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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
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Health RoundtableQld Chapter MeetingLatest Developments in ABFMember 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 StrategiesPurchasing Framework • 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 • Own Source Revenue • PHI target: 80% (currently 46%) • Bulk billed clinics target: 27% (currently 18%)
Demand Management StrategiesPurchasing Framework • 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 • Outpatient Ratios (repeat to new attendances) • Negotiated local targets for following clinic types: • General paediatrics / paediatric surgery • General surgery • Thoracic medicine
Demand Management StrategiesPurchasing Framework • 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% • 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 StrategiesPurchasing Framework • 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 • Activity Growth • Indexed areas → accepted corporate rate • Non-indexed areas → demand management strategies
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