Q U A L I T Y B A S E D P R O C E D U R E SO N TA R I O S T R O K E N E T W O R K - J A N U A R Y 2 0 1 5

Q U A L I T Y B A S E D P R O C E D U R E SO N TA R I O S T R O K E N E T W O R K - J A N U A R Y 2 0 1 5

QBP Implementation Team Meeting Room

O P E R AT I O N A L D I R E C T O R - M E D I C I N E & M E N TA L H E A LT H K I N G S T O N G E N E R A L H O S P I TA L

R E G I O N A L D I R E C T O R - O N TA R I O R E N A L N E T W O R K S O U T H E A S T

R I C H A R D J E W I T T

Q U E S T I O N S . . ?

…with an example…

…and maybe some answers..?

Q U E S T I O N O N E …

How do you achieve innovation, quality and volume within the QBP framework if the funding lag can be up to

18-months and not guaranteed..?

Q U E S T I O N O N E … A C H I E V I N G T H E ‘ Q ’

• Example:: Napanee to KGH stroke transfer

• small community hospital

• not QBP funded & no stroke unit

• 10 -20 patients per year

• large acute centre

• QBP funded regional stroke unit

• pricing impact $99k per annum net new

• [10*CMI(2.0)*Price($4970)] = ~$100k

Q U E S T I O N O N E … A C H I E V I N G T H E ‘ Q ’

• Example :: TIA management

• Don’t admit patients but transfer to urgent access clinic

• admission avoidance saves time, space and resources.

• Its the right thing to do

• How to we support the burgeoning outpatient TIA services?

• 875 patients cost about $150k per year in nursing time alone

Q U E S T I O N O N E … A C H I E V I N G T H E ‘ Q ’

• Answers?

• There’s never a bad time for a good idea..?

• NIKE (Just Do It)… or not…

• Do the ORN-thing and reconcile in year..and across patient-focused clinical bundles…

• Have we got clinical-system coverage by QBPs?

Q U E S T I O N T W O …

How do you manage non-elective, small-population variation and heterogeneous presentations?

Q U E S T I O N T W O … D E A L I N G W I T H VA R I AT I O N

What’s the difference

between 38 & 37?

Q U E S T I O N T W O … D E A L I N G W I T H VA R I AT I O N

• Example:: Hemorrhagic stroke

• 38 cases yr 1, 37 cases yr 2

• CMI 4.61 yr 1 & CMI 3.56 yr 2

• Cost per Case $5452

• Difference in 1 case = $237,702

• Equivalent of about 2.5 physiotherapists

Q U E S T I O N T W O … D E A L I N G W I T H VA R I AT I O N

• Answers?

• Wide-variation, Transfer Funds

• Risk Mitigation &/or in year reconciliation (like the ORN)

• There’s a minimum ‘cost of doing business’ that may need to be underwritten?

• Are there some things that shouldn’t be in the QBP?

Q U E S T I O N T H R E E …

Cross-organization patient flow where pricing is based, rightly, on the patient journey..?

Q U E S T I O N T H R E E … PAT I E N T F L O W

• Example:: Rehab flows

• Patients flow from KGH (acute) to PC (free-standing rehab)

• 5 & 7 day ELOS

• Acute is not Rehab & Rehab is not Acute

• There’s good reason for this

Q U E S T I O N T H R E E … PAT I E N T F L O W

• Answer?

• Acute becomes rehab or Rehab becomes Acute

• Regional Program Funding

• (…just like the ORN…seriously again with the ORN??)

• What happens if they’re not QBP cases, but need rehab - maybe rehab centre shouldn’t take them??

• Reverse [perverse] transfer payments, i.e. you’ll pay for what i don’t want to do

• Mechanism needed for cross organizational transfer payments

M Y Q U E S T I O N S …

• Have we got clinical-system coverage by QBPs?

• Are there some things that shouldn’t be in the QBP?

• Do we need a mechanism for cross organizational transfer payments?

C O N C L U S I O N S

• Our QBP is good - evidence-base is sound and broadly supported

• Care systems are complex and complicated

• ‘Complex’ requires sophistication in solutions

• ‘Complicated’ requires simplicity in thought

– J O H N N Y A P P L E S E E D