Health Roundtable Qld Chapter Meeting Latest Developments in ABF Member Perspective Dr Andrew Johnson Townsville Health Service District

Latest District Developments ABF Model released Purchasing Framework negotiations finalised Financial Plan including Demand Management Strategies developed District ABF Plan being developed Institute / service level specific strategies being formulated and implemented Routine reporting mechanisms established

Demand Management Strategies Purchasing Framework 1.Out of Scope Activities (male ster / vein strip & lig) –District communication strategy to be developed –Where clinically indicated procedure is required, second medical opinion will be sought and if concurred opinion → procedure undertaken 2.Own Source Revenue –PHI target: 80% (currently 46%) –Bulk billed clinics target: 27% (currently 18%)

3.Relative Utilisation (↓ or ↑ serving population) –District plan to be developed: Rebalance relative utilisation of approx three clinical services Develop work program for priority areas identified by clinicians and worthwhile for local population 4.Outpatient Ratios (repeat to new attendances) –Negotiated local targets for following clinic types: General paediatrics / paediatric surgery General surgery Thoracic medicine Demand Management Strategies Purchasing Framework

5.Potentially Avoidable Adms (uncomp cellulitis) –New ED short stay beds model of care includes treatment of cellulitis patients –Corporate supportive of this model, targets endorsed: Short stay outliers admissions (ED) = 33% Treatment provided outside hospital setting = 47% Overnight acute admissions = 20% 6.Mode of Treatment (in-centre vs home dialysis) –Integrated Planning and Policy Executive Committee –NQ benchmarks of 40% home and 60% in-centre Demand Management Strategies Purchasing Framework

7.Quality and Safety (falls, PU, HAI, treatment inj) –Clinical Improvement & Redesign Unit monitoring volume of pressure ulcers → developing reduction strategies –Review medical records → process changes required? –Review "Medicare Never Events" (US based study) → isolate further hospital treatment injuries for review 8.Activity Growth –Indexed areas → accepted corporate rate –Non-indexed areas → demand management strategies Demand Management Strategies Purchasing Framework

Current ABF Governance ABF (Casemix) Management Group –Nominated Institute representatives meet monthly –Operationally focussed (not generally clinical) –Forum for sharing ABF information and experiences ABF Management Group – Education Sessions –Attendees as above, meet monthly (alternate fortnight) –Education session topics based on: Identified issues Corporate developments Attendee feedback

Current ABF Governance Potential Bedday Savings Reports –Top 5 DRGs per Institute based on HRT data –Shows number of cases, monthly and YTD ALOS –Coloured coded to show improvement or ↑ ALOS

Current ABF Governance Bed Utilisation Report –Based on Relative Stay Index –Shows beds required if state and HRT ALOS met –Supports decisions about bed allocations based on current need and efficiency

2011/12 District ABF Plan “Funding Better Care” Governance Committee –Clinical leadership group –TOR developed –Inaugural meeting → August / September Data Integrity and Improvement Group –Data management group –TOR developed –Currently calling for nominations –Inaugural meeting → August

2011/12 District ABF Plan ABF Training and Education Proposal –Executive overview sessions for all staff –Staff group specific information sessions for all staff –Routine information sessions & attendance at meetings Institute / clinical specialties –Developing initiatives to: Achieve Purchasing F’work / Demand Management strategies Improve ABF awareness Increase ABF knowledge base

2011/12 District ABF Plan Expanding current routine reporting: –Analyse and monitor throughput for Demand Management indicators –Develop mechanisms for early identification of issues Causal feedback needs to be supplied Issue resolution strategies to be formally tabled and monitored –Distribute and discuss information at existing Executive and Institute management meetings

Challenges “We’ve heard it all before…..” Clinical engagement Limited resources – District and Corporate Recruitment and retention of skilled staff

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