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LSAA Indicator Schedule Refresh 2015-2016 Education Session December 2014.

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Presentation on theme: "LSAA Indicator Schedule Refresh 2015-2016 Education Session December 2014."— Presentation transcript:

1 LSAA Indicator Schedule Refresh 2015-2016 Education Session December 2014

2 Agenda 1.Context 2.LSAA Organizational Structure 3.Approach to Indicator Validation 4.Changes to Indicators for 2015/16 5.Overall Timelines 6.Questions 2

3 Context  Ontario’s LTCHs provide valuable care to many of the province’s seniors and individuals with complex health needs. The sector has an important role to play in addressing the province’s demographic pressures, fiscal constraints and increasing public expectations related to seniors care. 3  There are 634 LTC homes in Ontario, with approximately 78,000 beds.

4  Ontario’s LTC homes have different governance structures. Some are operated by municipalities, some by hospitals and others by private entities that are either for-profit or not-for-profit.  The various homes are represented by their respective associations:  Ontario Long-Term Care Association (OLTCA)  Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS)  Association of Municipalities of Ontario (AMO)  Ontario Hospital Association (OHA) 4 Context

5  The LSAA is the service accountability agreement between a long-term care home licensee and the LHIN that is required by LHSIA.  The role of the LSAA is to clarify that the LTCH will be responsible for delivering not only performance, but also planning and integration towards the development of a health system.  The current LSAA has been signed for the period April 1, 2013 to March 31, 2016. 5

6 Context  LSAA schedules can be refreshed on an annual basis. For 2015/16, the LSAA Performance Schedule (Schedule D) will be updated to reflect new indicators, targets and standards.  These updates were a result of extensive stakeholder consultation and dialogue at key tables comprised of leadership within the LHINs, numerous sector associations and partners, and MOHLTC. 6

7 LSAA Organizational Structure 7  The LSAA Advisory Committee provides advice to and supports the development of the LSAA template agreement, as well as schedules and tools to ensure alignment with provincial strategic directions and streamline processes.  The Committee is comprised of representation from LTCHs, OANHSS, OLTCA, MOHLTC, OHA, LHINs, and various municipalities (see Appendix A for membership list).

8 LSAA Organizational Structure (cont’d) 8  The LSAA Indicator Work Group has been established to support the LSAA Advisory Committee.  Based on direction from the LHIN CEOs, the Work Group produces documents and recommendations for discussion by the Advisory Committee, including a list of recommended LSAA indicators, technical specifications, target setting guidelines and education materials.  The Work Group is comprised of representation from the LTC sector, including leadership from various homes, OANHSS, OLTCA, MOHLTC, LHINs, HQO and various municipalities (see Appendix B for membership list).

9 Approach to Indicator Validation Indicator Classifications 1) Performance  May trigger consequences under the SAA  Associated with a target and corridor, or at minimum have a benchmark  Are valid, feasible measures of system performance 2) Explanatory  Complementary to performance indicators  Support planning, negotiation or problem-solving at the provincial or LHIN level 3) Developmental  Require further validation to ensure quality criteria (e.g. validity) are met prior to moving the indicators to performance/explanatory status  Not included in the SAAs 9

10 Approach to Indicator Validation  The Indicator Validation Tool lists 10 criteria for an indicator to be validated for inclusion in a SAA: 1. Strategic Alignment  Reflects system perspective and important goals or aspects of the regional health system  Aligns with one or more provincial and/or local system imperative, and health system outcome objective 2. Reliability  Produces consistent results in repeated measurements of the same condition/event  Information is collected in a predictable and consistent manner using reliable methods 10

11 Approach to Indicator Validation 3. Actionable (Attribution)  Within a reasonable ability to influence/control  Relevant stakeholders are able to make change to improve the outcome 4. Directional Trending  Sufficient historical data to support timely target setting and quality improvement 5. Timeliness  Can be reported in time to allow users to take action to improve performance 11

12 Approach to Indicator Validation 6. Feasibility  Data for the indicator is readily available, and can be collected and calculated 7. Clarity/Understandability  Easily understood by stakeholders and the general public 8. Directional Validity  Addresses areas where performance improvement is likely to have significant impact on the outcomes  Clear whether a particular direction (increase or decrease) reflect better performance 12

13 Approach to Indicator Validation 9. Comparability  Can be compared overtime and/or place  Data for all comparators in the same units  Data should be in relative, rather than absolute, terms 10. Applicability to Accountability Agreement  Within the circle of influence of the sector to which the accountability agreement applies 13

14 Approach to Indicator Validation  To validate and review the indicators in depth, 3 sub-groups were formed, with focuses on:  Quality and Resident Safety Indicators  Coordination, Access and Primary Care Indicators  Organizational Health and Financial Indicators  The sub-groups utilized a modified Delphi approach to review the Indicator Validation Tool assessments, and further discuss and evaluate proposed indicators, which helped build consensus  Sub-groups submitted recommendations to the larger Indicator Work Group for discussion 14

15 Changes to Indicators for 2015/16 15 Below is the list of indicators and their classifications: # Indicator Name Status Quality and Resident Safety 1Percent of Residents who had a Fall in the Last 30 DaysExplanatory 2Percent of Residents whose Pressure Ulcer WorsenedExplanatory 3Percent of Residents on Antipsychotics without a Diagnosis of PsychosisExplanatory 4Percent of Residents in Daily Physical RestraintsExplanatory Organizational Health and Financial 5Total MarginPerformance 6Debt Service Coverage Ratio Performance (Note: Currently an explanatory indicator in LSAA) Coordination, Access and Primary Care 7Long-Stay Utilization Explanatory (Note: Percent Resident Days will eventually replace this indicator) 8 Number of Resident Transfers to ER from LTC Homes Resulting in Inpatient Admissions per 1,000 LTC Home Residents* Developmental 9 Wait Time from CCAC Determination of Eligibility to LTCH Response Explanatory 10Wait Time from LTCH Acceptance to Placement*Developmental 11Long-Term Care Home Refusal RateExplanatory *Note: Developmental indicators are not included within SAAs.

16 Notable Changes: Status of 2014/15 Indicators in 2015/16 (1) 16  The 2015/16 status of the 4 indicators in the 2014/15 Performance Schedule are as follows:  Long-Stay Utilization : Technical aspects regarding the calculation of a Percent Resident Days indicator—an improved alternative to Long-Stay Utilization—is currently being reviewed by MOHLTC. Until this is implemented, Long-Stay Utilization will remain an explanatory indicator. However, due to the impending arrival of the Percent Resident Days indicator, it is suggested that the establishment of any local targets for Long-Stay Utilization be delayed.  Median Wait Time to Placement in Long-Term Care Home : Not recommended for inclusion in LSAA.

17 Notable Changes: Status of 2014/15 Indicators in 2015/16 (2) 17  Debt Service Coverage Ratio for Non-Municipal Homes/Organizations : Recommended as performance indicator  Compliance Status : was not included as a performance indicator in the current LSAA, nor is it recommended for inclusion in the 2015/16 LSAA.  As a result of further review, the MOHLTC and LHINs are exploring collaborative and complementary approaches in monitoring operational performance of the Long-Term Care Sector. The objective is to develop stronger synergies between the LSAA and Compliance mechanisms.

18 Notable Changes: Debt Service Coverage Ratio 18  DSCR will be reclassified from an explanatory indicator to a performance indicator in 2015/16  It applicable to all LTC homes with long-term debt that are operated by either a non-profit or for profit entity. It is not applicable to Municipally operated homes, nor homes operated by entities that do not hold long-term debt.  Data source is the OHRS Trial Balance Submission

19 Notable Changes: Debt Service Coverage Ratio 19 Can be calculated at the home level or at the corporate level if appropriate. Should a LTC Home wish to calculate DSCR at the corporate level, the Home must notify the relevant LHIN(s) of their intent. A new approach to performance monitoring: if a home has a DSCR less than 1 for two consecutive reporting periods, this would trigger a performance conversation between the home and the LHIN.

20 Notable Changes: Total Margin 20  Total Margin is classified as a performance indicator in 2015/16.  Amount by which an individual LTC home’s (consolidated) revenues exceed or fall short of that LTC home’s total (consolidated) expense, excluding the impact of facility amortization, in a given year.  Data sources include:  Ontario Healthcare Financial and Statistical database (OHFS)  Income Statement  MIS Supplementary Report

21 Notable Changes: Total Margin (cont’d) 21  Identified and calculated at the LTC home level.  Performance target is equal to or greater than zero. Final performance measurement is taken at Q4 (Fiscal Year End)  Homes that report a Total Margin of less than zero at Q2 may trigger a performance discussion with the LHIN. Homes reporting a Total Margin of less than zero at Fiscal Year End will trigger a performance conversation with the LHIN.  Can indicate that a LTC home has a sound financial position even while individual envelopes (with eligible or ineligible expenses) are imbalanced. However, MOHLTC recently introduced additional flexibility that affected a LTC home’s ability to transfer funds between envelopes, which has helped reduce the aforementioned risk substantially.

22 Overall Timelines 22 DeliverableExpected Timeline  NB: In January 2015, the LSAA Indicator Work Group will begin to focus attention on data capture and reporting processes.

23 Questions? 23

24 24 Sector / Association OrganizationIndividual, Title LHINCE LHINDeborah Hammons, CEO (Chair) LHIN WW LHIN Bruce Lauckner, CEO (Vice-Chair) LHINHNHB LHINDonna Cripps, CEO (Vice-Chair) LHINCE LHINJames Meloche, Senior Director, System Design and Implementation MOHLTC Theresa Nowak, Manager, Financial Policies and Procedures Unit, PICB MOHLTC Jane Sager, Manager, LLB AMO Monika Turner, Director, Policy AMONorthumberland County Elizabeth Savill, CAO OANHSS Jeffrey Graham, Director, Public Policy OANHSSRegional Municipality of Peel Carolyn Clubine, Director, LTC Appendix A: LSAA Advisory Committee Membership

25 25 Sector / Association OrganizationIndividual, Title City of Toronto Reg Paul, GM, LTCH and Services OHA Lou Reidel, Director, Health Finance and Reserch OLTCA Candace Chartier, CEO OLTCAOMNI Health Care Ltd. Patrick McCarthy, President and CEO OLTCAExtendicareChristina McKey VP, Eastern Operations Appendix A: LSAA Advisory Committee Membership (cont’d)

26 26 Sector/ Association OrganizationIndividual and Title LHINCE LHINJames Meloche, Senior Director, System Design and Implementation (Chair) LHINNSM LHINBrian Putman Senior Advisor, Financial Health & Accountability LHINCE LHINEmily Van de Klippe Lead, System Finance and Performance Management LHINNSM LHINNeman Khokhar, Senior Manager, Performance, Financial Health & Accountability LHINMH LHINMichelle Collins Senior Lead, Health Systems Performance Management MOHLTC Theresa Nowak Manager, Financial Policies and Procedures Unit, PICB MOHLTC Domenic Della Ventura Team Lead, Performance and Accountability, LHIN Liaison Branch MOHLTC Feng Ding Data Management Specialist, Health Data Branch MOHLTC Jessie Wong Senior Health Analyst, Health Analytics Branch Appendix B: LSAA Indicators Work Group Membership

27 27 Sector / Association OrganizationIndividual and Title HQO Naushaba Degani Manager, Research Methods HQO Maaike Devries, Senior Methodologist AMORegional Municipality of York Tony Fernandes Manager, Program Support and Analysis, Long-Term Care and Seniors, Paramedic and Seniors Services OANHSS Dan Buchanan Director, Financial Policy OANHSSMarianhill Inc.Linda Tracey, CEO OANHSSCity of TorontoJane Simms Manager, Program & Strategic Support, LTC Homes & Services OANHSSBruyere Continuing Care Amy Porteous VP, Planning and Residential Programs OLTCA David Beirnes Director, Financial Policy & Planning OLTCASpecialty Care, Inc.Daile Moffat Director, Quality & Management Consulting OLTCAOMNI Health Care Ltd. Patrick McCarthy, President and CEO Appendix B: LSAA Indicators Work Group Membership (cont’d)

28 28 Sector / Association OrganizationIndividual and Title MOHLTC Ifeolu Ogunyankinm, Senior Financial Policy Advisor (alternate member) MOHLTC Sven Schoening, Senior Financial Policy Advisor, X-Ray Safety and Long-Term Care Homes Branch (alternate member) MOHLTC Stella Chan, Health Analyst, Health Analytics Branch (observer) Appendix B: LSAA Indicators Work Group Membership (cont’d)

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