hospital

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

Primary Care Hospital

• Emergency room

(24 hour)

• Primary care beds
• Basic diagnostics

(x-ray, ultrasound)

• Clinics

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2016/17 Operating Plan Implications

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Process to Find Financial Savings

Ensure all areas are meeting provincial benchmarks Staff number and skills mix Alignment of inpatient beds Utilization of tests, drugs and supplies Optimizing service hours Ambulatory care services not related to hospital core services

• 1. Admin/Support

Areas

• 2. Program

Efficiencies

• 3. Service

Consolidation

• 4. Service

Reduction

Consolidation/ movement of services across sites to ensure efficient delivery

• f high quality

care

• 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

Impact in 2016/17 ‐ Proposed

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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

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• 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 – Administrative areas

Non‐Clinical/Back‐Office Changes

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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

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Questions & Answers

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