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Amanda Humphreys & Mary Joyce delivered the presentation at 2014 Transition Care Conference: Improving Outcomes for Older People. The 2014 Transition Care Conference: Improving Outcomes for Older People formed a National account of the consumers' transition care journey within the current aged care environment, highlighted new initiatives to improve TCP access and quality of care, and showcased innovative service delivery models across jurisdictions. For more information about the event, please visit: http://www.informa.com.au/transitioncareconference14
Citation preview
The Impact of Activity Based Funding on the Patient and Family's Journey to
Transitional Care: A Hospital and Client Perspective!
Amanda Humphreys, Transition Care Central Coordinator, North Metro Health Services, Perth WA
Mary Joyce, HOD, Social Work Dept, Sir Charles Gairdner Hospital, Perth, WA
Aims
• The state of play of the health system in WA: introducing an ABF model
• Impact on Transition Care in Metro WA, for the health services and the client group
Perth, Western Australia
Sir Charles Gairdner Hospital - in the land of West Oz
Activity Based Funding
• What is it?
• A way of funding health services, based on the work they perform
! Improve efficiency
! Gain transparency
! Improve patient care
Activity Based Funding
• History
• Agreement by Council of Australian Governments (COAG) in 2008, to move to a nationally consistent approach to ABF
• Phased introduction commenced 2012/13
Activity Based Funding���
– in 20 words or less ! ���• On discharge hospital coders review the
client’s medical record and determine which Diagnostic Related Group (DRG) applies
• Each DRG has a weighting, which is multiplied by the State Efficient Price to determine the payment the hospital receives from the commonwealth
Activity Based Funding - example
• 86 year admitted post fall, daughter unable to manage at home due to mother’s deteriorating cognition, wandering
• Hospital stay was 29 days, TC ready at day 23
Activity Based Funding - example
• DRG code for this patient was B78A – “an intracranial injury with co-morbidities and complications”
• This code stipulates a stay of between 3 to 30 days and a weighting of 2.8203
• Hospital payment is 2.8203 x the State Efficient Price $5,325 = $15,018
Activity Based Funding - example
• The cost for the 29 day admission was approximately 29 x $1,464 = $42,456
• Unfunded cost to hospital = $27,438
• Break even point where cost equals payment is 10.25 days
Activity Based Funding - Data
• November 2013 – 24 patients discharged from Sir Charles Gairdner Hospital to TC
• Unfunded cost to hospital approximately $550,000
Transition Care in Perth
Who are our ���clients ?
• 265 clients of SCGH were discharged to Transitional Care in 2013
• (1903 discharged to TCP across North Metro)
• Restorative pathway 47%
• Residential care pathway 53%
How was the journey to TCP?
• What does this mean for the clients?
• Small sample
• From the hospital system to TCP
• Qualitative questions for client and carers after transfer to TCP
The human face
• Introducing some of our clients........
Systemic perspective
• Macro and micro view: need to view system as a whole
• Balance needs of both clients and hospital services
• economic imperatives = cost cutting
• other system changes: aged care reform, changes to TC
Impact for clients on this journey
• TCP clients identified as expensive to the health system
• Increased overt and covert pressure on patients and families to accept sub-optimal out of home care
• Changed care practices in the hospital environment?
Conclusion • Neither client or carer felt care was
compromised or overt pressure to discharge
• However, evidence of stress on the client and carer
• Clients and carers aware of limited hospital beds
• The future....