Planning Developments in Tasmania

1
Planning Developments in Tasmania
Kevin Ratcliffe Health and Human Services Tasmania
2
National and State ABF Developments

• Significant work around Activity Based Funding
  (ABF), in particular implications of the
  Nationally Efficient Price (NEP) and other
  National Health Reform (NHR) agenda items are the
  current focus of health policy and planning
  work in Tasmania
• National funding input will be approx. 40 of
  activity initially
• Rising to 50 for increases at nationally
  efficient price
• State funding will still be substantial
• State Activity funding model will be required to
  ensure appropriate funding over the regions
• State will still be responsible for demand
  management and service planning
• Funding agreement between state and LHNs will be
  required on ongoing basis for agreed activity
  levels and coordination of state-wide services.
• The ABF will cause shifts between classes of
  cases admitted/ED/IP

3
Broad Timelines of the ABF Agenda

• 3 agreements in 2 years
• NPA what was 1 (December 2008)
• Stage 1 agreed acute inpatient classification
  system (DRGv6) and Casemix costing methodology by
  30 Jun10 (achieved).
• Version 1.0 of the National Costing Standards
  agreed by all Jurisdictions Feb 2010
• Stage 2 common costing approach for Community
  Service Obligations (Not fundable by Casemix) and
  implement funding strategies for TR by 30 Jun
  2011.
• Stage 3 common Casemix classification and
  costing methodology for EDs, subacute, outpatient
  and community by 30 Jun 13.
• Stage 4 complete ABF methodology decision by 30
  Jun 14.

4
Broad Timelines ABF Agenda -2

• NHHN- what was 2 (April 2010)
• Decision to fund on Casemix already made and
  Agreed by COAG
• Payments for acute inpatient services to begin on
  an ABF basis against state-specific prices from 1
  July 2012
• Payments for ED, subacute and outpatients to
  begin to be paid-using nationally consistent
  activity proxies and state-specific processes
  from 1 July 2012, moving over time to payment on
  an ABF basis against state-specific prices and
  then national efficient prices.

5
Heads of AgreementNational Health Reform

• The latest part of the ABF agenda is a COAG heads
  of agreement to be augmented by a final agreement
  by 1 July 2011
• preservation of NHHN except where varied by the
  new agreement
• Signed February 2011
• Substantial number of agreed items including
• Increased Commonwealth Spending 16.4Bn between
  2014-5 and 2019-20
• Funding for efficient Growth from 45 (July 2014)
  to 50 (July 2017).
• Basis of activity - public patients in Public
  Hospitals
• Block grants for services best funded (CSO)
• Public Health programmes
• Payment to States then to LHNs (1 July 2012) at
  the same level SPP based on
• Efficient Price set by IHPA
• Volumes based on service agreements agreed by
  State Govts and LHNs
• Variations in price to LHNs reflect state cost
  factors
• National Funding body for health reform
• Fair and Efficient price for Hospital Services
• Relies on good costing data - NHCDC
• National Performance Authority

6
Tasmanian Developments

• Ongoing implementation of the Tasmanian Health
  Plan (using current Hardes projections and
  population data), in conjunction with National
  Role Delineation and Clinical Services Capability
  constructs to inform Health service planning 
• The particular Tasmanian context of recent
  significantly reduced GST receipts, limited
  population and economic growth, a demographic
  profile that is ageing and (relatively)
  socioeconomically disadvantaged , coupled with
  limited primary care availability,  is driving
  increased health service utilisation and acuity.
• Within this context Tasmanian health service
  planners within DHHS Policy, Information
  Commissioning (PIC) unit are developing service
  agreements for Area Health Services (AHS soon to
  be Local Hospital Networks or LHNs) that
• Detail price, volume and quality. 
• With a  policy intent of sustainability,
• service agreements are emphasising  manageable
  volume and affordable service models.

7
Admitted Activity Projections

• Most recent Projections now 4 years old.
• Policy initiatives have made them redundant
• Elective Surgery programmes causing substantial
  growth in activity and demand
• Impact of ABF will be to shift cases between
  streams
• Cases as Outpatients may become admitted
• ED admitted boundary may change
• This will cause current projections to require
  review
• Price volumes currently made on basis of last 8
  years activity in a simple growth function
• Only projecting 2 years into future for funding
• Elective surgery targets can be set at flat or
  low growth with impact costed.

8
Emergency Department Activity

• Activity projected using Hardes methodology and
  Tasmanian ED classes
• Reliable predictions for RHH and NWRH
• LGH has increased substantially more than
  predicted
• Substantial asymmetry of ED activity across the
  state
• No private sector ED in North of State
• Most growth is in GP type cases at RHH and LGH
• NW is relatively static
• Will be possible to incorporate National Urgency
  related Groups (URGs) into the ED projection
  methodology
• All jurisdictions will be using URGs
• National consistent projections methods should be
  possible

9
Outpatient Care

• Previous attempts were thwarted by
• Lack of sensible classification
• Clinic based classes exist but no classification
  rules
• Very poor data collection 70 complete
• New ABF OPD classes have more structure
• Broad groups
• Procedural, Consultation, Diagnostic,
  Nurse/Allied Heqalth
• Will make predictions more reliable
• Mandatory data collection
• Superior definitions of classes
• OPD will be in scope for future Activity
  projections and planning activities.

10
Current projects

• Tasmania will be going to tender for
  Demand/Activity projection consultancy in very
  near future
• Open tender will be conducted
• All ABF products to be included
• Admitted
• Subacute
• Mental health
• Emergency department
• Ambulatory
• Improved data definitions, boundary definitions
  and superior classification will improve
  reliability of projections and analysis
• Both public and Private sector included in
  activity estimates

11
Thank You

• Kevin Ratcliffe
• kevin.ratcliffe_at_dhhs.tas.gov.au
• 61 3 6233 3306