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• 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
Recommended