Activity Based Funding Maternity Services “ A Divisional Perspective”

Activity Based Funding
Maternity Services
“A Divisional Perspective”
Susan Gannon: Divisional Director
Women’s & Children’s Services
Western Health
The Health Reform Agreement
Commonwealth
State
National Funding Pool Comprising of individual state accounts
State Managed Fund
Local Health Networks
Health Services
Hospitals
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Hospitals
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At a Local Level
Local Health Networks
Health Services
Hospital
Hospital
Emergency Services
Medical Services
Surgical Services
Women’s & Children’s Services
Hospital
Cardiac & Crit Care Services
Subacute & Mental Health Services
Maternity Services
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Allocation of Funds
• Based on last years activity
• Separations
• Activity Based Funding Target (WIES & VACS) to be (NWAU)
• Predicted growth
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Overall Benefits of ABF
• Allows for the capture of consistent information on activity and costs
• Provides benchmarking to manage variations in costs and practices
leading to greater efficiencies
• Demonstrates the relationship between services provided and the funds
allocated
• Does it lead to rewarding good practice to improve quality and safety?
Or
• How could it ?
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Midwifery Services
How does it differ from other Acute Services?
• All care can be delivered in the community (unless clinically indicated)
• There is a need to provide a seamless service between acute settings and the
community for our families
• Maternity Services are not bound by walls of a hospital
• How do we ensure women are receiving continuity of care when transferred from
one health service to another, from one provider to another or from the community
to the hospital?
• Does activity based funding allow for this integration of care providers?
• Is activity based funding determining care models ?
• However, having a national system there is an opportunity for greater analysis,
benchmarking and review
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Pricing
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Case Review: Sunshine Hospital
How activity based funding influences revenue or
How care models influence revenue
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2011/12 Weights Recorded Victoria
Vaginal Birth
Caesarean Birth
Hospital
Average weight per separation
Hospital
Average weight per separation
Statewide
0.712227041
Statewide
1.644287182
Sunshine Hospital
0.694995617
Sunshine Hospital
1.566685753
Hospital 2 *
0.724676193
Hospital 2 *
1.747877531
Hospital 3 *
0.779579016
Hospital 3 *
1.767439283
Hospital 4 *
0.777130196
Hospital 4 *
1.78840064
Hospital 5
0.716397075
Hospital 5
1.590204876
Hospital 6
0.706511144
Hospital 6
1.574610222
Hospital 7
0.682114562
Hospital 7
1.578055219
Hospital 8
0.663772999
Hospital 8
1.553209695
Hospital 9
0.686268887
Hospital 9
1.553209695
Hospital 10
0.714724493
Hospital 10
1.578055219
Hospital 11
0.634895777
Hospital 11
1.564562543
Hospital 12
0.720412852
Hospital 12
1.590603446
Hospital 13
0.632127027
Hospital 13
1.574860218
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Why is the alarming for Sunshine
Hospital?
• Decreased revenue
• Low socioeconomic demographic
• High refugee area
• Increasing complexity of clients
• High BMI numbers
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Why lower weights?
High Cost Weights
• Models of Care
•
•
•
•
Midwifery Group Practice
Home Birth Program
Efficient Early Discharge program
Over 70 % Midwifery lead care
• Ambulatory Management
Low Cost Weights
• Inefficient Coding
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Western Health Maternity Model of Care
Private
Midwifery
• 49 Community Clinics
• Integrated models with
local councils
• Western Collaborative
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Sunshine Hospital
• 1,080 Women per year in Midwifery Group Practice which includes
homebirth
• 76% women in a midwifery care model
• Close to 600 births per obstetrician
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Pregnancy Care
Lead Pregnancy % Sunshine
Care Provider
% Statewide
% Public Hospitals
% Private Hospitals
Obstetrician
9.3
55.0
36.4
99.2
Midwife
76.3
25.7
36.2
0.0
GP
12.6
17.5
24.9
0.2
None
0.2
1.0
1.2
0.0
The Consultative Council on Obstetric and
Paediatric Mortality and Morbidity (CCOPMM) 2009 Data Set
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Intrapartum Care
Lead
Intrapartum
Care Provider
% Sunshine
% Statewide
% Public Hospitals
% Private Hospitals
Obstetrician
30.5
62.9
48.2
98.3
Midwife
68.8
28.0
39.0
1.4
GP
0.1
8.5
12.0
0.2
None
0.6
0.5
0.6
0.1
The Consultative Council on Obstetric and
Paediatric Mortality and Morbidity (CCOPMM) 2009 Data Set
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2012/13 Weights (Victoria)
DRG
Same Day
Inlier
Average LOS
Vaginal uncomplicated
0.4586
0.8478 2.4
Vaginal Complications
0.5042
0.9568 2.7
Vaginal Catastrophic
0.5590
1.269 3.8
DRG
Same Day
Inlier
Average LOS
Caesarean Delivery 1.0737
1.7826 3.9 Caesarean Severe
1.2588
2.1297 4.9
Caesarean Catastrophic
1.0355
2.8535 7.2
1 = $4,270
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What does this mean in $$ terms ?
DRG
Same Day
Inlier
$ Difference
Vaginal uncomplicated
0.4586
0.8478 $1,665
Vaginal Complications
0.5042
0.9568 $1,696
Vaginal Catastrophic
0.5590
1.269 $2,776
DRG
Same Day
Inlier
$ Difference
Caesarean Delivery 1.0737
1.7826 $3,330
Caesarean Severe
1.2588
2.1297 $3,928
Caesarean Catastrophic
1.0355
2.8535 $7,891
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Vaginal Birth Exercise
• 5,000 births
• Caesarean rate of 28%
• 3,600 Vaginal Deliveries
• 50% were same day
• Revenue $3,457 800 as apposed to $6,454,800
• Saving or a loss of $2,997,000
•
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Saving or loss perspective will depend on efficiency of service in the initial
phase
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Midwifery Group Practice (MGP)
Births
MGP EFT
EFT Reduction
EFT Gap
Bed Stock
270
6
0.69
5.31
0
540
12
8.4
3.56
4
810
18
19.94
+1.95
8 + 1 Birth
1080
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23.95
0.05
12 + 1 Birth
The staffing to delivery the model is still required
therefore the staffing costs remain unchanged with the
reduced weights for decreased LOS therefore less
revenue for Maternity Service
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Health Round Table Data Vaginal Birth
• For complicated vaginal deliveries 4% decrease in LOS
• For women with co-morbidities 14% decrease in LOS
• Normal vaginal Delivery 16% shorter LOS
• 35% of women discharged before midday compared to state average
28%
• Sunshine saves 500 bed days more each year than the Victorian
average
• Emergency readmission rate is 66% lower than the Victorian average
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Health Round Table Data Caesarean
• 19% shorter than state average
• 51% discharged before midday compared to 37%
• Readmission rate 3% lower
• Save 700 bed days
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Ambulatory Care
• Pregnancy Day Stay Units
•
•
•
Iron Infusions
CTG Monitoring
AFI’s
Does it lead to rewarding good practice to
improve quality and safety?
• Breastfeeding Centres
• Admission Criteria of 4 hours with observation
• $177 as an outpatient
• $460 as an day admission
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Coding
• Raising the weights to gain increased funding
•
•
•
•
•
Co-morbidities
Complications
NWAU Aboriginal & Torres Straight Islanders
NWAU Remote adjustments
Note that the unqualified baby is as a package with the mother
• Accurate data recording and collecting and timely
• Audit
• Medical, midwifery and clerical education
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2012/13 Weights (Victoria)
DRG
Same Day
Inlier
Average LOS
Vaginal uncomplicated
0.4586
0.8478 2.4
Vaginal Complications
0.5042
0.9568 2.7
Vaginal Catastrophic
0.5590
1.269 3.8
DRG
Same Day
Inlier
Average LOS
Caesarean Delivery 1.0737
1.7826 3.9 Caesarean Severe
1.2588
2.1297 4.9
Caesarean Catastrophic
1.0355
2.8535 7.2
1 = $4,270
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National Approach
• Will allow for analysis between like services
• Allows for a greater voice in funding to promote women centred care
• Will demonstrate inefficiencies in care
• The question not yet answered is it the right funding model for a service
which should move between primary and acute care streams
• From a Western Health perspective, does it allow for the model of care
that is integrating services for Western Region of Victoria ? Or could it
stifle innovation?
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United Kingdom
Maternity Services Pathway Payment System
•
•
•
Supported by the Royal College of Midwives, Royal college of Obstetricians
and Gynaecology
April 2013
Single payment approach where the lead maternity provider is responsible
for providing care or payment if transfer is required
•
•
•
•
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Standard Care
Intermediate
Intensive
The system is to promote a culture based on normality to support providers
that attract women to chose normality rather than intervention
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This is Our Quantum Leap:
Breaking down boundaries
Maximising funding streams
• 4 Acute sites providing maternity care
• Medicare Locals
• Local Government
• Universities
• DoH
• Multiple Community Services
Mothers and Babies of the West
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The Western Collaborative Strategic Plan Does ABF lead to rewarding
good practice to improve
quality and safety in Maternity?
Collaborative Models of Care
Community Integration
.
Mothers & Babies of the West
2012 - 2022
Consumer centred, safe and accessible How does ABF promote:
• Continuity of care models
• Integration of care streams
• Lower LOS
• Decreased caesarean section
rate
• Increased breastfeeding rates
• Improved mortality &
morbidity rates
services
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Let the debate/discussion begin !
What are your thoughts?
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