Hospital Accountability Planning Submission 2014-2015

Education Session

January 14, 2014

Agenda

1. Context

2. Alignment

3. HSAA Organization

4. Structure

5. Guiding Principles

6. HSAA Schedules Naming Convention

7. Summary of Changes to Guidelines, Forms and draft Schedules for

2014/2015

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Agenda (cont’d)

8. Approach to Setting Planning Targets for 2014/15

9. Guidance for Report Submissions Process

10. HSAA Indicators

11. Timelines

12. Questions

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Context Planning for 2014/2015

• The HSAA Template Agreement will 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 H- SAA Schedules. Both the HAPS forms and the guidelines have been refreshed.

• The HAPS and related draft Schedules will cover one fiscal year (FY 2014/15).

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Context Planning for 2014/2015 (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 health system funding reform (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 Funding (QBP) and so “across the board” planning targets are no longer relevant or possible.

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Context Planning for 2014/2015 (cont’d)

• Hospitals are currently engaged in developing budgets to guide operations for fiscal 2014/15 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.

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Alignment with Health System Priorities Achieving the greatest efficiency

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MOHLTC: Minister’s Action Plan

Keeping Ontario Healthy Faster Access to Stronger Family Health Care Right Care, Right Time, Right Place

LHINs: Pan-LHIN Health System Imperatives

Leading with Quality and Safety Strengthening and Enhancing Access to Primary Care Enhancing Coordination and Transitions of Care for Targeted Populations Holding the Gains

HSAA

Advancement of/alignment with the Minister’s Action Plan Advancement of pan-LHIN health system imperatives

Advancement of /alignment with the LHIN’s IHSP

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2013

HSAA Organizational Structure Creating an ownership framework

Hospitals

(OHA)

HSAA Steering Committee

Co-Chairs:

Paul Huras, CEO SE LHIN

Bill MacLeod, CEO MH LHIN

Marian Walsh, CEO Bridgepoint

HSAA Planning & Schedules

Work Group

Co-Lead: Sherry Kennedy, SE LHIN

Co-Lead: May Chang, MSH

HSAA Communications Group

Elizabeth Carlton, Melissa Prokopy, OHA

Louise Biggar and Tracy Lobo, LHINC

HSAA Indicators Work Group

Mark Brintnell, SW LHIN

LHINs

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HSAA Organizational Structure Creating an ownership framework (cont’d)

• As in previous years, the HSAA Steering Committee was established to provide oversight and guidance to the current year’s consultation process.

• The HSAA Planning & Schedules Work Group was co-led by Sherry Kennedy, Chief Operating Officer of the South East LHIN, and May Chang, Executive Vice President, Finance and Operations, 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.

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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.

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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.

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HAPS Guidelines Main differences between 2013/14 and 2014/15

• Reorganized/reordered some content to improve flow.

• Streamlined content to remove duplication and commentary that was no longer necessary due to the maturation of the HAPS process over the years.

• Updated the language to reflect HSFR, to reference more recent key documents, and added some minor clarification to wording to reflect feedback from the field and improve understanding.

• Incorporated the new approach to setting planning targets.

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Draft HSAA Schedules: Schedule A - Funding Allocation Main differences between 2013/14 and 2014/15

• Updated to reflect HSFR and nomenclature and some revenue categories reorganized.

• Moved the funding summary to the top of the Schedule (includes the summary information from the detailed sections that follow it on the page).

• Added new Quality Based Procedures for 2014/2015.

• Summarized other funding not provided through the LHINs at the bottom of this Schedule.

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Draft HSAA Schedules: Schedule B – Reporting

Requirements Main differences between 2013/14 and 2014/15

• Updated reporting dates for the new term.

• Separated MIS Trial Balance and the SRI/Supplemental Reporting on the form as the dates are different.

• Extended the year-end reporting date to June 30th to allow for completion of the annual audit.

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Draft HSAA Schedules: Schedule C1 -

Performance Indicators Main differences between 2013/14 and 2014/15

• Updated nomenclature to reflect changes in LHIN indicator terminology (i.e. from ‘accountability’ indicators to ‘performance’ indicators).

• Aligned indicators with the Ministry LHIN Performance agreement (MLPA).

• Removed indicators that could be monitored outside of the H-SAA.

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Draft HSAA Schedules: Schedule C2 - Service

Volumes Main differences between 2013/14 and 2014/15

• Updated terminology and reordered some line items.

• Noted definitions/inclusions/exclusions within the Technical Specifications document.

• Added new Quality Based Procedure volumes for 2014/15 (see Appendix 4).

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Draft HSAA Schedules: Schedule C3 - LHIN

Local indicators Main differences between 2013/14 and 2014/15

• Reformatted the template to be consistent with other Schedules.

• Content remains to be negotiated locally.

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Draft HSAA Schedules: Schedule C4 - PCOP Main differences between 2013/14 and 2014/15

• Removed Schedule.

• Post construction operating plan funding and related performance requirements will be communicated through funding letter and become an addendum to the HSAA.

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Draft HSAA Schedules: Schedule D -

Declaration of Compliance Main differences between 2013/14 and 2014/15

• Removed reference to specific section (s. 10.3) of the HSAA.

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Draft HSAA Schedules: Schedule E – Project

Funding Agreement Template Main differences between 2013/14 and 2014/15

• Updated to reflect HSP “services” rather than “deliverables”.

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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

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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 2014/15 using their current knowledge.

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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.

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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 H-SAA 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.

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HAPS Report Submissions: Process Guidance

for LHINs and Hospitals

1. LHINs will review HAPS reference materials (HAPS Guidelines and User Guide) and post them to their websites

2. HAPS templates have been loaded onto SRI for hospitals to access 3. 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 review process

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HAPS Report Submissions (cont’d)

4. Hospitals will upload completed forms (final version only) to SRI. 5. LHINs begin HAPS review and negotiation process

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HSAA IWG Structure Creating an ownership framework

• The H-SAA Indicators Work Group (IWG) involved hospital and LHIN leaders with backgrounds in program delivery, performance improvement, finance, and decision support.

• Based on the HSAA Steering Committee’s direction, the core deliverables of the HSAA Indicators Work Group were to:

• Review current indicators and develop recommendations to ensure alignment with pan-LHIN system imperatives and ensure a manageable number of indicators

• Revise the HSAA Indicator Schedule to reflect changes in LHIN indicator terminology (e.g. from ‘accountability’ indicators to ‘performance’ indicators)

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HSAA IWG Structure (cont’d) Creating an ownership framework

• Update technical specifications and target setting guidelines based on the endorsed indicators

• Develop FAQs and other communication and education materials as needed

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Indicator Selection Approach & Guiding

Principles

• The following tools were developed to help guide the indicator selection process:

• SAA Indicator Toolkit (containing a Provincial Strategic Framework, Provincial Logic Model and IWG Templates)

• Indicator Validation Tool

• The following process was used by the HSAA IWG to arrive at the final list of indicators for 2014/15:

1. Review Pan-LHIN/ HSII Logic Model

2. Review existing HSAA indicators and any others proposed by the IWG for consideration

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Indicator Selection Approach & Guiding

Principles (cont’d)

3. Evaluate each indicator against the validation criteria outlined in the Indicator Validation Tool: alignment with system outcome objectives, validity, timeliness of data, reliability, feasibility, understandable, actionability, comparability, and trending

4. Review results and arrive at consensus on final list of indicators for recommendation to HSAA Steering Committee

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HSAA Indicators Update for 2014/15 Changes and Process – Performance Indicators

• All ‘90th Percentile Wait Times’ indicators have been replaced with ‘Percent of Priority 4 Cases Completed’: This change will be made to align with the Ministry-LHIN Performance Agreement.

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HSAA Indicators Update for 2014/15 Changes and Process – Explanatory Indicators

• ALC rate indicator added to prepare for provincial shift from % to rate

• Percentage of Full-Time Nurses’ Indicator has been removed: While nursing levels remain important, it is felt that this indicator can be monitored without it being required in the HSAA.

• Percentage of Paid Sick Time (Full-Time) removed: This information can be monitored as part of regular monitoring cycle

• Percentage of Paid Overtime removed: This information can be monitored as part of regular monitoring cycle

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H-SAA Indicators Moving Forward • The H-SAA IWG will continue to meet and work on the following

deliverables:

• Assess the current indicators listing to ensure ideal alignment of hospital performance and accountabilities to system outcomes (using the Logic Model)

• Consider current new developmental indicators taking into consideration alignment to other key work streams like HSFR Quality Based Procedures and Quality Improvement Plans (using the Indicator Validation Tool)

• Review and assess performance results for existing indicators to inform decisions on future indicators based on performance needs

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Timelines Completing the 2014/15 HAPS

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Projected Timelines

December 11 2014/15 HAPS available on SRI

January 14 2014/15 HAPS materials education session

February 14 Hospitals submit completed HAPS reflecting initial hospital/LHIN discussions

March 26 LHIN analysis, final negotiations of indicator targets and population of schedules

March 28

Final HSAA template and schedules sent to hospitals for Board approval

April 30 HSAAs signed. All Board-approved HSAAs are due to the LHINs by April 30, 2014

*Note: Education on the H-SAA Schedules and final template agreement will be forthcoming

Questions?

Please contact your local Hospital representative

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APPENDIX 1: HSAA Planning & Schedules

Work Group Membership

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Sector Organization Individual, Title

LHIN SE LHIN Sherry Kennedy, COO (Co-Chair)

Hospital Markham Stouffville Hospital May Chang, Executive VP, Finance and Operations (Co-Chair)

Hospital Sunnybrook Hospital David Couch, Director

Hospital Red Lake Margaret Cochenour Memorial Hospital

Paul Chatelain, President and CEO

Hospital St Michael’s Hospital Tomi Nieminen, Director

OHA Ontario Hospital Association Imtiaz Daniel, Senior Consultant

LHIN SW LHIN Scott Chambers, Team Lead

LHIN TC LHIN Chris Sulway, Senior Consultant

LHIN SE LHIN Mike McClelland, Senior Financial Analyst

APPENDIX 1: HSAA Planning & Schedules

Work Group Membership (cont’d)

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Sector Organization Individual, Title

LHIN NE LHIN Marc Demers, Controller / Corporate Services Manager

LHIN NW LHIN Kevin Holder, Senior Consultant

LHIN CH LHIN Elizabeth Woodbury, Senior Accountability Specialist

LHIN TC LHIN Raza Khaki, Consultant

APPENDIX 2: HSAA Indicators Work Group

Membership

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Sector Organization Individual, Title

Hospital Markham Stouffville Hospital May Chang, Executive VP, Finance and Operations

Hospital Grey Bruce Health Services Martin Mazza, CFO

Hospital Mt. Sinai Hospital Joan Sproul , Sr VP, Finance

Hospital Ontario Shores John Chen, VP Finance and Support Services

Hospital MHA Nancy Maltby, COO

Hospital SJHC Hamilton Jane Loncke, Director

OHA Ontario Hospital Association Imtiaz Daniel, Senior Consultant

LHIN SW LHIN Mark Brintnell, SD (Chair)

LHIN NE LHIN Marc Demers, Controller / Corporate Services Manager

LHIN TC LHIN Chris Sulway, Senior Consultant

APPENDIX 2: HSAA Indicators Work Group

Membership (cont’d)

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Sector Organization Individual, Title

LHIN CE LHIN Marilee Suter, Senior Consultant

LHIN Central LHIN Jennifer Chiarcossi, Sr. Business Analyst

MOHLTC MOHLTC Sarah Costa, Senior Policy Consultant

MOHLTC MOHLTC Soma Mondal, Manager

MOHLTC MOHLTC Naomi Kasman, Senior Health Analyst

MOHLTC MOHLTC Thomas Custers, Manager

APPENDIX 3: HSAA Content – Schedules

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Schedule Title Description

A Funding Allocation

Reflects the hospital’s best assumptions with respect to planning targets for each relevant category of revenue

B Reporting Requirements Lists various reporting obligations and relevant timelines

C1 TOTAL ENTITY Performance Indicators

Reflects recommendations of the Provincial Performance Indicator Committee, approved by the HSAA Steering Committee

C2 Service Volumes Similar to prior years. Language updated

C3 Local Indicators and Obligations

Standard template for locally negotiated indicators and obligations

D Declaration of Compliance Template used for funding special projects

E Project Funding Agreement Template

Form to be completed by the HSP’s Board of Directors to declare that the HSP has complied with the terms of the Agreement

APPENDIX 4: 2014/15 QBPs

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2014/15 Quality Based Procedures (QBPs)

Paediatric • Tonsillectomy

• Neonatal Jaundice (Hyperbilirubinemia)

Respiratory • Pneumonia

Orthopaedics

• Knee Arthroscopy

• Hip Fracture

Vision Care • Retinal Disease

Cancer • Colposcopy

• Cancer Surgery

Cardiac • Coronary Artery Disease

• Aortic Valve Replacement