Service Accountability Agreements
Transcript of Service Accountability Agreements
The Proposed 2013-2016 L-SAA Developing the new L-SAA
• The L-SAA is the service accountability agreement between a long-term care
home licensee and the LHIN that is required by the Local Health System
Integration Act, 2006 (LHSIA).
• A service accountability agreement is a tool. It assists the LHIN with:
i. Fulfilling the LHIN’s obligations to MOHLTC, the province and the
taxpayer in respect of funding (i.e. risk management): and
ii. Fulfilling a LHIN’s obligations under LHSIA to plan, fund and integrate its
local health system (i.e. system management).
• It is generally entered into in respect of a single LTCH.
• The 2013-2016 L-SAA is the second L-SAA that the LHINs will enter into with
LTCH licensees and will replace the current 2010-2013 L-SAA. The new
L-SAA will cover the 3-year term between April 1, 2013 to March 31, 2016.
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The Proposed 2013-2016 L-SAA
• A copy of the draft 2013-16 L-SAA Agreement and the indicators was
presented at the November 28th Board meeting, where the following
motion was passed:
˗ Be it resolved that the Central East LHIN Board approve the
Central East Local Health Integration Network’s use of the draft
template Long-Term Care Service Accountability Agreement for
2013-2016, as presented to this Board.
˗ And further be it resolved that the Central East LHIN Board
authorize the Board Chair and LHIN CEO to execute the Long-
Term Care Service Accountability Agreements on behalf of the
Central East LHIN provided that the executed version of the
Long-Term Care Service Accountability Agreement is
substantially similar to the draft template attached to the minutes
of this meeting.
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Summary of Changes Main differences between the current and proposed
2013-2016 L-SAA
The final version of the 2013-16 is not materially different from that presented to
the Board of Directors in November. The current L-SAA was updated to:
• Align the L-SAA with current SAA standards: correct minor errors in
references, use of defined terms, conformance and formatting;
• Bring the SAA up to date: changes have been made to align with current law,
policy and LHIN obligations under the MLPA;
• Update schedules: All the schedules have been updated;
• Align LTC sector performance indicators to achieve provincial
priorities: new performance indicators have been introduced into the 2013-16 L-SAA;
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Quick Overview – L-SAA Performance
Indicators
Provincial Indicator Indicator Classification
Percent Occupancy/ Long –Stay Utilization Performance
Median Wait Time To Placement In LTC Home Explanatory
Compliance Status Performance
Debt Service Coverage Ratio Explanatory
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Provincial Indicator Indicator Classification
Percent Occupancy/ Long –Stay Utilization Performance
Median Wait Time To Placement In LTC Home Explanatory
Compliance Status Performance
Debt Service Coverage Ratio Explanatory
LHIN-Specific Indicator
Accreditation; (Must pursue and/or obtain accreditation within life of
agreement)
BSO Indicators: (Compliance with BSO reporting requirements)
Response Time to Application: (Respond to application by CCAC within
legislated timeframe)
Resident Transfers to Emergency Department and Hospital Inpatient
Admissions: (Report monthly to the LHIN)
Central East LHIN Process & Timelines
Timeline Activity
January 23 L-SAA webinar, release of L-SAA forms, schedules
January/February Target-setting and review of LAPS submissions
Mid-February Populated SAAs sent to providers
February/March Final negotiations/low occupancy discussions with
targeted organizations
February/March Boards/Corporations to approve L-SAA agreements
March 22-31 Central East LHIN CEO and Chair sign agreements
March 31 All LHIN- and HSP-approved agreements executed
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2013-14 Process
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A Hospital Service Accountability Agreement (H-SAA)
is required under the LHSIA and the Ministry-LHIN
Performance Agreement (MLPA). It is a legal vehicle
that delineates accountabilities and performance
expectations, and allows the LHINs to flow funding to
hospitals.
The 2012-13 H-SAA Extension Agreement expires
March 31, 2013.
2013/14 HAPS Process
• The government is implementing an evidence-based funding model through its
Health System Funding Reform (HSFR) and LHINs and the hospitals recognize
that HSFR will impact the H-SAA process.
• Hospital funding has become unique to each individual hospital with the roll out
of the Health-Based Allocation Model (HBAM) and Quality-Based Procedures
(QBPs) and so, “across the board” planning targets are no longer relevant or
possible.
• The 2013-14 HAPS process has:
• Streamlined content to remove duplication and unnecessary commentary.
• Updated the language to reflect HSFR, to reference more recent key
documents, and added clarification to wording to reflect feedback and
improve understanding.
• Incorporated the new approach to setting planning targets.
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Recommended Provincial Approach to Setting
Planning Targets
• Leveraging and aligning with internal hospital budget processes:
Hospitals will locally determine their best estimates for planning
assumptions for global, HBAM, QBPs, etc. (including an assumption for
mitigation where applicable) for use in completing the HAPS and
related schedules for 2013/14 using their current knowledge.
• Materiality assessed on performance indicators and volume
targets: In the event that actual funding allocations are different than
the planning targets AND this difference directly results in a hospital
being unable to deliver on an H-SAA performance indicator or volume
target, then this will trigger a renegotiation/resubmission of the affected
component of an H-SAA Schedule.
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2013/14 H-SAA – Central East LHIN
Common Assumptions
˗ All hospitals must balance.
˗ Current ratio trend must be increasing.
˗ Hospital inflationary increase for all hospitals = 0%.
˗ QBP and HBAM impacts are unique for each hospital:
· Cataract funding finalized
· All other QBPs in flux
· HBAM will likely stay more or less the same as 2012/13
˗ Global funding reduces from 54% to 45% in year 2.
˗ forecast, which identified cumulative pressures at a high
level.
˗ 2013/14 numbers form the basis of the H-SAA discussions.
˗ Local Partnership has embarked upon next stages of the
process to prioritize and begin strategizing on year 2 and 3
QBPs.
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Hospital Indicators and Volume Metrics
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Global Volumes - Accountability Wait Time Volumes – Accountability
Emergency Department (Weighted Cases) Cardiac Surgery -CABG
Complex Continuing Care (Weighted Patient Days) Cardiac Surgery -Other Open Heart
Day Surgery (Weighted Visits) Cardiac Surgery -Valve
Total Inpatient Acute (Weighted Cases) Cardiac Surgery -Valve/CABG
Inpatient Mental Health Paediatric Surgery
Inpatient Rehabilitation General Surgery
Elderly Capital Assistance Program (ELDCAP) Hip Replacement - Revisions
Ambulatory care Knee Replacement - Revisions
Magnetic Resonance Imaging (MRI)
Computed Tomography (CT)
Services and Strategies (cases) – Tracking Quality Based Procedures - Volumes
Catheterization Primary hip
Angioplasty Primary knee
Other Cardiac Cataract
Organ Transplantation Inpatient rehab for primary hip
Neurosurgery Inpatient rehab for primary knee
Bariatric Surgery
Cochlear Implants – New!!
Sexual Assault Clinic – New!!
Cleft Palate – New!!
HIV Outpatient Clinics – New!!
Hospital Indicators and Volume Metrics
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Patient Experience – Accountability Indicators 90th Percentile ER LOS for Admitted Patients "90th Percentile ER LOS for Non-Admitted Complex (CTAS I-III) Patients" 90th Percentile ER LOS for Non-Admitted Minor Uncomplicated (CTAS IV-V) Patients 90th Percentile Wait Times for Cancer Surgery 90th Percentile Wait Times for Cardiac Bypass Surgery 90th Percentile Wait Times for Cataract Surgery 90th Percentile Wait Times for Joint Replacement (Hip) 90th Percentile Wait Times for Joint Replacement (Knee) 90th Percentile Wait Times for Diagnostic MRI Scan 90th Percentile Wait Times for Diagnostic CT Scan Rate of Ventilator-associated Pneumonia Central Line Infection Rate Rate of Hospital Acquired Cases of Clostridium Difficile Infections Rate of Hospital Acquired Cases of Vancomycin Resistant Enterococcus Bacterium Rate of Hospital Acquired Cases of Methicillin Resistant Staphylococcus Aureus Bacterium
Hospital Indicators and Volume Metrics
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Explanatory Indicators 30-day readmission of patients with stroke or transient ischemic attack
(tia) to acute care for all diagnoses
Percent of stroke patients discharged to inpatient rehabilitation
following an acute stroke hospitalization
Hospital standardized mortality ratio (hsmr)
Total margin (hospital sector only)
Percentage of paid sick time (full-time)
Percentage of full-time nurses.
Percentage of paid overtime
Adjusted working funds New!!
Adjusted working funds / total revenue % New!!
Most 2013-14 Targets have been successfully negotiated with all
Central East LHIN Hospitals
2013-14 Timelines
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February 1 – HAPS
Launched
February 1 – March 1
Negotiations
March 1 HAPs Due
Hospital Boards Review
HAPs
March 31 – Agreements
Executed
Provincial Timelines
Nov. 2012 – Jan. 2013
Hospital Negotiation Meetings
Hospital Boards
Review Plans
February 1 – HAPS
Launched
March 1 HAPs Due
LHIN Board Reviews H-
SAAs
March 27
March 31 – Agreements
Executed
Central East LHIN Timelines
• The LHINs and community-based Health Service Providers (HSPs)
entered into an M-SAA for a three year period effective April 1, 2011 to
March 31, 2014.
• At that time, the year three (2013/14) financial, service activity and
performance indicator schedules were indicated as “to be determined
(TBD)”.
• All sectors—Community Health Centre (CHC), Community Care Access
Centre (CCAC), Community Mental Health and Addiction (CMH&A) and
Community Support Service (CSS) need to complete a refresh of the
2013/14 CAPS for the final year of the 2011-14 M-SAA.
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Context: Why a 2013/14 CAPS and M-SAA Refresh?
Current Core Indicators (All Sectors)
Accountability
• Fund Type 2 balanced budget
• Proportion of budget spent on administration
• Variance forecast to actual expenditures
• Percentage total margin
• Service activity by functional centre
• Variance forecast to actual units of service
• Number of individuals served
Explanatory
• Cost per unit of service by functional centre
• Cost per individual served (by program/service/functional centre)
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New Core Indicator (All Sectors)
Accountability
Percentage of acute ALC days (closed cases)
• Central East LHIN target-setting methodology:
˗ HSP target = LHIN MLPA ALC target of 15.2%.
˗ Target will be applied to organizations involved in
Home First, Hospital to Home, and/or ALSSH.
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Current CCAC-specific Indicators
Accountability
• Wait time from hospital discharge to service initiation (hospital
clients) (90th percentile).
• Wait time for home care services – Application to first service
(community setting) (90th and 50th percentile).
• Clients with MAPLe scores high and very high living in the
community supported by CCAC.
• Clients placed in LTCH with MAPLe scores high and very high as a
proportion of total clients placed.
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Current CCAC-specific Indicators Cont’d Explanatory
• Wait time from hospital discharge to service initiation (short-stay
acute clients, short stay-rehab clients, long-stay complex clients).
• Wait time for home care services – Application to first service
(community setting) (short-stay acute clients, short-stay rehab
clients, long-stay complex clients).
• Average monthly cost per episode (adult short-stay acute clients,
adult long-stay complex clients, end of life clients, end of life clients
in the 3 months immediately preceding death, long-stay medically-
fragile children).
Developmental
• Medication safety for long-stay home care clients.
• Falls for long-stay home care clients.
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New CCAC-specific Indicator
Accountability
Percentage of registrations with Health Care Connect (HCC) which
were referred
• Methodology: CCAC Target = 80% (3 year average = 79.5; 11/12
performance = 75.9%)
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Current CSS-specific Indicators
Explanatory
• Number of persons waiting for service (by functional
centre)
• Repeat unscheduled emergency visits within 30 days for
mental health conditions
• Repeat unscheduled emergency visits within 30 days for
substance abuse conditions
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New CSS-specific Indicator
Accountability
Average number of days waited for first service (by
functional centre)
• The Central East LHIN will be focusing on Adult Day
programs for this indicator; however, the targets will be
“N/A*” until data is available
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Current CHC-specific Indicators
Accountability
• Cervical cancer screening rate (PAP tests);
• Colorectal cancer screening rate;
• Inter-professional diabetes care rate;
• Influenza vaccination rate;
• Breast cancer screening rate;
• Periodic health exam rate;
• Vacancy rate (nurse practitioners and doctors);
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Current CHC-specific Indicators Cont’d
Explanatory
• Repeat unscheduled emergency visits within 30 days for mental
health conditions
• Repeat unscheduled emergency visits within 30 days for substance
abuse conditions
Developmental
• CHC clients hospitalized for ambulatory care sensitive conditions
(ACSC)
• Individuals served by functional centre
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New CHC-specific Indicator
Accountability
Access to primary care
• No data available until Q2 – “TBD” will be used
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Current CMH&A-specific Indicators
Explanatory
• Average number of days waited from referral/application
to initial assessment complete
• Client experience
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New CMH&A-specific Indicators
Accountability
• Repeat unscheduled emergency visits within 30 days for mental
health conditions
• Repeat unscheduled emergency visits within 30 days for
substance abuse conditions
˗ Methodology: Aligned HSPs with hospitals within the
catchment area (creating a composite of H-SAA target and
total ED/SA repeat visits)
Explanatory
• Average number of days waited from Initial Assessment
Complete to Service Initiation
Developmental
• OCAN/GAIN indicator
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Central East LHIN Process
• 3 CAPS review sessions were held with members from both SDI and
SFPM to review submissions for targeted agencies (e.g. identified as
high risk).
• Action Logs and results of actions were recorded for agencies using the
PERFORM database system which keeps track of any issues related to
a given agency over time.
• Additional in-depth review by performance and finance staff with
clarification and resubmission of CAPs as required.
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Summary of Target Negotiation Assumptions
• HSPs must submit a balanced budget based on a 0% base
increase assumptions.
• All agencies are expected to maintain or improve service activity
levels by finding efficiencies.
• Any variance of over 5% requires an explanation and/or
negotiation.
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Timelines and Process
Date Description
Nov 30 Completed CAPS were due to the LHINs by November 30, 2012. The
CAPS will facilitate the development of the 2013/14 M-SAA amending
schedules
Dec – Feb Target Negotiations – LHIN review of the 2013/14 CAPS and HSP
negotiations on the 2013/14 M-SAA indicators
Jan 10 HSP education session was held by the LHIN on the 2013/14 M-SAA
refresh process, indicators and updated timelines
Mar 22 2013/14 M-SAA schedule amendments are due to the LHIN with HSP
governance sign-off by March 22, 2013
Apr 1 Year 3 of the current 2011-14 M-SAA will come into effect on April 1,
2013
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