Q U A L I T Y B A S E D P R O C E D U R E S O N TA R I O S T R O - PowerPoint PPT Presentation

O N TA R I O S T R O K E N E T W O R K - J A N U A RY 2 0 1 5 Q U A L I T Y B A S E D P R O C E D U R E S

O N TA R I O S T R O K E N E T W O R K - J A N U A RY 2 0 1 5 Q U A L I T Y B A S E D P R O C E D U R E S QBP Implementation Team Meeting Room

R I C H A R D J E W I T T O P E R AT I O N A L D I R E C T O R - M E D I C I N E & M E N TA L H E A LT H K I N G S T O N G E N E R A L H O S P I TA L R E G I O N A L D I R E C T O R - O N TA R I O R E N A L N E T W O R K S O U T H E A S T

Q U E S T I O N S . . ? …with an example… …and maybe some answers..?

Q U E S T I O N O N E … How do you achieve innovation, quality and volume within the QBP framework if the funding lag can be up to 18-months and not guaranteed..?

Q U E S T I O N O N E … A C H I E V I N G T H E ‘ Q ’ • Example:: Napanee to KGH stroke transfer • small community hospital • not QBP funded & no stroke unit • 10 -20 patients per year • large acute centre • QBP funded regional stroke unit • pricing impact $99k per annum net new • [10*CMI(2.0)*Price($4970)] = ~$100k

Q U E S T I O N O N E … A C H I E V I N G T H E ‘ Q ’ • Example :: TIA management • Don’t admit patients but transfer to urgent access clinic • admission avoidance saves time, space and resources. • Its the right thing to do • How to we support the burgeoning outpatient TIA services? • 875 patients cost about $150k per year in nursing time alone

Q U E S T I O N O N E … A C H I E V I N G T H E ‘ Q ’ • Answers? • There’s never a bad time for a good idea..? • NIKE (Just Do It)… or not… • Do the ORN-thing and reconcile in year..and across patient-focused clinical bundles… • Have we got clinical-system coverage by QBPs?

Q U E S T I O N T W O … How do you manage non-elective, small-population variation and heterogeneous presentations?

Q U E S T I O N T W O … D E A L I N G W I T H VA R I AT I O N What’s the difference between 38 & 37?

Q U E S T I O N T W O … D E A L I N G W I T H VA R I AT I O N • Example:: Hemorrhagic stroke • 38 cases yr 1, 37 cases yr 2 • CMI 4.61 yr 1 & CMI 3.56 yr 2 • Cost per Case $5452 • Difference in 1 case = $237,702 • Equivalent of about 2.5 physiotherapists

Q U E S T I O N T W O … D E A L I N G W I T H VA R I AT I O N • Answers? • Wide-variation, Transfer Funds • Risk Mitigation &/or in year reconciliation (like the ORN) • There’s a minimum ‘cost of doing business’ that may need to be underwritten? • Are there some things that shouldn’t be in the QBP?

Q U E S T I O N T H R E E … Cross-organization patient flow where pricing is based, rightly, on the patient journey..?

Q U E S T I O N T H R E E … PAT I E N T F L O W • Example:: Rehab flows • Patients flow from KGH (acute) to PC (free- standing rehab) • 5 & 7 day ELOS • Acute is not Rehab & Rehab is not Acute • There’s good reason for this

Q U E S T I O N T H R E E … PAT I E N T F L O W • Answer? • Acute becomes rehab or Rehab becomes Acute • Regional Program Funding • (…just like the ORN…seriously again with the ORN??) • What happens if they’re not QBP cases, but need rehab - maybe rehab centre shouldn’t take them?? • Reverse [perverse] transfer payments, i.e. you’ll pay for what i don’t want to do • Mechanism needed for cross organizational transfer payments

M Y Q U E S T I O N S … • Have we got clinical-system coverage by QBPs? • Are there some things that shouldn’t be in the QBP? • Do we need a mechanism for cross organizational transfer payments?

C O N C L U S I O N S • Our QBP is good - evidence-base is sound and broadly supported • Care systems are complex and complicated • ‘Complex’ requires sophistication in solutions • ‘Complicated’ requires simplicity in thought

– J O H N N Y A P P L E S E E D