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Irene Jansen

New hospital financing models not without risks - 1 views

www.vancouversun.com/...story.html

ABF

shared by Irene Jansen on 23 Jan 12 - No Cached
  • The provinces of British Columbia, Alberta and Ontario have each recently announced plans to tackle this problem by introducing what is referred to as activity-based funding (ABF)
  • If the objective of implementing ABF is to reduce waiting times, shortening the lengths of stay is a desirable outcome. Plus, ABF creates incentives for hospitals to take the initiative to discharge "bed blockers"
  • However, ABF creates its own set of problems: incentives for hospitals to provide the most "profitable" types of care by treating the least ill, and to centralize services, which may improve efficiency but reduces access for small and remote communities.
  • ...1 more annotation...
  • The biggest criticism of ABF is that while aiming for increased efficiency, hospitals may "skimp" on quality. Careful monitoring of hospital quality has helped to avoid this.
Irene Jansen

Canadian Doctors for Medicare | Activity-Based Funding (ABF) 2008 - 0 views

www.canadiandoctorsformedicare.com/abf-bulletins.html

privatization abf important funding cdm

shared by Irene Jansen on 06 Mar 12 - No Cached
  • Under ABF the services that patients receive in hospitals for a particular illness are classified into clinical groups that use similar levels of hospital resources. Hospitals receive a fixed amount for treating patients in these groups. The money follows the patient to the facility that provides the service. Thus, hospitals do not receive an annual budget from the government based on what was spent last year, but instead receive money based on the numbers of patients seen with a given medical problem and diagnosis-related group classification.
Govind Rao

Prelude to a Systematic Review of Activity-Based Funding of Hospitals: Potential Effect... - 0 views

www.openmedicine.ca/...526

funding health care

shared by Govind Rao on 27 Nov 13 - No Cached
  • decision-makers throughout the country are now seriously considering an alternative funding model referred to as activity-based funding (ABF). Under this system, hospital services are classified prospectively into clinically meaningful “bundles” of care that use similar levels of resources.
  • In contrast with global budgeting, ABF pays hospitals per episode of care for each patient served. In simple terms, the money follows the patient. Under this system, hospital services are classified prospectively into clinically meaningful “bundles” of care that use similar levels of resources. These bundles take into account patient characteristics such as diagnosis and complexity, along with anticipated volume and intensity of care. Different jurisdictions use various terms to describe these bundles of services; for example, they might be called “diagnosis-related groups” in the United States and “health-resource groups” or “case-mix groups” in Canada.1 Various costing methods are used to set a “price” for the bundle of services provided to each patient during a hospital stay.
CPAS RECHERCHE

Looking abroad to cure Canada's healthcare ailments | Financial Post - 1 views

business.financialpost.com/...as-health-care-be-found-abroad

funding ABF

shared by CPAS RECHERCHE on 18 Jun 14 - No Cached
  • One of the hurdles to adopting ABF more widely is a lack of data about many dimensions of health care in Canada, including demographics and the specific costs of many aspects of delivering services, and the analytic capacity to develop an accurate funding formula based on those factors
  • Global budgets provide predictability, which is useful for planning purposes for providers as well as administrators,” she points out, “and it helps hospitals to live within their means, which is generally a good thing. But the downside is that this can affect access to care, because there are incentives to do less if the hospital faces going over budget.”
  • incentive to innovate or find efficiencies when funding levels are fixed by a global budget, rather than geared to delivery of services.
  • ...6 more annotations...
  • Some countries using this system, including the UK’s National Health Service, found a tendency to “cherry pick”
  • “Healthcare systems evolve within the context of a specific culture, economy, politics and history and what worked in one place or time won’t necessarily work in a different country, or now,”
  • To that point, the differences between German and Canadian public health care go far beyond funding mechanisms
  • It’s really the result of almost a century and a half of evolution, and it’s very organic to Germany.
  • is cost control particularly as it relates to salaries and access to new drugs and procedures.
  • The negotiations between hospitals, providers and funds are really the key to lower spending, rather than direct competition between the funds.
Govind Rao

New funding model a leap of faith for Canadian hospitals - The Globe and Mail - 0 views

m.theglobeandmail.com/...article22100796

from heather funding hospital afb

shared by Govind Rao on 05 Jan 15 - No Cached
  • Dec. 16 2014,
  • Most Canadians probably don’t realize that health care in Canada is quietly undergoing a major transformation in funding that could significantly impact patients. Three provinces – Quebec, Ontario and British Columbia – are implementing a new funding model for hospitals and other provinces are watching with interest.
  • Canadian hospitals have been traditionally funded through annual lump-sum payments – global budgets – meant to pay for all care each institution delivers. The good thing about global budgets is that they are predictable, stable and administratively simple. The problem with global budgets, critics argue, is they lack incentives to boost efficiency, are not transparent and funding is not targeted to priority areas.Enter activity-based funding (ABF). Under ABF, hospitals receive a pre-determined fee for each episode of care, intended to fund the bundle of services provided to each patient with a particular diagnosis, regardless of the actual costs for any particular patient. The fee is expected to account for the anticipated complexity, type, volume and intensity of care ordinarily provided to clinically similar patients.
Irene Jansen

Long-term care operators warn of cuts over new funding model (part 2) - 0 views

www2.canada.com/...story.html

abf Alberta ltc wages privatization

shared by Irene Jansen on 29 Jan 13 - No Cached
  • one of the issues with the new approach is that it assigns money based on the provincial average cost of a health worker, but staff at many non-profit operations are longer-term employees who make more than average
  • In addition, non-profits typically offer more expensive benefits, including higher pension
  • the biggest problem is the long-term-care sector overall is underfunded
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  • Any cuts to contracted operators, both for-profit and non-profit, will begin April 1, but will be phased in over three years
Irene Jansen

Long-term care operators warn of cuts over new funding model (part 1) - 0 views

www2.canada.com/...story.html

abf Alberta ltc wages privatization

shared by Irene Jansen on 29 Jan 13 - No Cached
  • Two not-for-profit agencies that together operate more than 1,000 long-term care beds in Alberta say their operations are financially strained and they will need to consider staffing or service reductions unless the government gives them more money.
  • T he Shepherd's Ca re Foundation in Edmonton and Calgary-based Bethany Care Society say a new patient-based funding model from Alberta Health Services is insufficient to manage rising expenses.
  • AHS pushes ahead with the new funding model, which it says is designed to ensure equality for all long-term care residents, whether their care is provided by a public institution, a not-for-profit agency or a for-profit corporation.
  • ...2 more annotations...
  • uses a formula to take into account the needs of each patient, calculate the health resources required, and then allocate a standard funding amount
  • The old system was considered more uneven, in that different long-term care operators each received a block of funding based on individual agreements with health authorities.
Irene Jansen

Canadian hospitals turn to Internet to fight emergency room wait times | News | Nationa... - 0 views

news.nationalpost.com/...ight-emergency-room-wait-times

report cards competition abf on hospital alberta

shared by Irene Jansen on 18 Apr 12 - No Cached
  • Patients who log on to the website for Calgary’s hospitals are offered a surprising choice these days: wait times for four emergency departments across the city, posted automatically, 24/7 in “real time.”
  • Kitchener has just become the first in that province to launch its own, enhanced version of the same idea
  • Administrators argue the online information should help patients better decide where to seek out medical aid, spur staff to improve service — and one day even fuel competition between hospitals under new, demand-based funding models.
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  • worry about doctors and nurses cutting corners to speed up the Internet clock, and critically ill patients staying clear of their local hospital because of long queues that might not even apply to them.
  • “It leads to the commercialization of the care we provide in emergency departments,” said Dr. Peter Toth, president of the Canadian Association of Emergency Physicians. “It’s a marketing strategy, perhaps. I’m not sure how it really adds to the overall quality of the experience.”
  • Ontario moves to so-called patient-based funding of hospitals, where the province pays hospitals per patient treated, rather than handing over money in annual lump sums.
  • it seems people are still largely choosing the hospital nearest them, not necessarily the one with the shortest wait time.
  • For the staff working in emergency departments, though, the online postings could have unwanted effects, pushing them to give short shrift to some patients to improve the numbers and satisfy superiors, said Dr. Brian Goldman
  • He also worries about patients choosing the hospital that posts the shortest wait times, potentially meaning a longer trip that could prove fatal for someone suffering a heart attack.
Irene Jansen

Drummond report to cut deeper and last longer than Harris reforms of 1990s | rabble.ca - 0 views

rabble.ca/...st-longer-harris-reforms-1990s

on drummond abf privatization cuts

shared by Irene Jansen on 19 Feb 12 - No Cached
  • By Jonah Gindin | February 16, 2012
  • February 16, 201
  • Just six weeks before the expected announcement of the Ontario provincial budget
  • ...11 more annotations...
  • The report contains 362 recommendations, over 100 of which focus on health care
  • According to Drummond, eliminating the deficit by 2018 will require cutting program spending in real terms by 16.2 per cent over the next seven years. The Conservative government of Mike Harris cut program spending by 4.7 per cent in the first four years, but was forced to raise spending in the second term for a total increase of 5.6 per cent over the 8-year period.
  • Michael Hurley, President of the Ontario Council of Hospital Unions, says that bringing more profit motive into health-care services will be bad for quality and for costs. Speaking of the recent scandal involving Ontario's Air Ambulance service ORNGE, Hurley notes, "They gamed the system for millions of dollars of public funds. It appears as though the Liberals are willfully blind to the lessons from the ORNGE fiasco."
  • The Commission was prohibited from considering revenues, but a recent report from the Canadian Centre for Policy Alternatives has shown that Ontario's deficit is largely equal to the cuts to capital, corporate and income taxes under the Liberal and Conservative governments of the last 15 years.
  • In the last year for which calculations were available, Ontario had forgone $15 billion in revenues due to these tax cuts.
  • Under pressure from the New Democratic Party, Finance Minister Dwight Duncan said yesterday that he is considering delaying further corporate tax cuts.
  • In health care, Drummond calls for changing hospital funding to an "activity-based financing" model,
  • A related recommendation calls for allowing more for-profit private sector companies to provide health services, while keeping payment under OHIP.
  • The report also recommends moving more patients out of hospitals and into care in the community. But a recent report by the Ontario Health Coalition questions where these patients will go unless home care and long-term care are significantly expanded.
  • In a departure from past years, there will be no public budget hearings this year. Instead, Finance Minister Dwight Duncan is holding a series of telephone town-halls.
  • limiting job security provisions for unionized public sector workers
Irene Jansen

Make money follow hospital patients - 0 views

www.nationalpost.com/...story.html

abf neoliberalism quebec

shared by Irene Jansen on 23 May 12 - No Cached
  • activity-based funding
  • The B.C. government set up a program that applies the new approach to about 17% of hospital funding.
  • Last March, the Ontario government announced that the province will begin reimbursing 91 hospitals (excluding 55 other, smaller hospitals) on the same basis.
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  • The Quebec government has reacted by convening a panel of experts whose mandate is to evaluate the feasibility of a pilot project on activity-based funding for the hospital network.
  • Reforming hospitals' funding model also paved the way for other changes to the English health-care system that have produced beneficial results. Patients can now choose the hospital in which they will be treated, and hospitals compete to attract them.
  • Yanick Labrie is an economist at the Montreal Economic Institute.
Irene Jansen

A slate of health-care promises for PQ to keep in Quebec. Health Edition - 1 views

www.healthedition.com/article.cfm

quebec election seniors abf

shared by Irene Jansen on 07 Sep 12 - No Cached
  • The first health-related promise made by the PQ during the campaign was for “revolutionary change” in seniors’ care. The PQ would institute a provincial policy on home care, boost annual funding from $381 to $500 million a year, and provide more support for family caregivers.
  • It would also create a special fund to ensure the needs of the aging population are met within the public system, and that services are accessible to all regardless of income.
  • the health minister-designate (although not yet official) is Dr. Réjean Hébert, a renowned geriatrician and until two years ago dean of medicine at the Université de Sherbrooke
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  • The PQ also wants to ensure every Quebecer has a family doctor, something it plans to accomplish in the next four years. To do this it will expand the current model of team-based primary care called groupes de médecine de famille (GMFs) – adding 61 to the current complement of 244 at a cost of $36 million, according to the party’s financial plan.
  • Furthermore, the PQ wants more emphasis on the health-care “team” by making better use of nurses (including more nurse practitioners), pharmacists and others. The financial plan earmarks another $60 million for additional manpower in GMFs.
  • The PQ would also move ahead with activity-based funding for hospitals
  • The PQ has not said categorically that it would do away with the ASSS, but during its time in opposition it said the health ministry is overly involved in day-to-day operations of health care.
  • One promise that will please taxpayers is the elimination of the provincial health premium – a $200 head tax – that collects about $1 billion a year
  • The PQ would recoup about 60 per cent of the revenue lost from the premium by adding two new income tax brackets for people earning more than $130,000 and $250,000 per year.
Irene Jansen

Hospital's heart diagnoses surge after pay changed | California hospital - 0 views

www.sfgate.com/...article.cgi

fraud abf us

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Chino Valley Medical Center in San Bernardino County claimed that 35.2 percent of its Medicare patients were suffering from acute heart failure
  • That's six times the state average
  • the hospital's parent company, Prime Healthcare Services
  • ...9 more annotations...
  • The hospital appears to have taken advantage of Medicare rule changes that authorized bonus payments for treating patients with major complications.
  • national data shows about 5 or 6 percent of Medicare patients have acute heart failure as a primary diagnosis
  • the chain, based in Ontario, is the target of a federal investigation for suspected Medicare fraud involving "upcoding"
  • That probe, by the U.S. Department of Health and Human Services, was requested by two lawmakers in response to the chain's high rate of blood infections known as septicemia
  • several former Prime doctors and coders have contended that Prime's founder and board chairman, Dr. Prem Reddy, urged aggressive coding of routine medical conditions to obtain enhanced Medicare payments
  • Earlier this month Prime sued Kaiser and the Service Employees International Union, accusing them of conspiring to drive Prime from the Southern California health care market in violation of antitrust laws.
  • Sandy Barber, a coding supervisor who worked at Prime's Desert Valley Hospital in Victorville in San Bernardino County, testified in a 2005 employment lawsuit that Reddy convened meetings where he "ordered" coders to engage in illegal upcoding to boost reimbursements from Medicare.
  • It's a 126-bed facility that Prime obtained in 2004 after the prior owners, a physicians group, went bankrupt.
  • California Watch, the state's largest investigative reporting team, is part of the independent, nonprofit Center for Investigative Reporting.
Irene Jansen

The Mowat Centre for Policy Innovation. A TRANSFORMATIVE BLUEPRINT FOR REDUCED COSTS, I... - 0 views

www.mowatcentre.ca/press-releases.php

abf private clinics competitive bidding it

shared by Irene Jansen on 23 Jan 12 - No Cached
  • the Mowat Centre at the University of Toronto has released a blueprint for transformative changes to the healthcare system
  • The report recommends five significant changes: • Modernize the organization of hospitals, with academic centres focused on diagnostic work-ups, specialty clinics providing routine procedures efficiently and accessibly, and networks of care that monitor patient well-being • Embrace the ‘‘virtualization’ of many existing services that are currently only delivered in person • Widely deploy digitization by reforming agencies so that they can respond to technological change more quickly and by providing more IT funding directly to providers • Encourage organic governance evolution without undertaking wholesale restructuring, and • Reform the way health services are purchased.
  • The report is part of the Shifting Gears Series on the transformation of public services and was supported financially by KPMG.
  • ...1 more annotation...
  • To read the full report, please click here
  • Irene Jansen on 23 Jan 12
     
    National Post coverage: Innovations seen as lowering health costs. National Post. Nov 1 2011 Tom Blackwell  Provinces must find ways to profit from efficiencies - like the steadily falling cost of cataract surgery. While favouring marketstyle competition, the academics draw the line at allowing a private tier of medicine or even expanding the role of privatehealth operators in the public system. Set up more stand-alone clinics, like those that do cataract surgeries. Move away from block funding of hospitals (an institution is paid a lump sum every year to cover most services) toward payments tied to treatment of individual patients. Cap increases in physicians' fees, link fees more closely to changes in technology and hold auctions in the public system, to get the best deal for providing some procedures. Experience suggests doctors may not welcome some of their proposals. In 2002, a $4-million study funded by the Ontario government - and initially supported by the Ontario Medical Association - recommended an overhaul of the fee schedule to better reflect the up-to-date value of each doctor service. It would have meant income drops for some specialists - such as the opthalmologists who do cataracts - while others would earn more. See also: Health Care reform? Despite frightful predictions of ever-rising costs, governments can reap savings by managing change Toronto Star Nov 1 2011  Opinion  Will Falk
Irene Jansen

Will Falk (Mowate Centre). October 31 2011. How to reform health care - thestar.com - 0 views

www.thestar.com/...107--how-to-reform-health-care

accord shared services specialty clinics abf

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Modernize the organization of hospitals
  • specialty clinics providing routine procedures efficiently and accessibly
  • with public funding and in partnership with traditional hospitals
  • ...4 more annotations...
  • Policy-makers should strengthen regional bodies, specialty care networks, and support mergers and acquisitions that build scale.
  • Reform the way health services are purchased. The health-care pricing system is fundamentally broken. Global budgeting for hospitals and inflation in fee-for-service payments for doctors need to be urgently reformed in most provinces.
  • These reforms do not rely on new revenues or any form of privatization to create a fiscally sustainable system. They could all take place within the Canada Health Act and are consistent with its principles.
  • Will Falk is executive fellow in residence at the Mowat Centre at the University of Toronto. He is lead author of a new report, Fiscal Sustainability and the Transformation of Canada's Healthcare System.
Irene Jansen

CHSPR Health Policy Conference February 28-29, 2012 Vancouver - 0 views

www.chspr.ubc.ca/hpc

conference abf

shared by Irene Jansen on 23 Jan 12 - No Cached
  • increasing attention from provincial governments to so-called “funding arrangements” – the processes through which provincial health ministries (and increasingly regional health authorities) purchase or pay for services for their ‘constituents’
  • activity-based-funding, pay-for-performance, and so on
  • Is there really anything innovative in all of this? What is the evidence base supporting the ‘new’ approaches? And how is the public to understand the confusing array of fact and fiction regarding health system funding, particularly in the ramp-up to the expiry of the federal/provincial/territory health accord in 2014?
  • ...1 more annotation...
  • These are some of the questions that CHSPR’s 2012 health policy conference will tackle.
  • Irene Jansen on 23 Jan 12
     
    Will paying the piper change the tune? Promise and pitfalls of health care funding reform
Irene Jansen

Health Care Funding - Evidence and perspectives for funding health care in Canada. - 0 views

www.hospitalfunding.ca

abf funding fromdelicious

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Irene Jansen on 23 Jan 12
     
    Health Care Funding is a website supported by the UBC Centre for Health Services and Policy Research, and the Canadian Institutes of Health Research which aims to be " A central, reliable and impartial resource for literature, news and discussion regardin
Irene Jansen

2012 CHSPR Conference Feb 28 and 29 2012 Vancouver - 0 views

www.chsrf.ca/...2012_CHSPR_Conference.aspx

conference abf payment methods funding

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Will paying the piper change the tune?  Promises and pitfalls of health care funding reform
  • Sheraton Wall CentreVancouver, British Columbia
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