Implementing the National 13/14 ABF Model in Queensland

1. Implementing the National 13/14 ABF Model in Queensland Bill Stomfay Manager, ABF Models, Queensland Health

2. Overview Disclaimer Status Structural Differences (localisations) Implementation and Results Unintended Incentives Other Issues

3. Disclaimer QH model only finalised last week Analysis is draft and subject to change Does not cover Quality Improvement Payments

4. Status – 2013/14

5. Process and Costing

6. Price Setting

7. Structural Differences Acute Inpatients Critical Care Mental Health Sub/non-acute Inpatients Emergency Department Outpatients Clinical Education

8. Acute Inpatients

9. Acute Inpatients

10. Acute Inpatients

11. Acute Inpatients

12. Acute Inpatients

13. Acute Inpatients

14. Critical Care

15. Mental Health

16. Sub/Non-Acute Inpatients

17. Emergency Departments

18. Outpatients

19. Block Funding

20. Block Funding

21. Clinical Education

22. Implementation and Results Funding Context Change of Government Review of State financial viability Reduction of public service staffing Productivity dividend Business as usual is not an option

23. Implementation SQL Server (pAWS) • ED and OP summary source data does not include indigenous status • summary OP data (unit record data not statewide) • OP clinic reclassification • SNAP V1 vs V3 – use of ICD10 data for SNAP Grouper Validation of Draft NEP by Ernst Young DSS Panorama (statewide reporting) • need to support current and previous State and national models with different structures

24. Results - Methodology All ABF funded hospitals, all components State funding model comparison Patient costed ABF hospitals only Actual costs vs funding QH Phase 15 (12/13) ABF Model QH Phase 16 (13/14) Actual 11/12 costs All costs and prices in 13/14 dollars

25. Q15 to Q16 Summary of Results

26. Please Note: This comparison only showed differences between the current 12/13 QH funding model and the 13/14 model. It does not mean that one is any better than the other and simply illustrates the magnitude of the change. Comparison with actual cost is a better indication of goodness of fit, but does not consider inefficiency.

27. Cost vs Q16 Summary

28. Comment: Acute inpatients has a reasonable goodness of fit but this is not the case with SNAP and Subacute. SNAP V3 data classification questionable as Qld currently uses SNAP V1 and developed a SNAP V3 grouper internally.

29. Peer Groups – Acute Inpatients Only

30. Comment: There is a clear differential between peer groups which would support a change in the national model. This may be addressed when a Teaching/Training/Research component is added.

31. Unintended Incentives Reduced private patient incentives ‘Own Source’ revenue retention Acute inpatients Critical care LOS Mental Health

32. Unintended Incentives SNAP vs Non SNAP Non-acute SNAP long stay per diem vs Care Type per diem Rehab DRGs Outpatients Classification failure Provider hierarchy

33. Critical Care bundling vs unbundling (provider risk) Peer Groups differential infrastructure costs and DRG relativities Outpatients new/repeat differential cost counting rules telephone consults Issues Raised by Sites

34. Other Issues Trim points • Fractional days • Percentiles rather than L3H3

35. Summary Structural Differences (localisations) Implementation and Results State funding model changes Fit to actual cost Unintended Incentives Other Issues

36. Contact Details: abf_model_team@health.qld.gov.au Bill_Stomfay@health.qld.gov.au