1Hospital Accountability Planning Submission 2015-2016 Education Session November 14, 2014
2Agenda Context HSAA Organizational Structure Guiding Principles HAPS Submission TimelinesSummary of Changes to Guidelines and Draft Schedules for 2015/16Approach to Setting Planning Targets
3Agenda (cont’d)7. HAPS Report Submissions: Process Guidance for LHINs and Hospitals 8. HSAA Indicators 9. Overall Timelines 10. Questions
4Context Planning for 2015/2016The HSAA Template Agreement is envisioned to be a multi-year agreement established through consultative stakeholder meetings between the LHINs, hospitals, the OHA and MOHLTC. The Schedules content will be negotiated annually.Information collected through the Hospital Accountability Planning Submission (HAPS) and the supplemental report will be used to populate the HSAA Schedules. Both the HAPS forms and the guidelines have been refreshed.The HAPS and related draft Schedules will cover one fiscal year (FY 2015/16).
5Context Planning for 2015/2016 (cont’d) The government continues to implement Health System Funding Reform (HSFR), which supports system capacity planning and quality improvement through directly linking funding to patient outcomes. LHINs and the hospitals recognize that HSFR will impact the HSAA process.Hospital funding has become unique to each individual hospital with the roll out of the Health Based Allocation Model and Quality-Based Procedure Funding (QBP) and so “across the board” planning targets are no longer relevant or possible.
6Context Planning for 2015/2016 (cont’d) Hospitals are currently engaged in developing budgets to guide operations for fiscal 2015/16 as part of their organization’s fiduciary duty and hospital services will continue to be provided to patients according to the hospital’s internal plan and based on the hospital’s best assumptions.There is great benefit for hospitals and LHINs to agree on performance expectations within a set of parameters that begins on day one of the fiscal year. The vehicle for this agreement is the HSAA.
7HSAA Organizational Structure Creating an ownership framework Hospitals(OHA)HSAA Steering CommitteeCo-Chairs:Paul Huras, CEO SE LHINBill MacLeod, CEO MH LHINMarian Walsh, CEO BridgepointHSAA Planning & SchedulesWork GroupCo-Chair: Sherry Kennedy, SE LHINCo-Chair: May Chang, MSHHSAA Indicators Work GroupCo-Chair: Mark Brintnell, SW LHINCo-Chair: Imtiaz Daniel, OHALHINs
8HSAA Organizational Structure Creating an ownership framework (cont’d) The HSAA Planning & Schedules Work Group is co-led by Sherry Kennedy, Chief Operating Officer of the South East LHIN, and May Chang, Executive Vice President, Strategy & Patient Experience, Markham Stouffville Hospital.Based on the HSAA Steering Committee’s planning assumptions, the core deliverables of the HSAA Planning & Schedules Work Group were to prepare draft schedules and planning submission documents and produce related education materials.
9HSAA P&S WG Guiding Principles Developing the HAPS materials The deliverables of the Planning & Schedules Work Group were set with the following guiding principles in mind:Practicality - Develop products that reflect our current reality and are easy to use/understand.Emphasis on local within the provincial context - For planning targets, performance indicator targets and other health system changes.Partnership Approach - Hospitals and LHINs should talk early and often in order to develop a mutually acceptable HSAA within the requisite timeline.
10HSAA P&S WG Guiding Principles Developing the HAPS materials (cont’d) Ensure alignment. All core HAPS/HSAA materials (Guidelines, Forms and Schedules), should align with one another. The Work Group will also strive for enhanced functionality whereby one form/schedule may be pre-populated by another where appropriate.
11HAPS Submission Timelines Main differences between 2014/15 and 2015/16 Last year the HAPS document was due in February Unfortunately, this did not leave enough time for the LHINs to complete their review and turn around the HSAAs for April 1. As a result, the HAPS completion timeline is earlier this year.HAPS submission period will be from December 19, 2014 to January 16, LHINs will be in touch with individual hospitals to confirm each hospital’s specific submission date within that period.Board approval is not required for HAPS submission.LHINs will also provide information to hospitals as to their approach to analysis to ensure necessary information/explanation can be provided by hospitals at submission.
12HAPS Guidelines Main differences between 2014/15 and 2015/16 Incorporated new content regarding Provincial Interest Programs.Provided greater clarity around the objectives of HBAM and QBPs.Added description of new HAPS Narrative template.Updated language regarding HSFR.
13Draft HSAA Schedules: Schedule A - Funding Allocation Main differences between 2014/15 and 2015/16 Updated to include all funding categories (HSFR and Non-HSFR)Additions for non-HSFR funded categories include:Recoveries and Miscellaneous RevenuesAmortization of Grants/Donations EquipmentOHIP Revenue and Patient Revenue from Other PayorsDifferential and Copayment Revenue
14Draft HSAA Schedules: Schedule A - Funding Allocation Main differences between 2014/15 and 2015/16 Quality Based Procedures for 2015/16 have been added and activated within the Schedules:Coronary artery diseaseAortic valve replacementCancer surgeryColposcopyKnee arthroscopyRetinal diseaseShort stay post-hospital discharge homecare: Medical discharge
15Draft HSAA Schedules: Schedule B – Reporting Requirements Main differences between 2014/15 and 2015/16Updated reporting dates for the new term.MIS Trial BalanceDue DateQ2 – April 01 to Sep 30, 2015Q3 – Oct 01 to Dec 31, 2015Q4 – Jan 01 to Mar 31, 201631-October-201531-January-201631-May-2016Quarterly SRI and Supplemental ReportingYear End07-November-201507-February-201630-June-2016Audited Financial Statements (Fiscal Year)30-Jun-2016French Language Services Report (Fiscal Year)30-Apr-2016
16Draft HSAA Schedules: Schedule C1 - Performance Indicators Main differences between 2014/15 and 2015/16Information on 2015/16 indicators will be communicated in the time ahead.
17Draft HSAA Schedules: Schedule C2 - Service Volumes Main differences between 2014/15 and 2015/16 Added new Quality Based Procedure volumes for 2015/16.Updates have been made to the following and will be available within the technical specifications document:AICD (Numbers of New Implants)Bariatric Surgery (Procedures)Cleft Palate (Cases)Cochlear Implants (Cases)General Surgery (Base and Incremental)Hip and Knee Replacement (Cases)MRI (Total Hours)OBSP MRI (Total Hours)Paediatric Surgery (Base and Incremental)Sexual Assault/Domestic Violence Treatment Clinics (Patients)CT (Total Hours)
18Draft HSAA Schedules: Schedule C3 - LHIN Indicators and Volumes Main differences between 2014/15 and 2015/16Content will be negotiated locally.
19Draft HSAA Schedules: Schedule C4 – PCOP Main differences between 2014/15 and 2015/16 The PCOP Schedule is expected to be re-introduced but without the requirement for funding or volume detail. Instead, the Schedule is expected to confirm that PCOP funding and related performance requirements will be communicated in separate funding letters and are subject to the Terms and Conditions applicable to the overall HSAA.
20Draft HSAA Schedules: Schedule D – Compliance Declaration Main differences between 2014/15 and 2015/16There is ongoing dialogue about the inclusion of this Schedule.
21Approach to Setting Planning Targets Premise: There is great benefit for hospitals and LHINs to agree on performance expectations within a set of parameters that begins on day one of the agreement year.Development Principles:Work in partnershipReflect local reality within the provincial contextBuild on existing/current hospital budget effortsManage mutual riskLeverage continuous quality improvement processes
22Approach to Setting Planning Targets (cont’d) Actual funding allocations are not available until well into any fiscal year and so setting planning target assumptions are necessary to develop and populate HAPS and Schedules. The HSAA Steering Committee has confirmed that the following is a practical and reasonable approach to this reality:Leveraging and aligning with internal hospital budget processes: Hospitals will locally determine their best estimates for planning assumptions for global, HBAM, QBP, etc. (including an assumption for mitigation where applicable) for use in completing the HAPS and related schedules for 2015/16 using their current knowledge.
23Approach to Setting Planning Targets (cont’d) Focus on reasonability: LHINs will review and discuss these assumptions with hospitals within their region and assess the proposed planning targets for reasonableness.Mitigating the risk: In order to mitigate the risk to hospitals and LHINs that actual funding will be different than planning targets used to populate the Schedules of an HSAA, a materiality “trigger” will be incorporated in the HSAA template.
24Approach to Setting Planning Targets (cont’d) Materiality assessed on performance indicators and volume targets: Where the HSFR assumptions used in planning are different than actual funding allocations, and these result in the hospital being unable to deliver on a performance commitment, this will trigger a resubmission/renegotiation of the affected HSAA schedules.Detailed language and process guidance to follow: Note that the HSAA Steering Committee has approved this approach and has requested the development of appropriate language for inclusion in the HSAA template as well as process guidance for the field.
25HAPS Report Submissions: Process Guidance for LHINs and Hospitals LHINs will review HAPS reference materials (HAPS Guidelines and User Guide) and post them to their websites.HAPS templates have been loaded onto SRI for hospitals to access. LHINs will organize meetings with their hospitals to:Understand each hospitals’ planning target assumptions and to determine reasonableness of sameCommunicate and discuss LHIN expectations with respect to volume and performance indicator targets (directional and/or specific as appropriate for the local context)Communicate the local LHIN HAPS approach to analysis and review process
26HAPS Report Submissions (cont’d) Hospitals will upload completed forms (final version only) to SRI.5. LHINs begin HAPS review and negotiation process.
27Overall Timelines Completing the 2015/16 HAPS Projected TimelinesOctober 62015/16 HAPS available on SRINovember 142015/16 HAPS materials education sessionDecember 19 – January 16Hospitals submit completed HAPS reflecting initial hospital/LHIN discussionsFebruary 13LHIN analysis completed, final negotiations of indicator targets and population of schedules completed, final HSAA template and schedules sent to hospitals for board approvalMarch 31HSAAs signed. All Board-approved HSAAs are due to the LHINs*Note: Education on the final template agreement, including finalized schedules, will be forthcoming
28HSAA Planning & Schedules Work Group Membership SectorOrganizationIndividual, TitleLHINSE LHINSherry Kennedy, COO (Co-Chair)HospitalMarkham Stouffville HospitalMay Chang, Executive VP, Strategy & Patient Experience (Co-Chair)London Health Sciences CentreDeepak Sharma, DirectorRed Lake Margaret Cochenour Memorial HospitalPaul Chatelain, Former President and CEOSt Michael’s HospitalTomi Nieminen, DirectorSunnybrook HospitalDavid Couch, DirectorMOHLTCMinistry of Health and Long-Term CareMaria van Dyk, Team LeadOHAOntario Hospital AssociationImtiaz Daniel, Senior ConsultantCH LHINElizabeth Woodbury, Senior Accountability SpecialistMH LHINAndrew Wahab, Senior Lead of Funding and AllocationNE LHINMarc Demers, Controller / Corporate Services Manager
33APPENDIX: HSAA Content – Schedules TitleDescriptionAFunding AllocationReflects the hospital’s best assumptions with respect to planning targets for each relevant category of revenueBReporting RequirementsLists various reporting obligations and relevant timelinesC1Performance IndicatorsReflects recommendations of the Provincial Performance Indicator Committee, approved by the HSAA Steering CommitteeC2Service VolumesSimilar to prior years. Language updatedC3LHIN Indicators and VolumesStandard template for locally negotiated indicators and obligationsC4PCOPClarifies that PCOP funding is subject to the terms and conditions of the overall HSAADCompliance DeclarationOngoing dialogue about whether this will be included*Appendix regarding Conflict of Interest Policy is also expected to be included.