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

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

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

QBP Implementation Team Meeting Room

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

R I C H A R D J E W I T 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