Item 5.1:Hospital Growth FundingAugust 26, 2008

John Lohrenz

Interim Senior Director, PCA

Outline

• Background

• CE LHIN Allocation Model

• Results

• Options:

1. Base Allocation Only

2. Strategic Initiative and Base Allocation

• Next Steps

Background: Funding Announcements

Announcement“LHIN Hospital Growth

Demands Funding”“$120 million over three years to assist hospitals in areas of

high-population growth to meet anticipated demand”

Year 2007-08 2008-09 2009-10 2010-11

Provincial Allocation

$5M allocated to five LHINS $30M $40M/$70M $50M/$120M

CE LHIN Allocation $1,063,372 $4,756,500

“These funds are only to be allocated as base dollars to hospitals in your area facing the fastest growth and the service pressures associated with

these demands.” (MOHLTC Memo, June 9, 2008)

LHIN funding amounts determined using HBAM

Allocation Model: General Approach

1. REGIONALISM: Hospital growth pressures are service pressures

shared by all CE LHIN hospitals = Shared Pressure + Shared

Solution

2. COST BASIS (70%): Direct program cost is valid measure of

program growth, includes cost and volume pressure. Allocation

based on share of costs.

3. IMPORTANCE: What are the Material and Significant pressures?

4. PERFORMANCE (30%): Recognize and fund performance

based on expected costs and expected weighted days.

Steps in the Allocation Process

Trends:

What isMaterial?

What isSignificant?

Direct Costs:

What are the direct costs: Regionally

and by Hospital share?

Determine ‘Pots’:

How much funding is

allocated to growth

services and to performance?

Allocation:Gross Allocation

Less:Shared Program Cost

= Net AllocationX

(Hospital Direct Cost)(Program Pots)

+(Performance Share)

=Final Hospital Level

Allocation

Allocation Model: Step One—Identify Material and Significant Growth

ACUTE INPATIENT DAYS

ICU-CCU INPATIENT DAYS

REHABILITATION INPATIENT DAYS

SURGICAL CASES

MENTAL HEALTH INPATIENT DAYS

EMERGENCY VISITS

531,444

40,779

51,656

162,916

156,770

516,276

2.3%

10.9%

-5.0%

-1.7%

10.2%

-1.0%CLINIC FACE-TO-

FACE VISITS 622,322 4.1%

Step Two: Identify High Direct Costs

ACUTE INPATIENT DAYS

ICU-CCU INPATIENT DAYS

MENTAL HEALTH INPATIENT DAYS

CLINIC FACE-TO-FACE VISITS

2.3%

10.9%

10.2%

4.1%

Service ‘Pots’ Cost Growth Total Direct Costs

$348,324,608

$48,561,314

$32,075,424

$24,362,736

$453,324,082

76.84%

Percent of Total

10.71%

7.08%

5.37%

Total

Step Three: Determine Pot Sizes—Cost Basis

ACUTE INPATIENT DAYS

ICU-CCU INPATIENT DAYS

MENTAL HEALTH INPATIENT DAYS

CLINIC FACE-TO-FACE VISITS

Service ‘Pots’

2.3%

10.9%

10.2%

4.1%

Significance

76.84%

Materiality

10.71%

7.08%

5.37%

45.58%

Combined

30.12%

18.62%

5.68%

Cost Basis: 70% of $4,756,500=$3,320,550

$1,517,739

Cost Allocation

$1,002,771

$619,808

$189,232

Total: $3,329,550

Step Three: Determine Pot Size—Performance Basis

ECPWC

Actual Cost

Weighted Cases

$

Performance Loss

Performance Bonus

Performance Basis: 30% of $4,756,500=$1,426,950

Step Four: Determine Hospital Level Allocations—Option One

Cost BasisHospital Mental Health Clinic ICU-CCU Acute IP

Campellford Memorial Hospital $0 $1,455 $0 $21,120 $21,845 $44,420Ross Memorial Hospital $44,326 $8,736 $50,061 $80,318 $73,939 $257,380Peterborough Regional Health Centre $92,835 $27,186 $156,390 $261,045 $231,969 $769,426Haliburton Highlands Health Services $0 $0 $0 $9,116 $7,925 $17,040Northumberland Hills Hospital $0 $4,058 $32,869 $51,031 $50,313 $138,271Lakeridge Health Corp $120,805 $49,013 $236,142 $320,397 $299,313 $1,025,668Rouge Valley Health System $197,562 $43,797 $263,459 $297,225 $301,302 $1,103,345The Scarborough Hospital $164,281 $54,988 $263,851 $477,486 $440,345 $1,400,951

Total: $619,808 $189,232 $1,002,771 $1,517,738 $1,426,950 $4,756,500

Performance Total Growth

Example: Lakeridge Mental Health19.49% of LHC Total Direct MH Costs X MH Pot of $619,808 = $120,805

+ Clinic + ICU-CCU + Acute + Performance = Total Allocation for LHC ($1,025,668)

Program Share Option: Regional Stroke Strategy

• The issue of LHIN & Stroke Region boundaries has been discussed for some time

• Central East LHIN Board has endorsed $2.7M in funding to achieve “unified stroke care in the LHIN”

• Board has listed as a strategic direction: enhanced stroke care in CE LHIN by 2010

REGIONALISM: Hospital growth pressures are service pressures shared by all CE LHIN hospitals = Shared Pressure + Shared Solution

CE LHIN Stroke Cases 2006-07ICD10 I60-I69

0 10 20 30 405Kilometers

Ajax

TweedMadoc

Hilton

Oshawa

Omemee

Barrie

AuroraCo bo urg

Marmora

Card iff

Toronto

Markham

Lind say

Orillia

Midland

Bancroft

BrightonColborne

Hastings

Uxbridge

Bramp ton

Port Hope

Lakefield

Pickering

W oodville

Newmarket

Belleville

Huntsville

Bobcaygeon

Trent River

Bracebridge

Gravenhurst

Enniskillen

Mississauga

Peterborough

Fenelon Falls

Richmond Hill

Sturgeon Point

Stroke—A Regional Pattern and Problem

Peterborough Acute 1sdand Stroke CasesCESTK06 alcptbodd1sd

PR HC IP 1sd 0506

0 10 20 30 405Kilometers

Ajax

TweedMadoc

Hilton

Whitby

Omemee

Cobourg

Marmora

Cardiff

Toronto

Markham

Lindsay

Orillia

Bancroft

BrightonColborne

Hastings

Uxbridge

Port Hope

Lakefield

Pickering

Woodville

TyendinagaBelleville

Bobcaygeon

Trent River

Bracebridge

Gravenhurst

Enn iskillen

Peterborough

Fenelon Falls

Richmond Hill

Sturgeon Point

Hospital CASESTOTAL

DAYSALC

DAYS % ALCCampbellford 34 910 545 59.9%Ross MH 108 1068 292 27.3%PRHC 235 3628 951 26.2%HHL 8 108 0 0.0%Cobourg 60 555 221 39.8%LHC Bowmanville 74 842 231 27.4%LHC Oshawa 219 2458 772 31.4%LHC Port Perry 28 268 112 41.8%

Total 321 3568 1115 31.3%Rouge--Ajax 126 1790 751 42.0%Rouge--Centenary 216 2649 494 18.6%

Total 342 4439 1245 28.0%Scarborough--Grace 182 2393 726 30.3%Scarborough--General 272 4163 1000 24.0%

960 Total 454 6556 1726 26.3%Grand Total 1578 20964 6097 29.1%

2006FISCAL YEAR

Stroke—Rurality and ALC

Towards a Central East Unified Stroke System • June – September 2007: IHSP and Strategic Direction Advancement – Project Charter to guide Unified

Stroke System in CE LHIN developed and approved by CDPM Steering Committee with leadership of

Northumberland-Havelock Collaborative.

• October 2007: LHIN Board received draft Unified Charter – no funding requested at that time

• November-December 2007: Project charter refined and Annual Service Plan request to MOHLTC identified as target funding source by LHIN Sr. Team

• January 2008: Senior Team met with Provincial Stroke Steering Committee (PSSC)

– CE LHIN supported in efforts to obtain appropriate stroke services in the Durham region.

– MOHLTC and the LHINs requested to address the need for clear accountability for the use of dollars allocated to the Ontario Stroke System.

– Review of alignment of the OSS regions and LHIN boundaries recommended to identify optimal relationships between the LHINs and OSS regions to continue to improve services along the continuum of stroke care.

• Feb-April 2008:

– Direction from MOHLTC to identify resources from within current CE LHIN allocations

– Central East Executive Committee support obtained for creation of a District Stroke Centre in Durham Region working with Lakeridge Health Care

• August 2008: Request to CE LHIN to allocate portion of Hospital Growth Funding for initiation of Durham District Stroke Centre and advancement of Unified Stroke System

Unified Stroke System – CE LHINA Phased Approach

Deliverables

• A phased approach to achieving equitable access to the continuum of stroke services in the CE LHIN

• Establish access to t-PA for stroke in the Durham region through creation of a District Stroke Centre

• Advocate for realignment of the OSS boundaries based on the CE LHIN boundaries.

Funding

2008-09

$300, 000

High growth

Hospital Fund

2009-10 2010-11 3 Yr Total

$534,000Minimum Acute

+$1M (As per

Charter for

continuum of

care)

$1.5M

(As per Charter

for Continuum

of Stroke Care)

$2.35M+

DMF: 84.7%

Alignment• LHIN Strategic Directions• Alternate Level of Care• CDPMDue Diligence• CDPM Steering • Northumberland-Havelock

Collaborative (Charter development)

• HKPR District Stroke System• Central East Ontario Regional

Stroke System• Provincial Stroke Steering

Committee

Unified Stroke System – CE LHINA Phased Approach

300,000SUBTOTALS FOR 2008-09 HOSPITAL GROWTH FUNDING 2008-09 (Sept 08 - March09)

534,500SUBTOTAL: 2009-10 ANNUALIZED UNIFIED STROKE CARE (PHASE 1 AND PARTIAL PHASE 2&3)

60,000Phase 3:Consulting Resources to advance establishment of CE LHIN stroke care continuum- establish LHIN-wide Stroke Steering Cttee-analysis of stroke continuum gaps-impact analysis of boundary realignment

60,000Phase 2:Funds to increase the acute care stroke infrastructure related to t-PA delivery in the CE LHIN:(e.g. contribution toward PRHC and LHC t-PA administration/cost of serum)

Advancing Unified Stroke System

12000Training/Development; Staff training related to delivery of t-PA at the Durham Stroke Centre

10000District Travel and meeting expenses

182500Physician on-call (including the cost of Durham District Stroke Centre Medical Director)

100000Nursing support

110000Stroke Coordinator

Phase 1:Establish District Stroke Centre at Lakeridge Healthcare Corporation to serve Durham Region (i.e. initiate t-PA service delivery and establish regional stroke protocols).

Budget $CE LHIN Stroke System Component

300,000SUBTOTALS FOR 2008-09 HOSPITAL GROWTH FUNDING 2008-09 (Sept 08 - March09)

534,500SUBTOTAL: 2009-10 ANNUALIZED UNIFIED STROKE CARE (PHASE 1 AND PARTIAL PHASE 2&3)

60,000Phase 3:Consulting Resources to advance establishment of CE LHIN stroke care continuum- establish LHIN-wide Stroke Steering Cttee-analysis of stroke continuum gaps-impact analysis of boundary realignment

60,000Phase 2:Funds to increase the acute care stroke infrastructure related to t-PA delivery in the CE LHIN:(e.g. contribution toward PRHC and LHC t-PA administration/cost of serum)

Advancing Unified Stroke System

12000Training/Development; Staff training related to delivery of t-PA at the Durham Stroke Centre

10000District Travel and meeting expenses

182500Physician on-call (including the cost of Durham District Stroke Centre Medical Director)

100000Nursing support

110000Stroke Coordinator

Phase 1:Establish District Stroke Centre at Lakeridge Healthcare Corporation to serve Durham Region (i.e. initiate t-PA service delivery and establish regional stroke protocols).

Budget $CE LHIN Stroke System Component

Program Share Option: Regional Stroke Strategy

• $300,000 2008-09 fiscal cost.

• Net Allocation for Distribution: $4,456,500

Mental Health Clinic ICU-CCU Acute IP

Campellford Memorial Hospital $0 $1,363 $0 $19,788 $20,467 $41,618Ross Memorial Hospital $41,530 $8,185 $46,904 $75,252 $69,275 $241,146Peterborough Regional Health Centre $86,980 $25,472 $146,526 $244,580 $217,338 $720,897Haliburton Highlands Health Services $0 $0 $0 $8,541 $7,425 $15,965Northumberland Hills Hospital $0 $3,802 $30,796 $47,813 $47,139 $129,550Lakeridge Health Corp $113,185 $45,921 $221,248 $300,189 $280,435 $960,978Rouge Valley Health System $185,102 $41,035 $246,842 $278,479 $282,298 $1,033,755The Scarborough Hospital $153,919 $51,519 $247,209 $447,370 $412,572 $1,312,591

Total: $580,716 $177,297 $939,525 $1,422,012 $1,336,950 $4,456,500

$300,000

$4,756,500

Cost BasisPerformance

Total Growth

Hospital

Options:

• Option One:

– Base Allocation of $4,756,500 based on cost and performance.

• Option Two: Staff Recommendation

– Base Allocation of $4,456,500 based on cost and performance;

– Allocation of $300,000 to implement the Durham District Stroke

Centre and creation of unified CE stroke system.

Mental Health Clinic ICU-CCU Acute IP

Campellford Memorial Hospital $0 $92 $0 $1,332 $1,378 $2,802Ross Memorial Hospital $2,796 $551 $3,157 $5,066 $4,663 $16,233Peterborough Regional Health Centre $5,855 $1,715 $9,864 $16,465 $14,631 $48,529Haliburton Highlands Health Services $0 $0 $0 $575 $500 $1,075Northumberland Hills Hospital $0 $256 $2,073 $3,219 $3,173 $8,721Lakeridge Health Corp $7,619 $3,091 $14,894 $20,208 $18,878 $64,691Rouge Valley Health System $12,461 $2,762 $16,617 $18,746 $19,004 $69,590The Scarborough Hospital $10,361 $3,468 $16,641 $30,116 $27,773 $88,360

Total $39,092 $11,935 $63,246 $95,726 $90,000 $300,000

Cost BasisPerformance Total

Option Two Impact

Next Steps

• Communication to hospitals:

– Funds are not for deficit reduction

– Hospitals have to meet their H-SAA obligations

(live within their means and address waiver

conditions).

– Obligation to participate with LHIN, other hospitals

and community organizations to reduce ALC

pressures.