Overview of National Partnership Agreement (NPA) on Improving Public Hospital Services & the National Surgery Access Target (NEST)

Sally Howard - Principal Project Officer

System Relations & Frameworks Branch

The National Health Reform Agenda commenced in August 2011

Agreements between all States and Territories in Australia focusing on delivering the funding public hospitals need, increased levels of transparency and accountability, less waste and less waiting for patients.

Source: http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/health-reform-overview

National Health Reform Overview

A new framework for funding public hospitals (ABF)

A focus on reducing emergency department (NEAT) and elective surgery waiting times (NEST)

Increased transparency and accountability across the health and aged care system

A stronger primary care system

The Australian Government taking full policy and funding responsibility for aged care services, including the transfer to the Australian Government of current resourcing for aged care services from the Home and Community Care (HACC) program, in most states and territories except Victoria and Western Australia

Other: Tobacco plain packaging, National Health Services Directory, Personally Controlled eHealth Record, Aged Care Education & Training Incentive program

MyHospitals website

National Partnership Agreement (NPA) on Improving Public Hospital Services • Schedule A: National Elective Surgery Target (NEST) –

Facilitation and Reward Funding – NSW receive $146M in facilitation funding & potential for $63M in reward funding

• Schedule B: Elective Surgery Capital Funding – NSW receive $40.3M – Majority to LHD for equipment purchase

– RFID readers & IT system

– Macular degeneration equipment – Liverpool, Westmead, Sydney Eye & POW

– Conversion of procedure rooms Tweed, JHH, Belmont

*National Partnership Agreement (NPA) on Improving Public Hospital Services, pg 14 - 26 http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/npa-improvingpublichospitals-agreement

National Partnership Agreement (NPA) on Improving Public Hospital Services • Schedule C: National Emergency Access Target

(NEAT) – Facilitation and Reward Funding – NSW receive $96.9M in facilitation funding & potential for $63.6M in reward funding

• Schedule D: Emergency Department Capital Funding – NSW receive $72.5M

• Schedule E: New Subacute Beds Guarantee Funding – NSW has potential to receive $527.4M

• Schedule F: Flexible Funding Pool - NSW receive $56.2M

*National Partnership Agreement (NPA) on Improving Public Hospital Services, pg 14 - 26 http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/npa-improvingpublichospitals-agreement

National Elective Surgery Target (NEST)*

The National Elective Surgery Target (NEST) is divided into two complementary strategies.

• Part 1: Stepped improvement in the number of patients treated within the clinically recommended time.

• Part 2: A progressive reduction in the number of patients who are overdue for surgery, particularly patients who have waited the longest beyond the clinically recommended time.

*National Partnership Agreement (NPA) on Improving Public Hospital Services, pg 14 - 26 http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/npa-improvingpublichospitals-agreement

National Elective Surgery Targets (NEST) –Part 1

• Definition : By 2015 100% of all Urgency Category patients waiting for surgery are seen within the clinically recommended time

Time Cat 1 Target Cat 2 Target Cat 3 Target

Baseline 92.3% 86.6% 89.4%

By Dec 2012 96% 90% 92%

By Dec 2013 100% 93% 95%

By Dec 2014 100% 97% 97%

By Dec 2015 100% 100% 100%

*National Partnership Agreement (NPA) on Improving Public Hospital Services, pg 20 http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/npa-improvingpublichospitals-agreement

National Elective Surgery Targets (NEST) - Part 2 • Definition : By 2015 the average overdue wait time

will be 0 days for those patients who have waited beyond the clinically recommended time

Cat 31 Dec 10 (Baseline)

31 Dec 12 (Target)

31 Dec 13 (Target)

31 Dec 14 (Target)

31 Dec 15 (Target)

1 0 days 0 days 0 days 0 days 0 days

2 39 days 29 days 20 days 10 days 0 days

3 130 days 98 days 65 days 33 days 0 days

*National Partnership Agreement (NPA) on Improving Public Hospital Services, pg 22 http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/npa-improvingpublichospitals-agreement

$209.2M from the National Elective Surgery Target (NEST) Facilitation & Reward Funding

Year Facilitation Reward (part 1)

Reward (part 2)

2010/11 $114.9M - -

2011/12 $31.1M - -

2012/13 - $7.9M $7.9M

2013/14 - $7.9M $7.9M

2014/15 - $7.9M $7.9M

2015/16 - $7.9M $7.9M

TOTAL $146M $31.6M $31.6M

*National Partnership Agreement (NPA) on Improving Public Hospital Services, pg 17 & 29 http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/npa-improvingpublichospitals-agreement/$File/National%20Partnership%20Agreement%20on%20Improving%20Public%20Hospital%20Services.pdf

Surgical Categories: recommended timeframes for elective surgery Surgical Category Description of recommended timeframes

Category 1 admission within 30 days desirable for a condition that has the potential to deteriorate

quickly to the point that it may become an emergency

Category 2 admission within 90 days desirable for a condition causing some pain, dysfunction or

disability but which is not likely to deteriorate quickly or become an emergency

Category 3 admission at some time in the future acceptable for a condition causing minimal or no

pain, dysfunction or disability, which is unlikely to deteriorate quickly and which does not

have the potential to become an emergency.

Not ready for Care A not ready for care patient can be defined as a patient who is not available to be admitted

(NRFC) to hospital until some future date and is either:

• Staged (meaning the patient is not ready for clinical reasons e.g. check cystoscopy that

is part of a periodic treatment)

• Deferred (meaning the patient is not ready for personal reasons e.g. the patient is

going on a holiday)

A postponement of admission by the hospital does not render the patient NRFC. These

patients should remain on the waiting list as they are still genuinely waiting, but are

delayed

Source: The Australian Institute of Health and Welfare (AIHW) (2008) National Health Data Dictionary no. 14, National Benchmarks. Urgency with which the patient requires elective hospital care/surgery

Examples of procedures Surgical Category Description of procedures

Category 1 Most Cancer surgeries e.g. Bowel cancer, breast cancer, bladder cancer

Certain Cardiac Surgery e.g. Coronary artery bypass graft (CABG), cardiac stents

AAA (abdominal aortic aneurysm) repair – leaking main blood vessel in abdomen

Amputation limb

Category 2 Amputation of finger/toe

Certain gynaecological procedures e.g. D&C, hysteroscopy (telescope into uterus)

Certain urological procedures e.g. Removal testes, enlarged prostate surgery

Certain ENT procedures e.g. Tonsils & adenoids, FESS (functional endoscopic sinus

surgery)

Category 3 Cataract surgery

Hip/Knee replacement

Vasectomy

Ingrown toenail

NRFC (Staged) Check cystoscopy

Series of treatments/procedures e.g. Expansion of skin

Removal of orthopaedic hardware e.g. Pins & plates

prior to grafting

Results so far...

And receiving reward payments

NEST (National Elective Surgery Target) – Part 1

Definition : By 2015 100% of all Urgency Category patients waiting for surgery are seen within the clinically recommended

time

Time Cat 1 Target

Cat 2 Target

Cat 3 Target

Baseline 92.3% 86.6% 89.4%

By Dec 2012 96% 90% 92%

By Dec 2013 100% 93% 95%

By Dec 2014 100% 97% 97%

By Dec 2015 100% 100% 100%

NEST Part 1- Receiving Reward Payments

• Reward payments rolled over to next reporting period if target not achieved A22 If a jurisdiction does not achieve the target for a period any unpaid reward payment will be added to the reward payment available to the jurisdiction in the next period. Any reward payments which are not made by the end of this Agreement will not be available to jurisdictions

• Reward payment given only if above baseline volume A23 Part 1 is comprised as follows: (a) Up to $100 million will be provided on the basis of proportional performance against the targets shown in Tables A5 to A7. This is also dependent on the volume of elective surgery being at least maintained and not going below the baseline. (b) Maintenance of effort once targets have been reached is required to receive ongoing reward funding.

• Minimal achievement must be met (50% between baseline & target) to receive reward payment A24 A jurisdiction’s minimum achievement to receive reward funding for a period is 50 per cent of the distance between the target for the preceding period and the target for the current period (or between the baseline and the target for the period in respect of the first period).

• Maximum achievement to receive all reward funding is 98% for all categories A25 Where a target for a jurisdiction is 98 per cent or higher (as set out in Tables A5 to A7), a jurisdiction will receive all the reward funding available, for that category in that year for that jurisdiction, if at least 98 per cent of patients within that jurisdiction receive surgery within

the clinically recommended time.

• If achieve less than baseline no reward & no ability to roll reward payment to next period A34 A jurisdiction is not eligible to receive any reward payment for a period if its achievement against any of the three targets in that period is less than the baseline in Tables A5 to A7. Any reward payment that is not paid in this case does not carry over to later periods.

• Reward payment split 3 ways between each category per year A35 A jurisdiction’s available reward payment under Part 1 will be split three ways, linked equally to each of the targets for Urgency Categories 1, 2 and 3 set out in Tables A5 to A7.

Achieving Reward Payment NEST Part 1 Time Cat 1 Minimal Results Cat 2 Target Minimal Results Cat 3 Minimal Results

Target achievement Achieved achievement Achieved Target achievement Achieved to receive to receive to receive

reward reward reward payment Cat payment Cat payment Cat

1 2 3

Baseline 92.3% 86.6% 89.4%

By Dec 2012 96% 94.2% 90% 88.3% 92% 90.7%

Reward payment given only if above baseline volume (A23) Jan-Dec 2011 = 209,116 & Jan-Dec 2012 = 212,795

Minimal achievement must be met (50% between baseline & target) to receive reward payment (A24) Achieved 95% for Cat 1 this is above minimal achievement & above target on Cat 2 & 3

If achieve less than baseline no reward & no ability to roll reward payment to next period Achieved above baseline in all categories

INTERPRETATION – able to receive total reward payment for NEST PART 1 for Jan-Dec 2012 assessment period based on above = $7.9M

NEST (National Elective Surgery Target) – Part 2

Definition : By 2015 the average overdue wait time will be 0 days for those patients

who have waited beyond the clinically recommended time

Cat 31 Dec 10 (Baseline)

31 Dec 12 31 Dec 13 31 Dec 14 31 Dec 15

1 0 days 0 days 0 days 0 days 0 days

2 39 days 29 days 20 days 10 days 0 days

3 130 days 98 days 65 days 33 days 0 days

NEST Part 2 - Receiving Reward Payments • Reward payments rolled over to next reporting period if target not achieved A22 If a jurisdiction does not achieve the target for a period any unpaid reward payment will be added to the reward payment available to the jurisdiction in the next period. Any reward payments which are not made by the end of this Agreement will not be available to jurisdictions

• % proportion of reward payment received based on % reduction of patients waiting longer than clinically recommended times

A26(a) Up to $100 million will be provided on the basis of proportional performance on the progressive reduction in the number of patients, who have waited longer than the recommended waiting times (long waits). (For example, if a jurisdictions’ progress is a 20 per cent reduction, 20 per cent of the allocated reward funding will be made available.)

• Must do 10% tail to be considered to received PART 2 reward funding A26(c) In each category, of the patients who have not had their procedure within the clinically recommended time, the 10 per cent of patients who have waited the longest must have their procedure in each year. This is a requirement to receive Part 2 reward funding.

• Adjustments can be made if exceptional circumstances exist that impacts achieving targets A30 Following receipt of an assessment from the COAG Reform Council, prior to a determination of a reward payment, the Commonwealth has discretion in the application of any adjustment having regard to any exceptional circumstances that may have impacted on a State or Territory’s capacity to meet the performance indicators or targets.

• If achieve less than baseline no reward received & no ability to roll reward payment to next period A34 A jurisdiction is not eligible to receive any reward payment for a period if its achievement against any of the three targets in that period is less than the baseline in Tables A5 to A7. Any reward payment that is not paid in this case does not carry over to later periods.

• To receive Part 2 reward must achieve 10% tail & all average overdue waiting time targets A39 A jurisdiction’s available reward payment under Part 2 will be contingent on achieving the target in all Categories in Table A8 and Clause A 26 (c).

National Elective Surgery Targets (NEST) –Part 2

Cat

31/12/11 (Baseline)

31/12/12 (Target)

Actual 31/12/12

31/12/13 (Target)

31/12/14 (Target) 31/12/15(Target)

1 0 days 0 days 0 days 0 days 0 days

2 39 days 29 days 20 days 10 days 0 days

3 130 days

98 days 65 days 33 days 0 days

*National Partnership Agreement (NPA) on Improving Public Hospital Services, pg 22 http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/npa-improvingpublichospitals-agreement

Achieving Reward Payment NEST Part 2

Must do 10% tail to be considered to received PART 2 reward funding Achieved by June 30 2012

Adjustments can be made if exceptional circumstances exist that impacts achieving targets

If achieve less than baseline no reward & no ability to roll reward payment to next period

INTERPRETATION – to early to call

Cat 31/12/11 - Baseline

31/12/12 - Target

Results Achieved

1 0 days 0 days TBA

2 39 days 29 days TBA

3 130 days 98 days TBA

Questions