annannette marley, nsw ministry of health: new south wales state hith services update
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by Annette Marley
Principal Project Officer
System Relationships Branch
NSW Health
13th Annual Hospital in the Home Conference, Novotel on Collins, Melbourne, 23rd May 2013
New South Wales
State HITH Services Update
Summary
• Demand and Capacity
• NSW HITH Program overview
• HITH Guideline
• HITH Revenue opportunities
• HITH Costing
⅓ of Australia's population lives in NSW
Source: Australian Bureau of Statistics, Regional Population Growth, Australia, 2009-10
NSW Health Overview
• NSW Population 7.3M (14% aged 65+)
• 15 Local Health Districts / 3 Specialty Health Networks
• 226 public hospitals / 500 community health centres /
14,000 GP locations
• Annual NSW Health activity (Source: AIHW (2012) Hospital Statistics 2011-12)
• 2.235M ED presentations
• Over 1.6M acute separations
• 21.5M non-admitted occasions of service
• 101,819 acute potentially preventable hospitalisations
Hospital admissions are the highest
volumes ever
Source: AIHW Australian Hospital Statistics 2001/2 - 2011/12
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
2001-2 2002-3 2003-4 2004-5 2005-6 2006-7 2007-8 2008-9 2009-10 2010-11
Australian Public Hospital Separationsby State and Territory
NSW Vic Qld WA SA Tas ACT NT
31% increase in Hospital admissions since 2001/2
The strain on NSW hospitals is
continually increasing
Source: AIHW Australian Hospital Statistics 2001/2 - 2011/12
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
2001-2 2002-3 2003-4 2004-5 2005-6 2006-7 2007-8 2008-9 2009-10 2010-11
NSW Public Hospital Separations2001/2 to 2011/12
NSW Hospital in the Home
• 66 services delivering HITH
care
• Range of service delivery
models
Achievements to date
Increased service numbers
18,000 HITH admissions
52,505 episodes in 2011/12
(33,902 in 07/08)
Reduced ALOS
Key drivers for change
In the current climate of state and national health
reform, NSW is leveraging key strategies to drive
change for HITH
Local Health District Service Agreement measures
NSW 2021 Goal 11 – Keeping people healthy and
out of hospital
National Emergency Access Target (NEAT)
Activity Based Funding (ABF)
Equivalent or better care, at better value
Whole of system approach
Planned Admission
Emergency Modelsand Units
3rd Door Options
InpatientWards
InpatientShort Stay Units
eg. Medical Assessment Units, Urgent
Care Centres
Quick Triage ED Streaming
Hospital Substitution (Hospital in the Home)
Hospital in the Home
· Daily or intermittent
· Home or ambulatory
ComPacks
· Non-clinical services to support early discharge
Community Nursing
Primary & Community Care
Chronic Care
Palliative Care
Aged Health
Out of HospitalCare
General Practice
General Practice
Hospital in the Home Program
Objectives
• NSW HITH services have consistent, measurable
and clearly defined service delivery models
• NSW Local Health Districts and Specialty Health
Networks have a clearly defined strategy to
increase their HITH capacity to meet the needs of
specific target patient groups and their broader
community
Hospital in the Home Program
Strategies
• NSW HITH Guideline
• Revenue opportunities
• HITH Costing study
Program status
Clinician led Working Group commenced June 2011
Work plan for 2012/13 developed
Guideline in draft May 2013
High level implementation plan drafted May 2013
NSW Hospital in the Home Guideline
What we want to achieve
• To provide clear, standardised guidance regarding definitions,
key elements and principles
• Consistency of reporting, defined data measurable data-to
enable coding counting & costing & enable ABF
• Improved HITH service planning
• Local development of service delivery models to meet local
needs
• Reduce variation, to achieve best practice across the state
• Incremental increase in % acute separations admitted to HITH
NSW Hospital in the Home Definition
Hospital in the Home (HITH) services provide acute
and post-acute care to children and adults residing
outside hospital, as a substitution or prevention of
in-hospital care. The place of residence may be
permanent or temporary.
• A person may receive their care at home (including
Residential Aged Care Facilities), in a community setting,
at school or in the workplace.
• HITH care is short-term and preferably interdisciplinary
NSW Hospital in the Home Definition
Daily HITH
• An individual requiring at least daily clinical care and assessment
of their treatment needs - clinically equivalent to an admitted
patient
• Daily HITH substitutes for inpatient care
• Meets the national definition
Intermittent HITH
• An individual with predominantly post-acute care needs who
requires less than daily clinical assessment of their treatment
needs
• Intermittent HITH is clinically equivalent to non-admitted care.
NSW HITH Guideline Implementation
IDHospital In the Home Program :
Phase Two
Aug 2013 Nov 2013Jun 2013 Sep 2013Apr 2013
5/5 15/1230/6 8/1214/4 21/4 1/1215/914/7 29/123/11 22/1225/82/6 10/1128/4 9/6
7
Supporting Communication to LHD’s (letter
to CE’s-ref to ABF, Data mgt, toolkit
?workshop nominees
11
½ day Workshop planning
HITH Self Assessment tool
Present:
A) Guideline
B) Data, Evaluation and Service Agreements
C) Costing / ABF implications
Explore opportunities and barriers in relation
to: Service Delivery Model – key elements +
admission criteria/Target groups
1HITH Program Working Group meetings
2 HITH Program Sponsorship Group meetings
Jan 2014Dec 2013
19/5 4/8 17/1121/7 24/117/716/6 23/612/5
HITH Costing Study -Site nominations8
10
Toolkit development to support LHD’s in
monitoring & Evaluation of HITH
program (disseminated via CEs)
A) Data, evaluation and Service Agreement
measures (suite of measures)
B) Costing / ABF implications
C) Clinical target groups
Finish
31/03/2014
31/03/2014
31/05/2013
13/05/2013
26/06/2013
30/10/2013
Start
12/12/2011
12/12/2011
24/05/2013
06/05/2013
06/05/2013
31/05/2013
3 24/05/201302/04/2013
NSW HITH Guideline Finalization &
Dissemination to LHDs for implementation
phase
May 2013
18/811/8 13/101/9
Jul 2013 Oct 2013
20/1031/3 8/97/4 27/1029/9 6/1028/726/5 22/9
12 28/03/201402/09/2013Monitoring, evaluation and reporting
5 28/06/201324/05/2013NSW HITH Guideline summary page
development, printing and distribution
1
3
4
Feb 2014 Mar 2014
5/1 12/1 19/1 26/1 2/2 9/2 16/2 23/2 2/3 9/3 16/3 23/3
4 17/04/201329/03/2013HITH Revenue survey & evaluation 2
Key Deliverable
Key Deliverable
6 26/07/201314/05/2013Dissemination of NSW HITH Guidelines &
toolkit to LHDs for implementation phase
13 28/02/201403/02/2014Post Implementation survey
14 02/04/201402/04/2014Agency for Clinical Innovation handover
9 27/09/201303/06/2013HITH Costing Study in collaboration
through the ABF Taskforce
We are here
Hospital in the Home Revenue
• In NSW, HITH Financial classes include only
• Medicare
• DVA
• Reciprocal
• Working within Ministry of Health to establish
gazetted rates for HITH in NSW
• Seeking revenue from Private, Motor Accident
Authority, Workcover, overseas patients
Hospital in the Home Costing
• Recommendations from a preliminary study will be
progressed to establish an ABF methodology for
HITH
• The range of HITH models in NSW will be costed
• Daily vs Intermittent
• Home vs Clinic
• GP vs Specialist led
• If approved, data collection to commence in June
2013
Hospital in the Home – Future Directions
• Targeted models of care – Paediatrics / RACF
• GP management – remuneration
• Blended funding models
• Ongoing governance – linking with Agency for
Clinical Innovation
• Expansion of service capacity across the state
NSW HITH Contact details
Rachel Nash
Principal Project Officer
System Relationships & Frameworks Branch
http://www.health.nsw.gov.au/performance/pages/HITH.aspx
rnash@doh.health.nsw.gov.au
(02) 9391 9632
Annette Marley 0477 351 723
amarl@doh.health.nsw.gov.au
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