Service Accountability Agreements

Service Accountability

Agreements

Update

Central East LHIN Board of Directors

February 27, 2013

2013-16 Long-Term Care Service

Accountability Agreement (L-SAA)

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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 Hospital Service

Accountability Agreement (H-SAA)

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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!!


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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


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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

2013-14 Multi-Sector Service

Accountability Agreement (M-SAA)

Refresh

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• 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


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


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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Motion

Be it resolved that the Central East LHIN Board authorize the

Board Chair and LHIN CEO to execute the 2013-14 M-SAA

Refresh Agreements on behalf of the Central East LHIN by

March 31, 2013.

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Documents

Service Accountability Agreements