by Annette Marley

Principal Project Officer

System Relationships Branch

NSW Health

13th Annual Hospital in the Home Conference, Novotel on Collins, Melbourne, 23rd May 2013

New South Wales

State HITH Services Update

Summary

• Demand and Capacity

• NSW HITH Program overview

• HITH Guideline

• HITH Revenue opportunities

• HITH Costing

⅓ of Australia's population lives in NSW

Source: Australian Bureau of Statistics, Regional Population Growth, Australia, 2009-10

NSW Health Overview

• NSW Population 7.3M (14% aged 65+)

• 15 Local Health Districts / 3 Specialty Health Networks

• 226 public hospitals / 500 community health centres /

14,000 GP locations

• Annual NSW Health activity (Source: AIHW (2012) Hospital Statistics 2011-12)

• 2.235M ED presentations

• Over 1.6M acute separations

• 21.5M non-admitted occasions of service

• 101,819 acute potentially preventable hospitalisations

Hospital admissions are the highest

volumes ever

Source: AIHW Australian Hospital Statistics 2001/2 - 2011/12

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

2001-2 2002-3 2003-4 2004-5 2005-6 2006-7 2007-8 2008-9 2009-10 2010-11

Australian Public Hospital Separationsby State and Territory

NSW Vic Qld WA SA Tas ACT NT

31% increase in Hospital admissions since 2001/2

The strain on NSW hospitals is

continually increasing

Source: AIHW Australian Hospital Statistics 2001/2 - 2011/12

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

2001-2 2002-3 2003-4 2004-5 2005-6 2006-7 2007-8 2008-9 2009-10 2010-11

NSW Public Hospital Separations2001/2 to 2011/12

NSW Hospital in the Home

• 66 services delivering HITH

care

• Range of service delivery

models

Achievements to date

Increased service numbers

18,000 HITH admissions

52,505 episodes in 2011/12

(33,902 in 07/08)

Reduced ALOS

Key drivers for change

In the current climate of state and national health

reform, NSW is leveraging key strategies to drive

change for HITH

Local Health District Service Agreement measures

NSW 2021 Goal 11 – Keeping people healthy and

out of hospital

National Emergency Access Target (NEAT)

Activity Based Funding (ABF)

Equivalent or better care, at better value

Whole of system approach

Planned Admission

Emergency Modelsand Units

3rd Door Options

InpatientWards

InpatientShort Stay Units

eg. Medical Assessment Units, Urgent

Care Centres

Quick Triage ED Streaming

Hospital Substitution (Hospital in the Home)

Hospital in the Home

· Daily or intermittent

· Home or ambulatory

ComPacks

· Non-clinical services to support early discharge

Community Nursing

Primary & Community Care

Chronic Care

Palliative Care

Aged Health

Out of HospitalCare

General Practice

General Practice

Hospital in the Home Program

Objectives

• NSW HITH services have consistent, measurable

and clearly defined service delivery models

• NSW Local Health Districts and Specialty Health

Networks have a clearly defined strategy to

increase their HITH capacity to meet the needs of

specific target patient groups and their broader

community

Hospital in the Home Program

Strategies

• NSW HITH Guideline

• Revenue opportunities

• HITH Costing study

Program status

Clinician led Working Group commenced June 2011

Work plan for 2012/13 developed

Guideline in draft May 2013

High level implementation plan drafted May 2013

NSW Hospital in the Home Guideline

What we want to achieve

• To provide clear, standardised guidance regarding definitions,

key elements and principles

• Consistency of reporting, defined data measurable data-to

enable coding counting & costing & enable ABF

• Improved HITH service planning

• Local development of service delivery models to meet local

needs

• Reduce variation, to achieve best practice across the state

• Incremental increase in % acute separations admitted to HITH

NSW Hospital in the Home Definition

Hospital in the Home (HITH) services provide acute

and post-acute care to children and adults residing

outside hospital, as a substitution or prevention of

in-hospital care. The place of residence may be

permanent or temporary.

• A person may receive their care at home (including

Residential Aged Care Facilities), in a community setting,

at school or in the workplace.

• HITH care is short-term and preferably interdisciplinary

NSW Hospital in the Home Definition

Daily HITH

• An individual requiring at least daily clinical care and assessment

of their treatment needs - clinically equivalent to an admitted

patient

• Daily HITH substitutes for inpatient care

• Meets the national definition

Intermittent HITH

• An individual with predominantly post-acute care needs who

requires less than daily clinical assessment of their treatment

needs

• Intermittent HITH is clinically equivalent to non-admitted care.

NSW HITH Guideline Implementation

IDHospital In the Home Program :

Phase Two

Aug 2013 Nov 2013Jun 2013 Sep 2013Apr 2013

5/5 15/1230/6 8/1214/4 21/4 1/1215/914/7 29/123/11 22/1225/82/6 10/1128/4 9/6

7

Supporting Communication to LHD’s (letter

to CE’s-ref to ABF, Data mgt, toolkit

?workshop nominees

11

½ day Workshop planning

HITH Self Assessment tool

Present:

A) Guideline

B) Data, Evaluation and Service Agreements

C) Costing / ABF implications

Explore opportunities and barriers in relation

to: Service Delivery Model – key elements +

admission criteria/Target groups

1HITH Program Working Group meetings

2 HITH Program Sponsorship Group meetings

Jan 2014Dec 2013

19/5 4/8 17/1121/7 24/117/716/6 23/612/5

HITH Costing Study -Site nominations8

10

Toolkit development to support LHD’s in

monitoring & Evaluation of HITH

program (disseminated via CEs)

A) Data, evaluation and Service Agreement

measures (suite of measures)

B) Costing / ABF implications

C) Clinical target groups

Finish

31/03/2014

31/03/2014

31/05/2013

13/05/2013

26/06/2013

30/10/2013

Start

12/12/2011

12/12/2011

24/05/2013

06/05/2013

06/05/2013

31/05/2013

3 24/05/201302/04/2013

NSW HITH Guideline Finalization &

Dissemination to LHDs for implementation

phase

May 2013

18/811/8 13/101/9

Jul 2013 Oct 2013

20/1031/3 8/97/4 27/1029/9 6/1028/726/5 22/9

12 28/03/201402/09/2013Monitoring, evaluation and reporting

5 28/06/201324/05/2013NSW HITH Guideline summary page

development, printing and distribution

1

3

4

Feb 2014 Mar 2014

5/1 12/1 19/1 26/1 2/2 9/2 16/2 23/2 2/3 9/3 16/3 23/3

4 17/04/201329/03/2013HITH Revenue survey & evaluation 2

Key Deliverable

Key Deliverable

6 26/07/201314/05/2013Dissemination of NSW HITH Guidelines &

toolkit to LHDs for implementation phase

13 28/02/201403/02/2014Post Implementation survey

14 02/04/201402/04/2014Agency for Clinical Innovation handover

9 27/09/201303/06/2013HITH Costing Study in collaboration

through the ABF Taskforce

We are here

Hospital in the Home Revenue

• In NSW, HITH Financial classes include only

• Medicare

• DVA

• Reciprocal

• Working within Ministry of Health to establish

gazetted rates for HITH in NSW

• Seeking revenue from Private, Motor Accident

Authority, Workcover, overseas patients

Hospital in the Home Costing

• Recommendations from a preliminary study will be

progressed to establish an ABF methodology for

HITH

• The range of HITH models in NSW will be costed

• Daily vs Intermittent

• Home vs Clinic

• GP vs Specialist led

• If approved, data collection to commence in June

2013

Hospital in the Home – Future Directions

• Targeted models of care – Paediatrics / RACF

• GP management – remuneration

• Blended funding models

• Ongoing governance – linking with Agency for

Clinical Innovation

• Expansion of service capacity across the state

NSW HITH Contact details

Rachel Nash

Principal Project Officer

System Relationships & Frameworks Branch

http://www.health.nsw.gov.au/performance/pages/HITH.aspx

rnash@doh.health.nsw.gov.au

(02) 9391 9632

Annette Marley 0477 351 723

amarl@doh.health.nsw.gov.au