Ministry LHIN Performance Agreement (MLPA) Report Presentation to the Hamilton Niagara Haldimand Brant (HNHB) Local Health Integration Network (LHIN) Board of Directors May 30, 2012
What is the Ministry LHIN Performance Agreement (MLPA)? • MLPA is the accountability agreement between the Ministry of Health and Long-Term Care (ministry) and the HNHB LHIN (2010-11 and 2011-12). • MLPA targets are negotiated yearly. Negotiations for 2012-13 are scheduled for late summer 2012. • Outlines the general framework for ministry-LHIN relationship, funding and policy directions, and performance obligations. 2
MLPA - Cascading Accountability Ministry MLPA LHIN H-SAA Hospital Service Accountability Agreement M-SAA Health Service HNHB LHIN Multi-Sector Service Providers Accountability Agreement L-SAA Long-Term Care Service Accountability Agreement 3
4 Source: MOHLTC May 2012
90 th Percentile Wait Times for Cancer & By-Pass Surgery Cancer Surgery • The 90 th percentile wait time for fiscal year 2011-12 was 62 days, which is one day above the HNHB LHIN target of 61 days. Wait times reported in March 2012 was 60 days. • Liver, head and neck, lung and prostrate continue to have highest wait times in the HNHB LHIN. Bone and joint, neurological and thyroid have shown the most improvement in fourth quarter (Q4.) Cardiac By-Pass Surgery • The 90 th percentile wait time for fiscal year 2011-12 was 46 days, which is two days below the HNHB LHIN target of 48 days. Wait times reported in March 2012 was 20 days. • Of note, Hamilton Health Sciences is the only hospital in the HNHB LHIN that performs by-pass surgery. 5 Source: MOHLTC MLPA, May 2012
90 th Percentile Wait Times Cataract Surgery • The 90 th percentile wait time for fiscal year 2011-12 was 143 days, which is 23 days above the HNHB LHIN target of 120 days . • Wait times for cataract surgery have shown a steady improvement in Q4. Wait times improved from 158 days in December 2011 to 147 days in March 2012. • Three out of five hospitals in HNHB LHIN are above the LHIN target at March 2012. 6 Source: MOHLTC MLPA, May 2012
90 th Percentile Wait Times for Total Joint Replacement Surgery (Hip & Knee) Total Knee and Hip Replacement Surgery • The Total Knee Replacement (TKR) 90 th percentile wait time for fiscal year 2011-12 was 267 days, which is 85 days above the HNHB LHIN target of 182 days . • Brant Community Healthcare System (BCHS) has some data quality issues that are driving the high wait times up for knee replacement surgery in the HNHB LHIN. • The Total Hip Replacement (THR) 90 th percentile wait time for fiscal year 2011-12 was 229 days, which is 52 days above the HNHB LHIN target of 177 days. • In March 2012 the HNHB LHIN’s 90 th percentile wait time for hip replacement surgery was 175 days which is below the LHIN target of 177 days, the provincial target of 182 days, and the provincial average of 183 days. • Niagara Health System (NHS) reported a wait time of only 89 days in March 2012 for THR surgery. 7 Source: MOHLTC MLPA, May 2012
90 th Percentile Wait Times for MRI and CT Scans MRI Scans • The MRI 90 th percentile wait time for fiscal year 2011-12 was 91 days, which is three days above the HNHB LHIN target of 88 days. • Wait times for the HNHB LHIN have been equal to or below the provincial wait time and below the HNHB LHIN target for the past four months, and continues to trend downward. CT Scans • The 90 th percentile wait time for fiscal year 2011-12 was 45 days, which is two days above the HNHB LHIN target of 43 days. • CT wait times have continued to improve in March and are below the LHIN target for the second straight month. 8 Source: MOHLTC MLPA, May 2012
% Alternate Level of Care (ALC) Days • The % ALC Days (closed cases) in 2011-12 showed improvement from a starting point of 17.88% to a reported low of 12.94% in the first quarter (the lowest rate reported since 2007). • The LHIN maintained the lower ALC rate (11.9% - 13.1%) from April to August 2011. • The ALC increased in Q3 (September – December 2011). This was the result of a focused strategy to support individuals experiencing long waits to transition to the right level of care. • This strategy has resulted in the successful discharge of 169 individuals that accumulated over 30,000 ALC days. • The LHIN’s internal monitored rate (open cases) ranged between 13-14% in 2011-12, for a final rate of The LHIN performance for 2011 -12 is 15.37%, this 13.3% in March 2012. rate is based on data from January to December 2011. 9 Source: MOHLTC MLPA, May 2012
90 th Percentile Wait Times for Admitted ER Patients • The ER length of stay (LOS) for patients admitted to the hospital for the fiscal year 2011-12 was 35.5 hours. This is a decrease of 3.4 hours compared to the previous fiscal year. The year end performance remains 25% away from the LHIN target. • The first two quarters showed significant improvement from April (40.4 hours) to July (28.6 hours), with July ER LOS the lowest in the LHIN for the last four years and 1% variance from target. • The declining performance of the last half of the fiscal year is largely driven by three NHS three sites, and Joseph Brant Memorial Hospital’s (JBMH) highly variable ER performance. 10 Source: MOHLTC MLPA, May 2012
90 th Percentile Wait Times for Non-Admitted ER Patients ER LOS – Non-Admitted High Acuity • The ER LOS for the fiscal year 2011-12 is 7.8 hours, which is 0.1 hours improved over the previous year and remains 0.3 hours from LHIN target. • There is a four year trend of increasing High Acuity Patient volumes impacting more significant performance improvement. ER LOS – Non-Admitted Low Acuity • The ER LOS for the fiscal year 2011-12 was 4.9 hours. which is 0.1 hours longer than the previous fiscal year and 0.4 hours from the LHIN Target (or a 8% negative variance). • LHIN hospitals have implemented Rapid Assessment Zones, Medical Directives, Physician See and Treat areas, and Nurse Practitioners to improve the flow of the non- admitted low acuity patient group. 11 Source: MOHLTC MLPA, May 2012
Community Care Access Centre (CCAC) In-Home Services Wait Time – Application from Community to first CCAC Service • Although a three day improvement was achieved during the year, the 90 th percentile wait time at year end was two days over the LHIN target. • Higher wait time (54 days) reported for the period of January – March 2011, impacted the LHIN’s year end wait time. • The peak in wait times during this time was the result of a number of individuals with low care needs transitioned from CCAC’s wait list to community providers – achieved through one-time funding from the LHIN. 12 Source: MOHLTC MLPA, May 2012
Readmission within 30 Days for Selected Case Mix Groups (CMGs) 13 Source: MOHLTC MLPA, May 2012
Repeat Unscheduled Emergency Visits within 30 days Mental Health Conditions • Repeat unscheduled emergency visits for mental health conditions increased to 21.3% in Q2 of 2011-12. • This is the highest rate since wait times were reported starting Q4 2008-09. Substance Abuse Conditions • Repeat unscheduled emergency visits for substance abuse conditions decreased to 23.0% in Q3 of 2010-11. The HNHB LHIN is working with mental health and substance abuse providers to identify factors contributing to the percent of unplanned ER visits for this population. 14 Source: MOHLTC MLPA August 2011
MLPA – Next Steps • July/August – negotiation with ministry on 2012-13 targets. • Monitoring of monthly trends and action items. • Reporting to Quality and Safety Committee. • Reporting to full Board on Access to Care indicators. 15
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