Long-Term Clinical Service Plan Impacts for 2016/17 October 2015 1 - PowerPoint PPT Presentation

Long-Term Clinical Service Plan Impacts for 2016/17 October 2015 1

Purpose 1. Ensure common understanding of what is driving change • Health System Funding Reform, QHC cost structure issues 2. Share significant proposed changes • Clinical service distribution across QHC hospitals • 2016/17 operating plan 3. Answer questions 2

HSFR – Future & Current State Future (Current) Past State Global 30% (56%) Quality Based Global Procedures 4? ‐ year transition (QBPs) 100% 30% (15%) Patient Focused Health Based Funding Allocation Methodology (HBAM) 40% (29%) 3

Quality Based Procedure Funding 4

HBAM Funding Hospitals lose funding if: Actual costs are higher than expected costs Hospitals gain funding if: Actual costs are lower than expected costs 5

Implications for 16/17 • All services, direct clinical care, indirect clinical care and administrative areas must perform at least at median cost in comparison to the rest of the province – Must remove at least $11.5M in expenses for 2016/17 – $7 million in non ‐ clinical, $4.5 million in direct care savings • In future years, will need to find efficiencies to: – Fund inflation – Meet changing expected costs – Adjust for any further volume decreases • Health Care Tomorrow – Hospital Services project will be important to finding efficiencies for future years by working more closely with 6 other hospitals in this LHIN

Process to Find Opportunities for 2016/17 • Director ‐ led planning team identified opportunities based on: – Community engagement to define top health care priorities – Recommendations of the Brighton/Quinte West Health Services Advisory Committee – Input from physicians and staff – Internal analysis and benchmarking QHC against high performing hospitals – External input from the Hay Group 7

QHC Long-Term Clinical Service Planning 8

Overall Summary of Feedback My local health care system should provide: 1. Family care providers who: 2. Local access to:   Provide system 24 hour emergency navigation and equitable services  access to services Inpatient beds   Help keep people healthy Basic diagnostic services  through health Home and community care promotion and services maintenance A sustainable, local system of care that can create healthy communities and is: Patient ‐ centered High quality Timely 3. Efficient access to 4. Effective coordination of specialist services services and communication • With adequate between providers transportation options

QHC Hospital System – Distribution of Services Primary Care Hospitals Regional Secondary Hospital QHC Belleville General Hospital QHC Prince Edward QHC North Hastings County Memorial Hospital Hospital Core Primary Care Services: • Emergency Room (24 hour) • Acute Inpatient beds • Appropriate basic diagnostics and clinics Regional Services: QHC Trenton Memorial • Obstetrics/Pediatrics Hospital • ICU • Surgery Each with “Protected” Core Services: • Internal Medicine • Emergency Room (24 hour) • Oncology Clinic • Acute Inpatient beds • Mental Health – inpatient/outpatient • Inpatient Rehab and Rehab Day Supported by: • Children’s Treatment Centre • Appropriate basic diagnostics for ER • Supported by advanced diagnostics: and inpatients - MRI - CT • Ambulatory clinics appropriate for - Cardiopulmonary - Bone mineral density hospital-based delivery and based on - Nuclear medicine - Lab local need - Interventional radiology

QHC North Hastings Hospital • Emergency room (24 hour) Efficient access to BGH • Acute inpatient beds specialist services • Basic diagnostics: - X-ray, ultrasound - Cardiopulmonary, ECG, holter - Point-of-care lab • Ambulatory clinics (e.g., mental health services) 11

QHC Prince Edward County Memorial Hospital: Near Future Low risk regional endoscopy services • Emergency room (24 hour) • Acute inpatient beds - General, acute care for elderly • Basic diagnostics: - X-ray, ultrasound - Point-of-care lab Efficient access to BGH • Ambulatory clinics (e.g., mental specialist services health services) 12

QHC Prince Edward County Memorial Hospital: Evolving to a Integrated Future Vision A range of integrated health care services “wrapped around the patient”… …co-located in a new health care campus 13

QHC Trenton Memorial Hospital: Near Future Some Regional Services: • Complex Continuing Care • Cataracts, cystoscopy • Minor surgery • Ambulatory clinics (e.g., breast assessment) • CT Scan • Emergency room (24 hour) • Acute inpatient beds • Basic diagnostics: - X-ray, ultrasound - Cardiopulmonary, holter, ECG, pulmonary function testing - Point-of-care lab • Ambulatory clinics (e.g., mental Efficient access to BGH health services) specialist services 14

Evolving to a Future Vision of Integration and Co-Location with Enhanced Primary Care Services Trenton Health Centre Primary Care Services FHT CHC Support Services CCAC Hospital Services Physician offices Hospice Health assessments ER Mental Health Health promotion Inpatient Beds Private Physio, X-Ray, Lab Chronic disease management Diagnostics Procedures/Clinics (e.g., medication management, foot Ambulatory and Etc. care, mental health, pain clinic, etc.) surgical services As Proposed by the Brighton/Quinte West Health System Advisory Committee 15

QHC Belleville General Hospital Regional Specialist Services • Obstetrics/Pediatrics • ICU • Surgery • Internal Medicine • Advanced Diagnostics Primary Care Hospital - MRI, CT • Emergency room - Cardiopulmonary (24 hour) - Nuclear medicine • Primary care beds - Bone mineral density • Basic diagnostics - Mammography (x-ray, ultrasound) - Interventional radiology • Clinics - Lab • Oncology Clinic • Mental Health – inpatient and outpatient • Inpatient Rehab and Rehab Day • Children’s Treatment Centre 16

2016/17 Operating Plan Implications 17

Process to Find Financial Savings 4. Service Reduction 3. Service Consolidation Ambulatory care 2. Program services not Efficiencies related to Consolidation/ hospital core 1. Admin/Support movement of services services across Areas Staff number sites to ensure and skills mix efficient delivery Ensure all areas Alignment of of high quality are meeting inpatient beds care provincial Utilization of benchmarks tests, drugs and supplies Optimizing service hours

Impact in 2016/17 ‐ Proposed • Continued implementation of the Interprofessional Patient Care Teams • Realignment of inpatient beds to maximize quality and efficiency, maintaining the overall number • Move 2400 day surgery cases to BGH operating rooms – Cataracts, cystoscopy and surgical clinics would remain at TMH – Consolidation of surgery reduces overhead costs associated with MDRD, equipment, supply chain, environmental service, imaging and laboratory 19

Impact for 2016/17 ‐ Proposed • Work with Hotel Dieu Hospital to provide the Pain Clinic services – HDH offers evidence ‐ based multidisciplinary program – Recently received funding to expand this program • More focussed services for Rehab Day Hospital – Stroke, neurology, pulmonary • Ensure appropriate utilization of tests and supplies • Optimizing hours, booking and wait times in diagnostic areas 20

Non ‐ Clinical/Back ‐ Office Changes • Changes in almost every department to ensure we are at least meeting median benchmark performance compared to other hospitals • Examples: – Information Systems – Materials management – Hospitality, portering, Resource Centre – Plant maintenance – Security – Patient registration – Health records – Administrative areas 21

Next Steps Education/Gather Input • Oct. 6 – 30: Community/staff/physician education on long ‐ term vision and opportunity to provide input on proposed changes (to inform implementation planning) Approval and Implementation • Mid ‐ Nov: Board review, QHC staff planning begins • April 2016 Implementation 22

Questions & Answers 23