Health leaders conference (2)

372 views

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
372
On SlideShare
0
From Embeds
0
Number of Embeds
9
Actions
Shares
0
Downloads
3
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Health leaders conference (2)

  1. 1. Timaru Eye Clinic
  2. 2. One river many streams Michael Mair FRANZCO Director Timaru Eye Clinic Health Leaders Conference Wellington NZ 04.05.07
  3. 3. Uniprice Public and Private funding for Ophthalmology <ul><li>One set of equipment, one team, one building, one process </li></ul><ul><li>One price for clinic assessments </li></ul><ul><li>Ideally, one surgical process </li></ul><ul><li>Many funding streams </li></ul><ul><li>The process managed, audited, monitored by Houston Ophthalmology software. </li></ul><ul><ul><li>http://www.houstonm.com/index.php?option=content&task=view&id=139 </li></ul></ul>
  4. 4. Funding for Timaru Eye Clinic <ul><li>Public Inter District Flow (IDF) volumes </li></ul><ul><li>ACC </li></ul><ul><li>War Pensions </li></ul><ul><li>Private insurance </li></ul><ul><li>Police reports </li></ul><ul><li>Private discretionary funds </li></ul><ul><li>?other </li></ul>
  5. 5. Eye Clinics in New Zealand working to this model <ul><li>Timaru </li></ul><ul><li>Tauranga </li></ul><ul><li>Rotorua </li></ul><ul><li>New Plymouth </li></ul>
  6. 6. The problem: providing expensive care with limited resources <ul><li>Glaucoma, Cataract and Retina are the ‘big three’ in Ophthalmology </li></ul>
  7. 7. Glaucoma incidence and demographics in New Zealand <ul><li>2% over 40, 10% over 80 have glaucoma </li></ul><ul><li>Treating it costs $30 M per year in NZ </li></ul><ul><li>It generates about 25% of FU attendances and 15% of new patient referrals </li></ul><ul><li>patients with early-stage or suspected glaucoma use approximately $623 per year in health care resources, while patients with end-stage disease consume approximately $2,511. </li></ul><ul><li>Efficient Treatment is Equipment intensive </li></ul>
  8. 10. Treating Glaucoma Early Lowers Economic Burden, <ul><li>……… .. but the equipment is expensive </li></ul>
  9. 13. ‘ Perfect care’ might be unmanageable! <ul><li>Current standards of care call for treatment of all patients who have glaucoma. . </li></ul><ul><li>We now treat individuals with glaucoma who have no field loss and no elevations in IOP, but do have characteristic optic nerve or nerve fiber layer loss. </li></ul><ul><li>such a treatment protocol could potentially place upward of 15 million Americans on treatment for Glaucoma, and about 200,000 NZ… </li></ul>
  10. 14. One river many streams <ul><li>Use of ancillary staff </li></ul><ul><li>Triaging </li></ul><ul><li>screening </li></ul>
  11. 15. Age Related Retinal Disease
  12. 16. 2006 2050 2150 1 in 10 are 60 years or over 1 in 5 will be 60 years or over 1 in 3 will be 60 years or over 2006 100,000,000 Chinese 65 or over
  13. 17. Increase % 2025 AMD Prevalence % 2000 AMD 2000 50+ Country 30 3,564,750 14 2,735,500 19,429,000 UK 25 574,500 14 460,625 3,236,000 Sweden 77 2,711,500 14 1,534,500 10,825,000 Spain 72 2,008,750 14 1,165,875 8,563,000 Poland 16 939,625 16 808,125 4,935,000 Holland 52 385,2125 14 2,530,625 17,997,000 Italy 105 200,375 14 107.500 761,000 Ireland 21 5,492,125 13 4,441,500 33,559,000 Germany 42 3,780,000 14 2,653,250 19,046,000 France 37 329,375 15 240,500 2,300,000 Finland -13 323,450 13 371,875 2,803,000 Bulgaria 39 668,000 14 481,500 3,476,000 Belgium 61 535,875 14 322,875 2,377,000 Austria
  14. 18. AMD & European Union (EU) EU - 28 Million AMD Patients UK - 1 Million Pounds for every 145 Treatable AMD Patients EU - 10’s of Billions of Euros over next 2 Decades 2004 2025
  15. 19. How are we going to address this? <ul><li>Rationalized high cost care </li></ul><ul><li>No duplication of resources </li></ul><ul><li>One river many streams… </li></ul>
  16. 20. Cataract – 80% of people over 80 have it <ul><li>Prioritization has shown wildly different point score levels through out NZ </li></ul><ul><li>20 in Timaru, near 40 in some places </li></ul><ul><li>A population generates approx 500 per 100,000 per year </li></ul><ul><li>Efficient process is equipment intensive </li></ul>
  17. 21. The New Alcon Infinity Phaco Machine costs over $120,000, the training for the people to use it much, much more
  18. 22. Cataract is too expensive to duplicate resources <ul><li>One river, many streams </li></ul><ul><li>Regularize the point score across DHB boundaries </li></ul><ul><li>Send the work where the capability exists to do the work </li></ul><ul><li>Local care for local people!! </li></ul><ul><li>`(the elderly are frail….) </li></ul>
  19. 23. The Present Public/Private split <ul><li>Ophthalmologists and their equipment are expensive </li></ul><ul><li>Present system depends on hypocrisy </li></ul><ul><li>The public system pretends to deliver an adequate service, the Docs clean up in private! </li></ul><ul><li>A single process with different funding streams allows for efficiency, sincerity, and planning </li></ul>
  20. 24. Inter District Flow Funding for Ophthalmology (Public Sector) 2006/7 2007/8
  21. 25. The Houston Software generates any number of audits and reports <ul><li>Produced by The NZ Software Corporation </li></ul><ul><li>Developed initially in the Timaru Eye Clinic </li></ul><ul><li>A few token examples… </li></ul>
  22. 26. <ul><li>TIMARU EYE CLINIC CATARACT AUDIT 1 </li></ul><ul><li>Cataract Operations </li></ul><ul><li>Total Number of Cataract Operations: 178 </li></ul><ul><ul><li>Left Eye: 73 </li></ul></ul><ul><li>Right Eye:105 </li></ul><ul><li>Average Pre-op Acuity: Snellen 6/30 </li></ul><ul><li>Logmar 0.21 (6/6 = 1.00) </li></ul><ul><li>Average Post-op Acuity: Snellen 6/9 </li></ul><ul><li> Logmar 0.60 (6/6 = 1.00) </li></ul><ul><li>Average improvement in Acuity 190.28% </li></ul><ul><li>Change in Corneal H Shape 0.67% </li></ul><ul><li>Change in Corneal V Shape 1.4% </li></ul><ul><li>Capsule Ruptures 2.25% (4) </li></ul>
  23. 30. process meeting parting The Record Meeting Process Parting The Building, the Clinical Process and the Record are One
  24. 32. Timaru Eye Clinic
  25. 33. <ul><li>Can this ever happen? </li></ul><ul><li>Can this ever happen? </li></ul><ul><li>Can this ever happen? </li></ul><ul><li>Can this ever happen? </li></ul><ul><li>Can this ever happen ? </li></ul><ul><li>Can this ever happen? </li></ul><ul><li>Can this ever happen? </li></ul><ul><li>Can this ever happen </li></ul><ul><li>Can this ever happen? </li></ul><ul><li>Can this ever happen? </li></ul>
  26. 34. Thank you very much for your attention

×