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F4 Patient Focused Funding:  What Have We Achieved and Where Will It Take us - L. Vertesi and D. Pope
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F4 Patient Focused Funding: What Have We Achieved and Where Will It Take us - L. Vertesi and D. Pope






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  • I am going to discuss 5 examples of P4P in VCH as indicated in this slide.
  • The first component of the P for P reflected the term that necessity is the mother of invention. In the mid 2000’s our ERs were chockablock full, growing at 4-8% per year and there were a number of ministry lead conferences on what to do. The ED P4P was first tried out at VCH. We had targets, we estimated what we would make if we could achieve the targets and we started to put the resources in place at $ of our larger hospitals to achieve the goals. As you can see from this slide, payment was given for three categories. Each of our sites worked somewhat differently but all were able to achieve funds which exceeded what it cost to ramp up. The innovations ranged from purchasing more residential beds on the left hand side of the flow diagram to special units adjacent to the ED to facilitate investigations and care. The reward was about $600, 150 and 70 respectively. The saving stayed in the specific units The program was expanded to include other HA in the province
  • This slide shows the data from 2005 to 2010. In the blue are the ED average and actual length of stay times for admitted patients and in the red, the mean and actual data for the number of admits. The average wait in the Ed for admitted patients fell by 30% at the same time that the number of patient continued to keep coming to the Ed increased by 26%.While our hospitals stopped being in the newspaper headlines, all our sister health authorities in the province were continuing to have problems. In fact our success lead to a provincial roll out of the program…. With I must say some variable results which we can go into later.
  • The next example that I am going to discuss, we have termed activity based funding for acute care. Remember that the control funding is a block of funds based upon the larger population served, no relation to number of patients and no relation to acuity or intensity of patients.Also because we needed to make room for these patients from the Ed, we needed to move acute care to outpatient services and also to decrease the length of stay. We used the resource intensity weights as a measure of patient acuity. I know that in many parts of Europe and the Us DRG’s are used for this purpose. There is a relationship to our measures.
  • What we call procedural based care is, in my mind the least innovative of the P4P activities. Essentially, it hives off an amount of $ and identifies a specific number and type of procedures that need to be performed. Often it is focused on elective surgical procedures and often it is associated with an increment in funding.Does it work? Yes, the areas focused upon do deliver. Are there side effects? Yes….areas in the system not identified as priority become unhappy and feel less valued by the system. Where we have found it to be successful is in adding real rigor to the data that we collect……before the scheme, we had wildly inaccurate wait lists…in one surgical area, the waits went from 2 years to less than 2 weeks when the lists were cleaned up.As the next slide shows, this program, throughout the province decreased the wait times for the top 10 surgical procedures. Combined with the information on the RIW based P4P…it lead to another phenomenon: some HA asked us to take on their cases, because we could do the work faster and better than they could and at lesser cost. For example a highly specialized hip and knee program at one of our sites, does most of the uncomplicated replacement surgeries for us and for two other HA.(one of CC’s disruptive innovations)Where , I think procedure based P4P is interesting is where focusing seed $ on a procedure can decreased the costs of that thru efficiencies . MRIs are a good example.
  • Now let’s concentrate on the procedural care component: in this case The top ten categories of Day surgery wait times. As you can see , for each HA, over 7 financial periods, as specific funding was focused on each HA, their wait times for these procedures came down. VCH at the bottom was already at the best when it came to surgery and we dropped even lower.
  • BC performs fewer MRI scans than any other jurisdiction in Canada due to peculiar funding issues. This slide shows the wait time for MRI in red and the MRI tests done in blue. We had two tranches of funding, indicated by the boxes on the top. More funding, more tests decreased wait time….not very surprising. What was interesting however, wasthat by focusing the funds and efforts we were able to increase efficiencies so the cost per test fell from $800 to $250.
  • As we have been trying these various methods to improve patient care through innovative funding, the quality movement has been moving ahead as well and we thought that there should be a connection between quality and innovative funding. Our staff agreed that the one of the most mature of the quality programs was that of the American College of Surgeons. Moreover participation in that program showed significant improvement in one of the hospitals in our province that was having many issues….fortunately not in my HA. These next two slides show the effect, just of joining the NSQIP and the staff PAYING ATTENTION:
  • This slide shows 30 day mortality and at the beginning, this hospital was 70% more likely to have a death than the US average.
  • This is the acronym that we have been using for the community based component of P4P. Home is First is also used by our team. This is the purpose. So far there are 118 in the program and we have redirected them from community care to their homes. I don’t know the RC situation in Sweden, but in Vancouver we have over 80 RC beds /1000 people over the age of 75.Thus freeing up these beds is very important to us.
  • This is the acronym that we have been using for the community based component of P4P. Home is First is also used by our team. This is the purpose. So far there are 118 in the program and we have redirected them from community care to their homes. I don’t know the RC situation in Sweden, but in Vancouver we have over 80 RC beds /1000 people over the age of 75.Thus freeing up these beds is very important to us.
  • This slide shows the results for our Vancouver unit which is a 13% reduction in the use of RC beds with improvement in ALC in our acute units.
  • I would like to point out that in this slide ALC means alternative level of care….i.e. a patient who does not need acute care. Finally, what about P for P in encouraging the continuity of care? I think most folks would agree that at least a major component of what keeps people in hospital too long is where they can go after acute care. Now our colleagues in the US have been grappling with this and of course have set up Skilled Nursing Facilities which are a bridge to going to home or long tern care , where they have a continuity problem or ALC problem, it is seen there and not in acute care as much. Nevertheless we have put proposals to the paying agency to put small amounts towards what some have called Home First programs. Now we have had to commit to carrying on with these programs when the funding ceases. But, assuming that they are successful, why would we not? You see hidden within this is also another PforP project that I haven’t discussed which is paying hospitals on a discounted basis on the RIW of admission. It encourages them to admit complex patients and get them out within a reasonable period of time, and it is more advantageous to the institution to do that than to keep people at the ALC level.
  • Because so many health policy decisions lead to actions that are not performed in a double blind controlled fashion, it is often that we conclude that the effects are just due to the Hawthorne effect. I don’t apologize for that. If we are moving in the direction that we want, then I don’t see the the problem. The key in my mind , is this, if just PAYING ATTENTION will get to the results then don’t spend a lot of money on it. Thank you for your attention.

F4 Patient Focused Funding:  What Have We Achieved and Where Will It Take us - L. Vertesi and D. Pope F4 Patient Focused Funding: What Have We Achieved and Where Will It Take us - L. Vertesi and D. Pope Presentation Transcript

  • Patient Focused Funding in BC A Revolution or Just a System Tweak? Les Vertesi BCPSQ Forum March 9, 2012
  • Why Change at All?• Are you satisfied with the current state of health care in which you work? – Waitlists (20% > a year) – Crowding & Delays in Emergency Departments? – ALC rates near 20% of In-hospital Days – “Quality” is an uphill struggle – And one more small thing … 2
  • Ignore This at Your Peril 3
  • Changing the Game• A Conversation with Government (2006)• If you could fix One Thing in Healthcare …? – Will You Pay for it? – No? Why not?• What if it were fixed and the bill was …. ?• What if you only had to pay if it was fixed? 4
  • A New Game in Town• Governments are less willing to put money in when they don’t think they are getting Quality – Would YOU be willing to keep paying for something you are not getting? – Who is best placed to manage the RISK of success or failure?• Can government be a “purchaser” and let the Health Authorities be (competitive) providers? 5
  • Where to Start?• Fall of 2006: – ED Congestion chosen as Top Priority by Senior Executive of Cabinet – Unwilling to continue putting out money on faith – But Willing to Pay if it was “Solved” • i.e. for Success Only• RESULT: – $16.5M to a P4P formula at 4 Vancouver Hospital Emergency Departments 6
  • EDP4P Basics• All Money earned goes to the Hospital – Believe that best decisions are ones made locally – Sense of “provider ownership” created by control of money – But nobody keeps any money• EDP4P is not an improvement strategy in itself – Money must be invested in improvement (QI) processes – Relatively easy improvements can generate confidence & cash to fund more difficult changes• Hospitals are free to invest as they see fit, but must report how money has been used 7
  • What P4P is NOT• It is NOT a way to make People work Faster – It is a Way of making them Pay Attention and re-think their approach to the Patient Experience• Money is NOT the Incentive – Improvement is the real incentive• If Money is “not a reward”, then why is it tied to Performance? • Because it is a Shared RISK strategy 8
  • Did It Work? Numbers of Pts Meeting Targets All VCH Hospitals 4,400 2,200 4,200 2,000No. of CTAS Pts Meeting Targets No. of Admits Meeting Targets 4,000 1,800 3,800 1,600 3,600 1,400 3,400 # Non-adm CTAS 1-2-3 1,200 3,200 # Admitted 3,000 1,000 First Year of EDP4P 9
  • Did It Really Work? Percentages Meeting Transition Time Targets (All VCH Hospitals)70%65%60%55%50% Pct of CTAS 1-2-345% Pct of Admissions40% First Year of EDP4P 10
  • Later Things Became More Difficult Percentages Meeting Transition Time Targets (All VCH Hospitals) 70% 65% 60% 55% 50% Pct of CTAS 1-2-3 45% Pct of Admissions 40% First 30 Months of EDP4P 11
  • One of the Reasons Why Pct Change in Volumes of Visits & Admissions All VCHA Hospitals 1.20 1.15Pct Change from Base 1.10 1.05 1.00 0.95 % Change in Visit Volume % Change in Admissions 0.90 First 30 Months of EDP4P 12
  • EDP4P Experience at Lion’s Gate Number and Percentage of Admitted Patients Waiting in Emergency Department for < 10 hours (Lion Gate Hospital, April 2007 - March 2010)600 90%550 % of Patients 80%500 # Patients 70%450 60%400 50%350 40%300 30%250 20%200 10%150 0% Fiscal Period BEFORE PFF 13
  • ACCESS to Care at LGH Did Improve • Reduced length of stay (by 20%) • ALC dropped from 11% to 4% • Reduced occupancy levels (to 96%) • Shortened wait times in ED (38% to 65% within target) BUT …• More patients arrived to ED & required admission• More transfers from other hospitals since beds now available• Lower cost ALC days were reduced• Average Cost per patient day increasedThe budget went from breakeven to $4M deficit! The Fixed Budget PUNISHED Quality 14
  • Why?Because Patient Care Costs Money … and Money Comes in Boxes Things Work Best When the Money & the Patients are in the Same Place 15
  • The Message about Quality• For Quality to be Sustainable, Patients & Money have to be Matched• It is Hard to Move Patients, but Easy to Move Money• Activity Based Funding is NOT necessarily a stimulus• It is a way of Making Sure Money can move to Support Care Where it is Most Needed 16
  • So What are We Actually Doing in BC? Patient Focused Funding is an Umbrella Term Pay for Procedural Activity Quality CommunityPerformance Care Based Improvement Initiatives (Bulk Purchasing) Funding Common Theme: Funding Follows Patients not the Facilities 17
  • Supporting a Continuum of Care Home Support decreases need for Residential Care Home/CommunityABF funding eases discharge & lowers ALC population ALC decreaseABF lowers LOS & enables shift to Day Procedures Inpatient Flow ABF supports ED Admit Transfers to Wards ED Admissions Improved Emergency Department Access & Flow ED P4P 18
  • Mythbuster Myth: Activity Based Funding drives increased volume Truth:ABF provides incentive to care for the sickest patients in acute care, and others in same day or community care It is up to US! Slide Courtesy of Duncan Campbell Chief Financial Officer Vancouver Coastal Health Authority 19
  • From Theory to RealityThe Vancouver Coastal Health Experience with Patient Focused Funding 20
  • Vancouver Coastal Health Patient Focused FundingWhat Have We Achieved and Where Will It Take Us Quality Forum Darcia Pope, Executive Director, Transformation March 9, 2012
  • Vancouver Coastal Health Strategic Framework Lens People First Vision We will be leaders in promoting wellness and ensuring care by focusing on quality and innovation. Mission We are committed to supporting healthy lives in healthy communities with our partners through care, education and research. Values Service Integrity Sustainability Drivers Patient/Community Focus Engaged Team Operational Excellence Financial Sustainability Optimize our Promote betterGoals Provide the best workforce and Use our resources efficiently to sustain a viable health for our quality of care. prepare for the health care system. communities. future. Use a Reduce health Enhance Embed LEAN Respond to 1.1 2.1 3.1 4.1 4.4 standardized, ri inequities in the workforce thinking at all provincial patient- Respond to provincial gorous process to populations we utilization and match levels to fulfill centered funding patient-centered accelerate the serve through staffing to clinical objectives and to model. model. funding creation and broad focused volumes and patient deliver quality use of evidenced- improvements in acuity. outcomes. 4.5 Develop service Develop service based protocols in core public health agreements withwith agreements 4.2 Develop andObjectives all clinical areas programs. 3.2 Recruit and funders and service service and programs. retain the best implement best providers. Develop a people by fostering practices in care Build on VCH 1.2 regional 2.2 a culture of management to reduce integration program for Mental excellence, recogniti unnecessary days of 4.6 Develop and Develop and strategies to support Health and on and respect. stay. implement a implement a strategy to implementation of Addiction and strategy to secure secure increased the MoHS directive 4.3 Deliver Cardiac Sciences to Build increased capital capital funding. to deliver integrated administrative and improve quality of 3.3 organizational funding. primary care, home support efficiencies care. capacity by and community care through the shared Continue our strengthening 4.7 Continue our 1.3 Build a regional and community services organization commitment to “Green commitment to leadership and medication mental health management and consolidation. “Green Care”22 Care” alternatives by reconciliation services. competencies. alternatives by and our reducing wastereducing system across the carbon footprint. waste and our carbon continuum. footprint.
  • A Systems View Community Home Care ResidentialHome ED Acute Home • Treat people in the most appropriate care location • Deliver the highest quality of care • Ensure effective use of resources • Emphasize scalability of services 23
  • Examples of Pay for Performance at VCH1. P4P in the Emergency Department2. Activity Based Funding in Acute Care3. Procedural Care4. National Surgical Quality Improvement Program (NSQIP) Implementation5. Community Initiatives 24
  • Treat People Effectively in the ED Community Home Care ResidentialHome ED Acute Home Treat people effectively in the ED (ED P4P) • Improve access to care, including reducing wait times • Improve quality of care • Increase efficiencies • Maintain existing new initiatives and reward further improvement 25
  • VCH - Success with ED P4PThree separate streams of patients with independenttargets to reduce wait times and improve access:1. Admitted Patients (to an inpatient bed within 10 hours)2. Not admitted patients, High Priority (discharged within 4 hours)3. Not admitted patients, Low Priority (discharged within 2 hours) Additional 36,000 patients treated within target wait time in 2010/12 26
  • # ED Admissions 900 700 800 1000 1100 1200 1300 1400 1500 1600 2005-01 2005-02 2005-03 2005-04 2005-05 2005-06 2005-07 2005-08 2005-09 2005-10 2005-11 2005-12 2005-13 2006-01 2006-02 2006-03 2006-04 2006-05 2006-06 2006-07 2006-08 2006-09 2006-10 2006-11 2006-12 2006-13 2007-01 2007-02 2007-03 2007-04 2007-05 2007-06 2007-07 2007-08 2007-09 2007-10 ED Admits Volumes 2007-11 2007-12 2007-13 2008-01 2008-02 2008-03 2008-04 2008-05 2008-06 2008-07 2008-08 2008-09 2008-10 2008-11 2008-12 Fiscal Period 2008-13 2009-01 2009-02 2009-03 2009-04 2009-05 2009-06 2009-07 2009-08 2009-09 2009-10 2009-11 2009-12 (Fiscal Yr 04/05 to 11/12 YTD) 2009-13 2010-01 2010-02 Admit EDLOS (avg hrs) 2010-03 2010-04 2010-05 2010-06 VGH ED Admits Volumes vs Admit EDLOS 2010-07 2010-08 2010-09 2010-10 2010-11 2010-12 2010-13 2011-01 2011-02 2011-03 2011-04 2011-05 2011-06 2011-07 2011-08 2011-09 2011-10 2011-11 2011-12 2011-13 2012-01 2012-02 2012-03In P5 admitted 1480 patients with an average EDLOS of 9.2 hours. 2012-04 2012-05 ED Admits Volumes vs Admit EDLOS 7.0 6.0 8.0 9.0 10.0 12.0 15.0 18.0 11.0 13.0 14.0 16.0 17.0 19.0 20.0 27 Avg EDLOS (Admitted Patients)
  • Optimize Acute Care Services Community Home Care ResidentialHome ED Acute Home Optimize Acute Care Services • Activity Based Funding – RIW based funding provides incentive to care for the sickest patients and shift inpatient surgery to daycare • Procedural Care Program – Reduce wait times • NSQIP Implementation – improve the quality of surgical care 28 28
  • Activity vs. Gobal Funding for Acute Care• The shift from global funding to activity based funding has helped VCH to achieve desired performance, behaviour change and transformation of systems across acute, community and primary care service• Goal: To move acute care to outpatient services To decrease length of stay 29
  • Activity Based Funding at VCH• The ABF model for inpatient and same day procedures provides a tool for VCH to focus on service level changes and reallocate resources accordingly• The marginal funding rate fosters the requirement for efficiency and cost management• VCH continues to work with physicians and Health Records to improve quality and timeliness to ensure funding reflects acuity levels accurately• The ED P4P earnings + RIW earnings equals the cost of opening extra beds 30
  • Procedural Care Program• The Procedural Care Program was established to reduce the wait times for patients waiting the longest for care: • “Top 10” Day Surgeries • VCH Selected Procedures with High Wait Times • Surgical and Medical Procedures Mainly Performed in Procedure Rooms • Magnetic Resonance Imaging (MRI) Exams 31
  • Top 10 Day Surgery - Average Wait Time (Weeks) for Cases Waiting Contracted Cases at Contracted Facilities45403530 IHA FHA VCHA25 VIHA BC2015 2010-08 2010-09 2010-10 2010-11 2010-12 2011-01 2011-02 2011-03 Month End 32
  • MRI Wait Times VCH MRI Volumes and Average Wait Time HSPO 3,000 LMIIF 16 Annualized total 6,456 Exams 6,304 Exams 14 2,500 Average Wait Time (Months) 12 2,000 10MRI Volume 1,500 8 Total MRI 6 1,000 Average Wait Time 4 500 2 0 0 09 P1 09 P4 09 P7 10 P3 10 P6 10 P9 11 P2 11 P5 11 P8 12 P1 12 P4 12 P7 09 P10 09 P13 10 P12 11 P11 12 P10 33 Year Fiscal Period 33
  • NSQIP Program• Thesis: improve overall surgical outcomes by joining the American College of Surgeons’ National Surgical Quality Improvement Project• In October of 2002, the U.S. Institute of Medicine named NSQIP the “best in the nation” for measuring and reporting surgical quality and outcomes• Data can be used to help: – increase patient satisfaction – reduce the median length of stay – reduce postoperative mortality rates 34
  • Before – Surrey Memorial Hospital Overall* 30-Day Morbidity Observed rate: 17.69% Expected Rate: 10.46% O/E Ratio: 1.69 Status: Needs Improvement 35 * Includes General and Vascular Surgery Cases
  • After – Surrey Memorial Hospital Overall* 30-Day Morbidity Observed Rate: 11.88% Expected Rate: 10.88% O/E Ratio: 1.09 Status: As Expected 36 * Includes General and Vascular Surgery Cases 2010 Report
  • Invest in Community, Home Support and Primary Care Community Home Care Residential Home ED Acute Home Invest in Community and Home Support • Reduce ED visits • Reduce length of stay • Reduce ALC • Reduce Acute and Residential Care Admissions • Reduce Readmissions 37
  • Avoidance of Unnecessary Residential Care and Acute Admissions (AURAA)• A comprehensive set of community-based services designed to provide proactive care to prevent exacerbation of known complex disease• Will prevent avoidable ED, Acute and Residential Care admissions and reduce LOS amongst the population at highest risk, while improving overall health status at home• Targets: – Decrease RC use by 6 months per client – Reduction in ALC days by 30% per client continued… 38
  • Avoidance of Unnecessary Residential Care and Acute Admissions (AURAA) • 118 patients enrolled across 6 communities in VCH – All 118 patients were waitlisted or eligible for residential care – Over 90% of these patients are still in the community and have not had to be admitted to residential care • Patients waiting @ home have – declined RC bed when available – Shown marked functional and mental improvement • Collaboration between acute and community has evolved – Partnering in care planning across patient journey – Issue tracking promotes continuous learning • Culture shift in clients expectations for RC placements 39
  • # of RC Registrations (Total) by Fiscal Year (P11 YTD) Vancouver140012001000 800 600 400 200 0 08/09 09/10 10/11 11/12 # of RC Registrations (P11 YTD) Average 08/09 to 10/11 (P11 YTD) 40
  • PFF can Lead to Better, Earlier Discharges: AURAA VCH-Richmond Average # of ALC Clients 45 P2: Start of 40 Home First Initiative 40 39 35 38 38 35 30 25 27 27Clients 25 25 24 20 23 21 20 20 20 20 20 20 20 20 20 20 20 20 20 20 19 15 18 10 5 0 11-11 11-12 11-13 12-01 12-02 12-03 12-04 12-05 12-06 12-07 12-08 12-09 12-10 12-11 Period Clients Target 41 Source: VCH Decision Support Prepared by: Ana Himani, Business Analyst
  • Total Residential Care Placements by Period 30 25 25 22 20 18 18 16# of Placements 15 15 15 14 14 13 13 12 12 11 11 11 11 10 10 10 10 10 8 7 7 6 6 5 5 5 5 4 4 4 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 11-01 11-02 11-03 11-04 11-05 11-06 11-07 11-08 11-09 11-10 11-11 11-12 11-13 12-01 12-02 12-03 12-04 12-05 12-06 12-07 12-08 12-09 12-10 12-11 Period Acute to Facility Community Community Emergency Source : Priority Access Prepared by Ana Himani, Business Analyst 42
  • You can lead a horse to water but can 43 you make it drink? 43
  • Embracing PFF at VCH to Provide Better Patient Care Education Educate and Inform Real Time Information Managers on Funding Model Business Support Provide real time information for decision making and Revenue analysis of scenarios Provide day to day business and financial support to clinical operations Ensure revenue flows to the clinical area where service is delivered 44
  • Educate Front-Line Managers and DirectorsInpatient $1,520 / RIW Case Activity Based Funding (ABF) Max RIW is 3% above baseline  Funding mechanism for ABF acute and same day care Volume Case (RIW) cases with some exceptionsDaycare $3,800 / RIW Case  Funding unit is Resource Max RIW is 10% above Intensity Weight (RIW) baselineBaseline Baseline workload expressed in both case volume and RIW Case Baseline No gain in ABF revenue until workload is above baseline Volume Loss in revenue if workload is below baseline 45
  • Utilizing Emendo Cap Plan to Forecast Patient Volume and ABF RevenueHow VCH is utilizing the tool:• Includes 3 years of history and current activity to forecast demand and trends• Shift from producing a manual retrospective report to look at ABF revenue to forecasting ABF revenue and analyzing “what if” scenarios• Determine impact on capacity and strive to exceed projected discharge targets to create capacity• Develop a plan and budget and project revenue stream• Establish baseline, input RIWs and see how volumes have increased or decreasedObjectives of Cap Plan Forecasting Tool at VCH:• Optimize the match between staffing and clinical volumes• Optimize productive hours per patient day and reduce overtime by planning for fluctuations in demand• Exceed Discharge targets to create capacity for incoming volumes• Predict ABF Revenue 46
  • Provide Strategic Direction, Information and Business Support Clinical Operations Infrastructure and Business Support to Enable Clinical Operations Strategy, Project Management, Project Coordination, Education,Transformation Team CommunicationDecision Support Reporting Tools and Evaluation Business and analytical support, reporting on progress to targets, expenses,Financial Planning revenues and volumes 47
  • In Conclusion – Key Factors for Success1. Don’t chase money – funding needs to enable behaviour change to support the right clinical actions2. Not one time money- at VCH approach here to stay and grow3. Accountability is key4. Pay acute operations based on RIW funding – earnings drives understanding5. Need to resource real -time information and analytics6. Revenue and cash flow received must flow to operations monthly7. Coding accuracy and timing is key – need to compute RIW internally8. Must incentivize patient flow across the continuum of care – cannot concentrate on a single area in a bigger system.9. Part of the strategic direction 48
  • Questions? 49
  • Appendices 50
  • Patient Focused FundingPeriod 7 YTD Earnings Summary for VCH Procedural Care Community ED P4P funded by ABF Total HSPO ($ million) Program Programs² HSPO (New Floor) Payable Funding Vancouver 0.717 0.354 2.560 $ 2.13 $ 5.761 PHC 1.305 1.625 $ (0.67) $ 2.260 Coastal 1.352 0.114 0.912 $ 1.01 $ 3.388 Richmond 0.750 0.084 0.728 $ 1.63 $ 3.192 MRI (P6 YTD) 1.221 $ 1.221 Regional 0.005 $ 0.005 NSQIP¹ 0.996 $ 0.996 Less: MoH expected growth (unallocated) $ (0.82) $ (0.82) Total VCH $ 6.341 $ 0.557 $ 5.825 $ 3.28 $ 16.003 Annual contract $ 14.630 $ 11.560 ¹NSQIP - National Surgical Quality Improvement Program ²Community Programs (incl. start up funds) 51
  • VCH – Period 7 YTDABF $ Change from 2011/12 Baseline ABF Facilities (Included Procedures) Same Day ABF $ Inpatient ABF $ Total ABF $ 2011/12 Annual ($ million) Change Change Change Notional from 11/12 from 11/12 from 11/12 ABF ABF 2011/12 baseline 2011/12 baseline 2011/12 baseline Allocation Payable VGH/UBC $ 10.33 $ (0.13) $ 45.31 $ 2.26 $ 55.64 $ 2.13 $ - $ 2.13 PHC $ 8.40 $ 0.36 $ 26.59 $ (1.03) $ 34.99 $ (0.67) $ - $ (0.67) LGH $ 4.36 $ 0.07 $ 13.67 $ 0.92 $ 18.04 $ 0.98 $ - $ 0.98 Squamish $ 0.56 $ 0.03 n/a n/a $ 0.56 $ 0.03 $ - $ 0.03 RH $ 2.58 $ 0.29 $ 10.10 $ 1.35 $ 12.68 $ 1.63 $ - $ 1.63 Less: MOH expected growth (unallocated) $ (0.18) $ (0.65) $ - $ (0.82) $ (0.82) Grand Total $ 26.23 $ 0.44 $ 95.67 $ 2.85 $ 121.91 $ 3.29 $ 10.10 $ 3.29 Notes: - Procedural Care Program RIWs excluded - Unused funds in one HA can be earned by another HA subject to HSPO approval and up to the total maximum earnings available for all HAs. 52
  • VCH PFF Community Projects• Avoidance of Unnecessary Residential Care and Acute Admissions (AURAA)• Early Supported Discharge – Chronic Disease• ED Adverse Drug Events Screening• Home Based Treatment for Mental Health and Addiction• Supporting Transition of Seniors from Emergency 53