1. Hospital Accountability Planning Submission 2015-2016 Education Session
November 14, 2014

2. Agenda Context HSAA Organizational Structure Guiding Principles
HAPS Submission Timelines
Summary of Changes to Guidelines and Draft Schedules for 2015/16
Approach to Setting Planning Targets

3. Agenda (cont’d)
7. HAPS Report Submissions: Process Guidance for LHINs and Hospitals 8. HSAA Indicators 9. Overall Timelines 10. Questions

4. Context Planning for 2015/2016
The 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).

5. Context 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.

6. Context 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.

7. HSAA Organizational Structure Creating an ownership framework
Hospitals
(OHA)
HSAA Steering Committee
Co-Chairs:
Paul Huras, CEO SE LHIN
Bill MacLeod, CEO MH LHIN
Marian Walsh, CEO Bridgepoint
HSAA Planning & Schedules
Work Group
Co-Chair: Sherry Kennedy, SE LHIN
Co-Chair: May Chang, MSH
HSAA Indicators Work Group
Co-Chair: Mark Brintnell, SW LHIN
Co-Chair: Imtiaz Daniel, OHA
LHINs

8. HSAA 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.

9. HSAA 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.

10. HSAA 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.

11. HAPS 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.

12. HAPS 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.

13. Draft 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 Revenues
Amortization of Grants/Donations Equipment
OHIP Revenue and Patient Revenue from Other Payors
Differential and Copayment Revenue

14. Draft 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 disease
Aortic valve replacement
Cancer surgery
Colposcopy
Knee arthroscopy
Retinal disease
Short stay post-hospital discharge homecare: Medical discharge

15. Draft HSAA Schedules: Schedule B – Reporting Requirements Main differences between 2014/15 and 2015/16
Updated reporting dates for the new term.
MIS Trial Balance
Due Date
Q2 – April 01 to Sep 30, 2015
Q3 – Oct 01 to Dec 31, 2015
Q4 – Jan 01 to Mar 31, 2016
31-October-2015
31-January-2016
31-May-2016
Quarterly SRI and Supplemental Reporting
Year End
07-November-2015
07-February-2016
30-June-2016
Audited Financial Statements (Fiscal Year)
30-Jun-2016
French Language Services Report (Fiscal Year)
30-Apr-2016

16. Draft HSAA Schedules: Schedule C1 - Performance Indicators Main differences between 2014/15 and 2015/16
Information on 2015/16 indicators will be communicated in the time ahead.

17. Draft 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)

18. Draft HSAA Schedules: Schedule C3 - LHIN Indicators and Volumes Main differences between 2014/15 and 2015/16
Content will be negotiated locally.

19. Draft 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.

20. Draft HSAA Schedules: Schedule D – Compliance Declaration Main differences between 2014/15 and 2015/16
There is ongoing dialogue about the inclusion of this Schedule.

21. Approach 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 partnership
Reflect local reality within the provincial context
Build on existing/current hospital budget efforts
Manage mutual risk
Leverage continuous quality improvement processes

22. Approach 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.

23. Approach 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.

24. Approach 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.

25. HAPS 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 same
Communicate 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

26. HAPS Report Submissions (cont’d)
Hospitals will upload completed forms (final version only) to SRI.
5. LHINs begin HAPS review and negotiation process.

27. Overall Timelines Completing the 2015/16 HAPS
Projected Timelines
October 6
2015/16 HAPS available on SRI
November 14
2015/16 HAPS materials education session
December 19 – January 16
Hospitals submit completed HAPS reflecting initial hospital/LHIN discussions
February 13
LHIN analysis completed, final negotiations of indicator targets and population of schedules completed, final HSAA template and schedules sent to hospitals for board approval
March 31
HSAAs signed. All Board-approved HSAAs are due to the LHINs
*Note: Education on the final template agreement, including finalized schedules, will be forthcoming

28. HSAA Planning & Schedules Work Group Membership
Sector
Organization
Individual, Title
LHIN
SE LHIN
Sherry Kennedy, COO (Co-Chair)
Hospital
Markham Stouffville Hospital
May Chang, Executive VP, Strategy & Patient Experience (Co-Chair)
London Health Sciences Centre
Deepak Sharma, Director
Red Lake Margaret Cochenour Memorial Hospital
Paul Chatelain, Former President and CEO
St Michael’s Hospital
Tomi Nieminen, Director
Sunnybrook Hospital
David Couch, Director
MOHLTC
Ministry of Health and Long-Term Care
Maria van Dyk, Team Lead
OHA
Ontario Hospital Association
Imtiaz Daniel, Senior Consultant
CH LHIN
Elizabeth Woodbury, Senior Accountability Specialist
MH LHIN
Andrew Wahab, Senior Lead of Funding and Allocation
NE LHIN
Marc Demers, Controller / Corporate Services Manager

29. HSAA Planning & Schedules Work Group Membership (cont’d)
Sector
Organization
Individual, Title
LHIN
NW LHIN
Kevin Holder, Senior Consultant
SE LHIN
Mike McClelland, Senior Financial Analyst
SW LHIN
Scott Chambers, Team Lead
Betty Wang, Financial Analyst
TC LHIN
Chris Sulway, Senior Consultant
MH LHIN
Laura Salisbury, Executive Lead (Observer)
Hospital
St. Michael’s Hospital
Danielle Jane, Project Manager (Observer)

30. HSAA Indicators Work Group Membership
Sector
Organization
Individual, Title
LHIN
SW LHIN
Mark Brintnell, Senior Director (Co-Chair)
OHA
Ontario Hospital Association
Imtiaz Daniel, Senior Consultant (Co-Chair)
Hospital
Markham Stouffville Hospital
May Chang, Executive VP, Finance and Operations
Grey Bruce Health Services
Martin Mazza, CFO
Ontario Shores
John Chen, VP Finance and Support Services
MHA
Nancy Maltby, COO
SJHC Hamilton
Jane Loncke, Director
Cambridge Memorial Hospital
Mike Prociw, VP, Finance & Corporate Services, CFO & CIO
MOHLTC
Ministry of Health and Long-Term Care
Jillian Paul, Manager
Naomi Kasman, Senior Health Analyst
Thomas Custers, Manager

31. HSAA Indicators Work Group Membership (cont’d)
Sector
Organization
Individual, Title
MOHLTC
Ministry of Health and Long-Term Care
Domenic Della Ventura, Team Lead
Nam Bains, Manager
HQO
Health Quality Ontario
Gail Dobell, Director
LHIN
NE LHIN
Marc Demers, Controller / Corporate Services Manager
Central LHIN
Jennifer Chiarcossi, Sr. Business Analyst
HNHB LHIN
Ajay Bhardwaj, Advisor
CE LHIN
Marilee Suter, Senior Consultant
TC LHIN
Chris Sulway, Senior Consultant
Ranjeeta Wadhwani, Analyst

32. Questions?

33. APPENDIX: HSAA Content – Schedules
Title
Description A
Funding Allocation
Reflects the hospital’s best assumptions with respect to planning targets for each relevant category of revenue B
Reporting Requirements
Lists various reporting obligations and relevant timelines C1
Performance Indicators
Reflects recommendations of the Provincial Performance Indicator Committee, approved by the HSAA Steering Committee C2
Service Volumes
Similar to prior years. Language updated C3
LHIN Indicators and Volumes
Standard template for locally negotiated indicators and obligations C4
PCOP
Clarifies that PCOP funding is subject to the terms and conditions of the overall HSAA D
Compliance Declaration
Ongoing dialogue about whether this will be included
*Appendix regarding Conflict of Interest Policy is also expected to be included.