1. Outstanding Care ~ People Focused 2013-2014 Budget Consultation

2. PROVINCIAL FINANCE Why is change happening now?

3. 3 Ontario – Surplus/Deficit History

4. 4 2012 Ontario Budget

5. 5 Total hospital operating funding is the largest area of health spending and has increased by an average of 5.1 per cent annually since 2003 This Budget will help maintain excellent health care for Ontarians while slowing the overall growth in health spending in Ontario to an average of 2.1 per cent annually, over the next three years.

6. 6 Health System Funding Reform

7. 7 Health System Funding Reform Contd Health Based Allocation Model (HBAM) Formula driven - Price X Volume – Based upon population characteristics – Evidence-based activity – Funding rates informed by best practice Provides 40% of MAHC Funding – Acute and Day Surgery – Emergency Department – Complex Continuing Care

8. 8 Quality Based Procedures Hospital funding is reduced at the hospitals average cost per procedure/weighted case The hospital then receives new funding at the 40 th percentile cost of performing the procedure This will account for approximately 30% of MAHC Funding by 14/15 Health System Funding Reform Contd

9. 9 Cataract Funding Based on 409 proceduresCarve Out 2012/13 Funding Unmitigated Funding Rate per Procedure$970$825$497 Total Funding$397,014$337,442$203,317 Funding Lost($59,572)($193,697) Excluding bi-lateral procedures/funding Quality Based Procedures Funding Health System Funding Reform Contd

10. 10 Quality Based Procedures for 2013/14 2011/12 Cases Weighted Cases Congestive Heart Failure135208 COPD193256 Stroke126217 Cardiovascular Surgery35 Colonoscopy2,765184 Chemotherapy – Systemic Treatment00 Total 2011/12 Volume870 Health System Funding Reform Contd

11. PROPOSED SOLUTIONS FOR 2013/14 Closing the Funding Gap

12. 12 Planning and Decision Guides Rural and Northern Healthcare Report (2010) 90% of residents in a community or local hub will receive specialty inpatient hospital and tertiary diagnostic services within four hours travel time from their place of residence. 90% of residents in a community or local hub will receive emergency services (24/7/52) within 30 minutes travel time from their place of residence 90% of residents in a community or local hub will receive basic inpatient hospital services within one hour travel time from their place of residence

13. 13 Planning and Decision Guides Contd 2012 Ontario Budget The [funding reform] model will drive provincial health care funding towards better patient outcomes by: – directing funding to efficient providers who provide better or more efficient services or treatments; and – improving quality through specialization.

14. 14 2013/14 Budget 2013/14 Budget Changes000$ Reduced Revenue *(150) Cost increases(2,160) Identified Savings1,060 Deficit/Further Savings Required($1,250) * MOH/LHIN funding is unknown at this time, but is expected to decrease from 2012/13. $150k reduction in revenue is revenue from all other sources.

15. 15 Proposed Solutions for 2013/14 Funding Reform is shifting funding to community providers, so some patients previously cared for in the hospital will now receive care outside the hospital Acute Care Bed Reductions – we can continue to service the same volumes with the same quality care with planning and process transformation Complex Continuing Care – Single siting Complex Continuing Care allows efficient utilization of staff and resources

16. 16 Proposed Solutions for 2013/14 Contd Integrated Stroke Rehab Beds – there is a high need for Acute Stroke Rehab Beds in Muskoka – HDMH has been identified as a stroke unit site – MAHC is working to establish a ten bed unit to serve the population of Muskoka

17. 17 Bed Reductions BED COUNT Current BedsProposed Beds HDMHSMMHHDMHSMMH Acute Care 37483238 Complex Continuing Care 1018024 Proposed Integrated Acute Stroke Rehab 10 TOTAL 47664262 Proposed Solutions for 2013/14 Contd

18. 18 Single Siting Services It is believed that single siting services and combining the volumes will enhance clinical competency, patient outcomes and improve the operating position of MAHC Ophthalmology Chemotherapy (day clinic) Proposed Solutions for 2013/14 Contd

19. CURRENT PROGRAMS/SERVICES SMMHHDMH Urology Dialysis Ontario Breast Screening Program Nuclear Medicine Seniors Assessment & Support Outreach Team Pacemaker Clinic Histology Microbiology/Cytology PROPOSED PROGRAMS/SERVICES Ophthalmology Chemotherapy Day Clinic Programs & Services Across MAHC

20. 20 The proposed budget solutions are not about reducing or cutting services, they are: – intended to find a more efficient way of providing and preserving these services in our communities; – creating capacity for other services; MAHC must balance the level of those services within defined fiscal resources Proposed Solutions for 2013/14 Contd

21. 21 Thank you! Questions?