TOWARDS AN ABF PRICING
FRAMEWORK AND A
NATIONAL EFFICIENT PRICE
PROFESSOR RIC MARSHALL, CONSULTANT ON ABF SYSTEMS
INDEPENDENT HOSPITAL PRICING AUTHORITY – 21MAR12
AUSTRALIAN HEALTH REFORM
AGREEMENTS
• Transparency and responsibility for results
• Independent Hospital Pricing Authority
• National Funding Body
• National Performance Authority
• National uniform measures
• Comprehensive coverage of all hospital services
• Local Hospital networks – as points of
responsibility for results (outcomes)
• States as Hospital system managers
• Australian Commission for Safety and Quality in
Health
ROLE OF THE IHPA
• In 2010-11, the Australian Government committed $91.8 million over four
years to establish an Independent Hospital Pricing Authority to:
•
manage the development of national activity based funding
arrangements
•
advise on cross border and cost shifting between jurisdictions
•
set the efficient price for public hospital services
• The National Health Reform Agreement (NHRA) agreed by COAG in
August 2011 details these arrangements
• National Health Reform Amendment (Independent Hospital Pricing
Authority) Bill 2011, currently before the Parliament provides the statutory
basis for IHPA
3
STRUCTURE OF THE IHPA
• The IHPA Board has a Chair appointed by the Commonwealth, a
Deputy Chair appointed by the States and a member appointed
by each jurisdiction
• Chair – Shane Solomon
• Deputy Chair – Jim Birch
• A CEO is responsible for day-to-day administration
• Acting CEO – Dr Tony Sherbon
• The IHPA has around 40 employees (including the CEO)
• The IHPA will be supported by jurisdictional, clinical and technical
committees and will draw on external expert advice
4
JURISDICTIONAL ADVISORY COMMITTEE
(JAC)
• A Jurisdictional Advisory Committee (JAC) has been included
in the legislation
• The JAC will provide high level advice on the implementation
of strategic pricing framework
• The Committee will consist of 9 members:
• a Chair appointed by the IHPA
• one representative from the Commonwealth
• one representative from each state and territory
5
ABF TECHNICAL COMMITTEE
• Chaired by the Acting IHPA CEO, the ABF Technical
Committee will:
• advise the IHPA and the JAC on clinical costing,
clinical classification, data processing and modelling
that underpins Activity Based funding;
• provide a mechanism for the states, territories and the
Commonwealth to participate in the development of
ABF;
• provide a forum for the negotiation of the technical
structures of the activity based funding system
6
ABF WORKING GROUPS
• The TAC is supported by working groups for:
• Hospital Costing (National Hospital Cost Data
Collection)
• Emergency Care
• Non Admitted Care
• Sub-acute Care
• Mental Health
• The working groups include Commonwealth and
state and territory members
ABF DEVELOPMENTAL ELEMENTS
ABF Elements
Product ID &
Classification
Counting
Costing
Data
Management,
Analysis &
Reporting
Funding
Governance &
Management
Admitted
Acute
Emergenc
y Care
Subacute
Care
Mental
Health
Outpatien
t Care
Hospital
auspiced
CHS
Communi
ty service
obligation
s
Teaching
Training &
Research
CLINICAL ADVISORY COMMITTEE
(CAC)
• A Clinical Advisory Committee (CAC) has been included
in the legislation
• The CAC will provide expert clinical advice to the IHPA
• Members clinicians appointed by the Commonwealth
minister for health, in consultation with other health
ministers and the IHPA
• The CAC consists of a chair and at least 8 other members
• The CAC can establish sub-committees as required
9
FUNCTIONS OF THE IHPA
• To deliver ABF, the IHPA will determine :
• the scope of health services
• national classifications, data collection and coding standards
• the national efficient price for in-scope health services,
including adjustments to account for variances in service
delivery
• provide annual national efficient price projections for a 4 year
period
• resolve cost-shifting and cross-border disputes as required
10
TIMETABLE FOR IMPLEMENTATION OF
ABF
• Introduction of national activity based funding (ABF)
•
1 July 2012 - ABF for acute admitted, emergency and non-admitted services starts
•
1 July 2013 - ABF for sub acute and mental health services starts
• The key short term tasks for the IHPA are:
11
•
March 2012 - supply national efficient price for 2012-13 (using 2009-10 data) to states
•
1 July 2012 - finalise rolling 3 year data plan
•
November 2012 - supply national efficient price for 2013-14 (based on 2010-11 data)
•
November 2013 - supply national efficient price for 2014-15 (based on 2011-12 data)
IMPROVING TRANSPARENCY
• ABF will improve transparency in hospital funding and use evidence
to inform hospital pricing. The IHPA will determine the data it requires.
• In relation to hospital services to patients, the IHPA may require:
• information identifying the patient to whom the services were
provided;
• the public or private status of the patient;
• the nature of the service; and
• the facility providing the service;
• The IHPA will draw on hospital activity and costing data from the
States data, and may require additional data from Commonwealth,
including AIHW, ABS and DOHA
12
IMPROVING TRANSPARENCY: PUBLIC
REPORTING
• The IHPA will improve transparency by publicly reporting on:
• the national efficient price
• ABF, including release of nationally consistent classifications,
costing methods and data and efficient prices
• its advice in respect of block funding and the basis of that advice
• its findings and supporting analysis on cost-shifting and cross
border issues raised by parties to the agreement
• The IHPA will also :
• report to Commonwealth and State/Territory Ministers, as required
• publish an annual report.
13
DATA AND INFORMATION
REQUIREMENTS
• To deliver its functions the IHPA will require the states
and the Commonwealth to provide (as necessary):
•
•
•
•
•
•
hospital activity data
hospital costing data
Medicare and pharmaceutical benefits data
advice on block funding criteria
advice on the scope of services
advice and data on cost shifting and cross border
arrangements
• The IHPA will also seek public submissions on an
annual basis to inform its work
Data Flow for funding models
Hospital Information Systems
Hospital Financial Data
Minimum Basic Data SetDRG Data Entry Tool
- Clinical Data, DRG
- Resource Consumption Data
Cost data
- GL mappings
-Allocation Statistics
(analysis tool)
(prepare costsheet)
(volumefile)
Diagnosis and
Procedures
Analysis Reports
Coding Analysis Reports
(costfile)
(separations tbl)
PICQ Software
Data Analysis Reports
Combo Software
Cost Reports
DATA PRINCIPLES AND PRIVACY
• The National Health Reform Agreement includes
principles to underpin data collection to:
• ensure patient privacy
• minimise administrative burden
• improve the evidence base of hospital funding
• The Commonwealth and the States will enter into a
National Health Information Agreement by that
reflects the objectives of the National Health
Reform Agreement
TOWARDS A NATIONAL PRICING
MODEL FOR HOSPITALS
• What is a hospital?
• Normative pricing
>>> best practice
pricing
• Indexation rules
• Private patients
• http://www.ihpa.gov.au/internet/ihpa/p
ublishing.nsf/Content/EB8EFD07DF85BC7
0CA25798300033BE1/$File/IHPA%20Draft
%20Pricing%20Framework_long%20versio
n.pdf
Health Policy Solutions (in association with Casemix Consulting and Aspex
Consulting) Page 58
WHERE DOES QUALITY COME IN?
•
•
•
•
•
•
•
•
•
NHPA
ACSQH
Sentinel events loops
Clinical pathways
Complaints
Pricing signals
Epidemiology
Clinical trials
R&D new technology marketing
Health Policy Solutions (in association with Casemix Consulting and Aspex
Consulting) Page 59
HOW TO MEASURE QUALITY
• Process indicators
• Protocol compliance
• Outcome indicators
• Effort
• Inputs
• Failures and risks
• Value for money
THE IDEA OF EFFICIENT COST
• Quicker and sicker?
• Is it possible for something to be efficient
without quality?
• Efficiency ?and? Effectiveness
• Unnecessary healthcare – can that be
efficient?
• Allocative efficiency – allocative quality
• Prevention and early intervention
• Demand – how much is enough