Hospital Accountability Planning
Submission 2015-2016
Education Session
November 14, 2014
Agenda
1.
Context
2.
HSAA Organizational Structure
3.
Guiding Principles
4.
HAPS Submission Timelines
5.
Summary of Changes to Guidelines and Draft Schedules for 2015/16
6.
Approach to Setting Planning Targets
2
Agenda (cont’d)
7. HAPS Report Submissions: Process Guidance for LHINs and Hospitals
8. HSAA Indicators
9. Overall Timelines
10. Questions
3
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).
4
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.
5
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.
6
HSAA Organizational Structure
Creating an ownership framework
Hospitals
(OHA)
LHINs
HSAA Steering Committee
Co-Chairs:
Paul Huras, CEO SE LHIN
Bill MacLeod, CEO MH LHIN
Marian Walsh, CEO Bridgepoint
HSAA Planning & Schedules
Work Group
HSAA Indicators Work Group
Co-Chair: Sherry Kennedy, SE LHIN
Co-Chair: May Chang, MSH
Co-Chair: Mark Brintnell, SW LHIN
Co-Chair: Imtiaz Daniel, OHA
7
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.
8
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:
1. Practicality - Develop products that reflect our current reality
and are easy to use/understand.
2. Emphasis on local within the provincial context - For planning
targets, performance indicator targets and other health system
changes.
3. Partnership Approach - Hospitals and LHINs should talk early
and often in order to develop a mutually acceptable HSAA within
the requisite timeline.
9
HSAA P&S WG Guiding Principles
Developing the HAPS materials (cont’d)
4.
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.
10
HAPS Submission Timelines
Main differences between 2014/15 and 2015/16
•
Last year the HAPS document was due in February 2014.
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, 2015. 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.
11
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.
12
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
13
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
14
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
Due Date
Q2 – April 01 to Sep 30, 2015
Q3 – Oct 01 to Dec 31, 2015
Q4 – Jan 01 to Mar 31, 2016
Year End 2015-16
07-November-2015
07-February-2016
30-June-2016
30-June-2016
Audited Financial Statements (Fiscal Year)
Due Date
2015-16
30-Jun-2016
French Language Services Report (Fiscal Year)
Due Date
2015-16
30-Apr-2016
15
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.
16
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:
o
o
o
o
o
o
o
o
o
o
o
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)
17
Draft HSAA Schedules: Schedule C3 - LHIN
Indicators and Volumes
Main differences between 2014/15 and 2015/16
•
Content will be negotiated locally.
18
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.
19
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.
20
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
21
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.
22
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.
23
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.
24
HAPS Report Submissions: Process Guidance
for LHINs and Hospitals
1.
2.
3.
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
25
HAPS Report Submissions (cont’d)
4. Hospitals will upload completed forms (final version only) to SRI.
5. LHINs begin HAPS review and negotiation process.
26
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
27
HSAA Planning & Schedules Work Group
Membership
Sector
LHIN
Organization
Individual, Title
SE LHIN
Sherry Kennedy, COO (Co-Chair)
Hospital
Markham Stouffville Hospital
May Chang, Executive VP, Strategy & Patient
Experience (Co-Chair)
Hospital
London Health Sciences Centre
Deepak Sharma, Director
Hospital
Red Lake Margaret Cochenour Memorial
Hospital
Paul Chatelain, Former President and CEO
Hospital
St Michael’s Hospital
Tomi Nieminen, Director
Hospital
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
LHIN
CH LHIN
Elizabeth Woodbury, Senior Accountability Specialist
LHIN
MH LHIN
Andrew Wahab, Senior Lead of Funding and
Allocation
LHIN
NE LHIN
Marc Demers, Controller / Corporate Services
Manager
28
HSAA Planning & Schedules Work Group
Membership (cont’d)
Sector
Organization
Individual, Title
LHIN
NW LHIN
Kevin Holder, Senior Consultant
LHIN
SE LHIN
Mike McClelland, Senior Financial Analyst
LHIN
SW LHIN
Scott Chambers, Team Lead
LHIN
SW LHIN
Betty Wang, Financial Analyst
LHIN
TC LHIN
Chris Sulway, Senior Consultant
LHIN
MH LHIN
Laura Salisbury, Executive Lead (Observer)
St. Michael’s Hospital
Danielle Jane, Project Manager (Observer)
Hospital
29
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
Hospital
Grey Bruce Health Services
Martin Mazza, CFO
Hospital
Ontario Shores
John Chen, VP Finance and Support Services
Hospital
MHA
Nancy Maltby, COO
Hospital
SJHC Hamilton
Jane Loncke, Director
Hospital
Cambridge Memorial Hospital
Mike Prociw, VP, Finance & Corporate Services, CFO
& CIO
MOHLTC
Ministry of Health and Long-Term Care
Jillian Paul, Manager
MOHLTC
Ministry of Health and Long-Term Care
Naomi Kasman, Senior Health Analyst
MOHLTC
Ministry of Health and Long-Term Care
Thomas Custers, Manager
30
HSAA Indicators Work Group
Membership (cont’d)
Sector
Organization
Individual, Title
MOHLTC
Ministry of Health and Long-Term Care
Domenic Della Ventura, Team Lead
MOHLTC
Ministry of Health and Long-Term Care
Nam Bains, Manager
HQO
Health Quality Ontario
Gail Dobell, Director
LHIN
NE LHIN
Marc Demers, Controller / Corporate Services
Manager
LHIN
Central LHIN
Jennifer Chiarcossi, Sr. Business Analyst
LHIN
HNHB LHIN
Ajay Bhardwaj, Advisor
LHIN
CE LHIN
Marilee Suter, Senior Consultant
LHIN
TC LHIN
Chris Sulway, Senior Consultant
LHIN
TC LHIN
Ranjeeta Wadhwani, Analyst
31
Questions?
32
APPENDIX: HSAA Content – Schedules
Schedule
A
B
C1
C2
C3
C4
D
Title
Description
Funding Allocation
Reflects the hospital’s best assumptions with respect to
planning targets for each relevant category of revenue
Reporting Requirements
Lists various reporting obligations and relevant timelines
Performance Indicators
Reflects recommendations of the Provincial Performance
Indicator Committee, approved by the HSAA Steering
Committee
Service Volumes
Similar to prior years. Language updated
LHIN Indicators and Volumes
Standard template for locally negotiated indicators and
obligations
PCOP
Clarifies that PCOP funding is subject to the terms and
conditions of the overall HSAA
Compliance Declaration
Ongoing dialogue about whether this will be included
*Appendix regarding Conflict of Interest Policy is also expected to be included.
33