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Activity Based Funding in Tasmania

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Activity Based Funding in Tasmania Ellen France & Kevin Ratcliffe Business Planning Negotiated process Ownership of targets Accountability structure Hospital ... – PowerPoint PPT presentation

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Title: Activity Based Funding in Tasmania


1
Activity Based Fundingin Tasmania Ellen
France Kevin Ratcliffe
2
New Governance Framework
  • Business Planning
  • Negotiated process
  • Ownership of targets
  • Accountability structure
  • Hospital contracts
  • Common reporting and performance indicators up
    and down the structure
  • Central data repository and easy user access
  • Data warehouse (SQL server)
  • Qlikview front end

3
Objective
  • A shadow activity based budget in use for 2008/9
    that
  • Fairly allocates resource based on the costs of
    efficiently providing the appropriate level of
    service
  • Assists in the implementation of the changes
    required under the Tasmanian Clinical Services
    Plan, and
  • Encourages operational budget management
  • Is manageable within current resource
  • 50 project manager
  • No full time resource

4
Transitional Approach
  • Transitional grant represents the difference
    between the historical and ABF budgets
  • 2-3 years (or more !)
  • Identification of reasons for grant
  • Staged reduction

5
Elements of the model
6
Inpatients - General
  • Activity 2006/7 activity levels
  • In future will be negotiated based on Hardes
    projections and service planning
  • AR-DRG 5.1
  • National Weights and Prices
  • Prices - 2006/7 national public estimated exc
    depreciation
  • Weights - exc ED and critical care
  • Indexed to 2008/9 costs using ABS issued health
    price indices
  • No WIES reduces complexity
  • Long stay outliers
  • 4 ALOS
  • Daily rate, maintenance care
  • Extraordinary cases
  • LOS is over 6 months, or
  • treatment has cost over 250,000

7
Inpatients specific - A06Z
  • A06Z compression problem
  • 5 of national average costs and growing
  • 8,200 episodes, ALOS 30 days
  • Next closest DRG
  • 2.6 vaginal delivery
  • 5 vaginal delivery DRGs 3.9 of costs, 132,000
    episodes
  • Remove 31.4m using the critical care cost
    weights
  • Further breakdown the critical care episodes and
    fund according to
  • LOS (ICU daily rate) and
  • Hours of mechanical ventilation

8
Inpatients specific - Hyperbaric
  • No defined short stay outliers
  • Hyperbaric creates large short stay distortion
  • 1773 same day patients with a DRG ALOS of 2.91
    days
  • 33 Overnight patients
  • ALOS 6 days
  • National ALOS for the DRGs 10 days
  • DRG funding allocates 5.2m
  • Hyperbaric unit costs 1.2m

9
DEM
  • 3 DEMs have different patient demographics GP
    availability
  • GP type - RHH 12, LGH 20 NWRH 35
  • Differing morbidity levels
  • from 70 for GP care to
  • 1,500 for major trauma
  • No ED only admits
  • In line with DoHA and AHCA

10
DEM classifications
  • Triage not based on resource use
  • Insufficient triage classes create compression
  • Triage costs in NHCDC study driven by the service
    weights
  • Blended approach to funding
  • 50 cost based (fixed)
  • 50 activity based
  • 2 payment rates
  • Admitted through ED Adm ED DRG
  • Non admitted NonAdm ED
  • Further research essential
  • Developments in Costing and Classification of
    Emergency Department Activity presentation
    earlier today

11
Outpatient Classifications
  • Classifications
  • NHCDC Tier 1 and Tier 2
  • NPHED (National Public Hospital Establishments
    Database) Classifications AKA 25 clinics
  • NCHDC Tier 1 most substantially costed system
  • At Tier 2 level Tasmanian activity made up to 90
    of some categories and 0.05 of others
  • Tier 1 suffers from compression
  • Managed by blended approach

12
Outpatient Activity
  • Recording processes
  • Up to 50 of reported activity not found in the
    mainstream systems
  • 50 block grants
  • 50 activity based on Tier 1
  • Opportunities to improve recording through new
    PAS
  • More national work required on classification and
    costing

13
NAI - Non-acute inpatients
  • Funding at average daily Tasmanian cost
  • Rehabilitation
  • Palliative Care
  • Geriatric Evaluation and Management
  • Psycho geriatric
  • Organ Donors
  • Maintenance
  • Funded at a daily rate based on a standard model
    of care
  • The same overhead costs as inpatients
  • 40 of the nursing costs of medical ward patients

14
Fixed Funding and other
  • Research
  • Teaching
  • Blood
  • Dialysis at home
  • Boarders
  • Contracted out activity
  • Other Tasmanian specific issues
  • Revenue
  • CW
  • Compensable patients
  • Other budgets
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