ACTIVITY REPORT - Agence technique de l’information sur ... · générale de la cohésion sociale...

ATIH Headquarters - Lyon117, bd Vivier Merle 69329 Lyon cedex 03Tél. : 04 37 91 33 10Fax : 04 37 91 33 67 ATIH Paris Branch13, rue Moreau 75012 ParisTél. 01 40 02 75 63Fax : 01 40 02 75 64 www.atih.sante.fr

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Technical Agencyfor Informationon Hospital Care

ACTIVITYREPORT

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ATIH IN 2015*, YANN ABD-EL-KADER, MOUNIA ABOULOSSOUD, WADII ACHOUR ANNE

ALDEBERT, THOMAS ANDRE, TANTELY ANDRIANOELY-MALIN, MARIE ASTIER, JAMILA

BAHRA, ALIRÉZA BANAEI, ANNE BATAILLARD, YASSINE BELHAJ, MARIE-JOSÉ BEN NACEUR,

MAX BENSADON, MARLÈNE BERNARD, CATHERINE BISQUAY, JEAN-PAUL BLANC, AURÉLIE

BORDE, FATIHA BOUALOUAN, NELLY BOULET, SÉBASTIEN BOURDY, FRANÇOISE BOURGOIN,

JEAN-CHARLES BUISSON, ANNE BURONFOSSE, LAËTITIA CHOSSEGROS, RONALD CHUNG,

MARIE-CAROLINE CLEMENT, GAËLLE CONTESTI, OCÉANE CORNIC, ALINE CUSSON,

NICOLAS DAPZOL, PHILIPPE DE MEY, JEANINE DEFEVER, ALEXANDRA DELANGLE, ALBANS

DEMBLOCQUE, YANN DROCOURT, JOËLLE DUBOIS, CHRISTOPHE DUJARDIN, ERIC EKONG,

CHABI-FABRICE ELEGBEDE, ANIS ELLINI, LISE FRANCOIS, AURÉLIE GARNIER, CLÉMENT

GARRIGOU, FRANÇOIS-XAVIER GIRARD, SOPHIE GRANGER, CHRISTOPHE GUEGAN, OLIVIER

GUYE, ABILÉ HAIBOU KOUSSE, MORGAN HAMON, GAËLLE HARMENIL, ISABELLE HERNANDO,

MARIE-SOPHIE HERRARD, THANH-AN HOANG, DELPHINE HOCQUETTE, HOUSSEYNI HOLLA,

CLARA HURAND, NADINE JACQUEMET, SERGE JALOYAN, STÉPHANIE JOULLIE, SAMIR KAIDI,

ÉLISE KAYSER, YAMINA KHELOUFI, KATIA LA MELA, ANNE LAVALLARD, CATHERINE LE GOUHIR,

CÉLINE LEFEVRE, CAROLE LÊ-LEPLAT, CLAUDINE LESUEUR, ROBIN LOUVEL, XAVIER MALIN, JULIEN

MARANDET, ESTELLE MARIN-LAFLÊCHE, MYRIAM MARTIN, CATHERINE MARTIN, NICOLAS

MAYOT, MATHIEU MAZUIR, NICOLE MELIN, AXELLE MENU, MATTHIEU MERCIER, ISABELLE

MERY, FLORENT MONIER, VINCENT MONOT, MARC MOSSAND, AGNÈS MOUNIER, DAMIEN

MURE, DIANE PAILLET, KARINE PALMIERI, FABIENNE PECORARO, STÉPHANE PEQUIGNOT,

FLORENCE PINELLI, VINCENT PISETTA, STÉPHANIE POINT, ROMAN POURCHER, GAËL PRIOL,

CHRISTINE PRODOM, THIERRY PROST, FRÉDÉRIC QUICHON, CLÉMENT RALLET, CHARLINE

RAPPASSE, CAROLINE REVELIN, THOMAS RICOU, AURÉLIE RIGAUD, NATHALIE RIGOLLOT,

GUYLÈNE ROBERT, LYES ROUABAH, MARJOLAINE ROUMANI, MÉRIEM SAÏD, MESSAOUDA

SASSI, DOMINIQUE SAUTEREAU, VÉRONIQUE SAUVADET-CHOUVY, BRICE SAUVAJON, OLIVIER

SERRE, PADRIG STEUNOU, SANDRA STEUNOU, SOLÈNE TADJ, FATMA TEKRANE, AGNÈS

TEUTSCH, EMMANUEL THAMMAVONG, BORNIYA TOUAHRI, LAURENT VOISIN, DIANE WALLET

* On December 31st, 2015

I. Presentation 5 II. Overview of work done in 2015 9

III. Work done in 2015 13

1. Overhauling hospital funding 14

2. Extending the work of the Agency 25in the realm of health and social sector

3. Supporting ARS in the management 27of healthcare services

4. Ensuring security and integrity 29of data managed by the Agency

5. Collecting and returning information 32with a view to enhancing knowledge of hospital

6. Positioning the agency vis-à-vis its partners 36

7. Optimizing the Agency’s internal performance 40

8. Publications in 2015 44

IV. Glossary 45

SUMMARY

Lise Rochaix

EDITORIAL by the President of the Board of Directors of ATIH*

Thanks to its quality work, ATIH has established itself among the top French institutions as a reference in data production and data crunching. The recent development in the Agency's mandate is going to strengthen this position, particularly for data crunching, which will be expanded to new domains such as the medico-social sector. Under the new decree, there will be an opening up to the academic world - in the aftermath of a new governing body- and the representatives of the academia to the Board of directors will be welcomed. The latter is now welcoming a staff representative with voting powers, which proves ATIH’s willingness to closely integrate or involve all employees or collaborators in the decision making process.

Given the importance the Agency grants to transparency, to information sharing and independence, ATIH plays a central role in shedding light on public healthcare decision at the macrœconomics level. It has already mobilized the necessary skills needed or required to carry out this mission. The main challenge for such institution is to provide secured and correct information, at the right time, in the correct format and to the various decision-makers. This provision should be facilitated and extended to various participants, researchers, professionals, patients and to the population at large.

In order to be able to take up these challenges, the three key instances of the new governance, namely the Executive Board, the Steering Committee and the Scientific Council, will have to work hand in hand. In this regard, the board should be fully involved in the future planning and definition of broad policy directions. Such openness will make it possible to encourage other disciplines besides statistics or management, which today are strongly represented in ATIH, to collaborate with such disciplines as social sciences, all of which are intended to clarify the decision. Steps will also be taken to facilitate exchanges between ATIH and its fellow agencies abroad, which will contribute to giving ATIH a broader international influence.

Through the three-year mandate entrusted to me, my primary goal is to make the Agency even more solid, more creative and more useful. In this perspective, I will do my best so that the user’s interest is put forward, whether it be that of the policy maker, researcher, the health professional, journalist, or the patient. Sharing information indeed strengthens the transparency of the health sector.

* ATIH : Technical Agency for Information on Hospital Care (Agence technique de l’information sur l’hospitalisation)

Housseyni Holla

EDITORIAL by the Managing Director of ATIH

In 2015, consistent with the 2014-2016 objectives and performance goals the Agency continued to work on finding ways to adapt the funding models, the development of information-gathering, the restitution of the data by securing the access terms and the improvement of its response to the requests of the Regional Health Agencies (Agences régionales de santé - ARS).

Three points in particular marshalled the energy of our teams :

The funding of institutions : - The improvement of the tools has made it possible

to continue moving our work forward, especially the tools about the medico-economic classification, and the cost studies. These tools have been refined and adjusted in the fields of Medicine, Surgery and Obstetrics (Médecine Chirurgie Obstétrique MCO), Post-Acute Care and Rehabilitation (Soins de suite et de réadaptation - SSR), psychiatry and Home care (Hospitalisation à Domicile - HAD).

- The adjustment or overhauling the funding measures : when it comes to the MCO field, it has been taken account of the financing of local hospitals, the generalisation of the funding incentive of the quality criteria put in place through the IFAQ program; regarding the SSR, the funding model definition has been improved, with a focus on the transition. In the HAD field, the exploratory work to adapt the funding mechanism are being implemented with the support of the participant on the ground, notably medical and social Federation.

The medico-social sector : the Agency has assisted the General Direction of Social Cohesion Cohesion (Direction générale de la cohésion sociale - DGCS) and the

National Solidarity Fund for Autonomy (Caisse nationale de solidarite pour l’autonomie - CNSA) on the funding reform of this sector. Following two cost inquiries on the 2012-2013 data, the Agency has carried out a cost study on the Accommodation Facilities for Dependent Elderly (Etablissement d’hébergement pour personnes âgées dépendantes - EHPAD) based on the 2015 data, which constitutes a more accurate measurement of the cost.

Access to data structured around three sectors of intervention : ensuring a secure access to the PMSI data (Program for medicalization of information systems - Programme de médicalisation des systèmes d’information - PMSI), via the implementation of a device whose methods are adapted to various sectors : such as institutions, private providers, researchers, health centers : improving the returning of information thanks to the HealthScan app (ScanSanté) which offers a new and a more friendly, more ergonomic and more dynamic browsing experience. Last, the development of tools such as the dashboard of the institutions and medical and social structures, the e-Satis customer satisfaction survey, and the investigation survey on hospitals drugs consumption.

Under the new decree published in July 2015, ATIH was endowed with a new governing body. The latter includes an Orientation Committee, a Scientific Advisory Board and a Board of Directors.

ATIH is now fully prepared to conduct its mission around three major axes drawn by the above-mentioned bodies : taking better account of the requests of the key players involved, consolidating its methods and meeting the expectations of the different bodies under the authority of an independent and qualified figure.

I. PRESENTATIONFounded in 2000, the Agency for Information on Hospital Care (ATIH), is a public administrative institution overseen by the minister for health and social security. The headquarters of the Agency are located in Lyons with a branch based in Paris. The strategic guidelines of the Agency are dictated by the Management Board, a Steering Committee and a Scientific Council. The head of the Administrative Board is appointed by the Ministers for health, Social Affairs and social Security.

ATIH is a centre of expertise in charge of : - The collection, hosting and data analysis from various

health facilities- The technical management of the institutions funding

schemes. - The conducting of costs studies on health and medico-

social institutions- The development and maintenance of health nomenclatures

6

Publics concerned

The data processed by the Agency are shared with the following :

• Services of the ministry : Directorate General of Healthcare Provision (Direction générale de l’offre de soin - DGOS), Social Security Directorate (Direction de la sécurité sociale - DSS), General Direction of Social Cohesion (DGCS), Directorate for Research, Studies, Directorate for Research, Studies, Evaluation and Statistics (Direction de la recherche, des études, de l’évaluation et des statistiques - DREES)

• Supervisory Body• Health Insurance• National Agencies• Hospital Federations• Regional Health Agencies (ARS)• Health facilities• Companies (law research and consulting)…

7Presentation

Internal organization of the Agency

Direction• Regional Health Agency (ARS) Mission• External communication• “ Returning data ” Mission (ScanSanté)

Administration• Quality• Legal affairs and markets• Budget, accounting, management• Human Resources management and internal communication• Secretariat

Replies to external inquiries

Architecture and IT Production• Web Information System• Medical information collection systems• Health facilities software• System and network

Classifications, medical informationand funding methods• MCO / Home Care (HAD)• Post-Acute Care and Rehabilitation (SSR) / Psychiatry• Health Classifications (nomenclature)• Medical Statistics

National cost studies

Financing and economic analysis• Resource allocations to Health Facilities• Monitoring the National Objective for Health Care Spending (Objectifs nationaux de dépenses d’assurance maladie - ONDAM)• Data analysis and performance indicators

Staff

Division of labor within the Agency

(the leadership team not included).

Statisticians

Computer scientists

Administrative staff

General Practioners

Management accountants

Others

5%

34%

6%

12%

16%

27%

As of December 31 2015, the Agency employed 122 employees – On a contractual basis and civil servants on secondment or provision.

Division of labor within the Agency

(the leadership team not included).

Statisticians

Computer scientists

Administrative staff

General Practioners

Management accountants

Others

5%

34%

6%

12%

16%

27%

Typology Average age : 40 years oldGender breakdown : 57% of women and 43% of men

8

The Agency’s budget

The 2015 budget amounted to € 23,548,000.

Health Insurance

Private resources

Funds allocated to the modernization of public and private health institutions (Fonds pour la modernisationdes établissements de santé publics et privés - FMESPP)

National Solidarity Fund for Autonomy (CNSA)

Payroll

Operating costs

Investments

5 %

37 %

58 %

3 %

37 %

9 %

46 %

Expenditures

Health Insurance

Private resources



Payroll

Operating costs

Investments

5 %

37 %

58 %

3 %

37 %

9 %

46 %

Expenditures

Health Insurance

Private resources



Payroll

Operating costs

Investments

5 %

37 %

58 %

3 %

37 %

9 %

46 %

Expenditures

Health Insurance

Private resources



Payroll

Operating costs

Investments

5 %

37 %

58 %

3 %

37 %

9 %

46 %

Expenditures

II. OVERVIEW OF WORK DONE IN 2015

9

10

Overhauling hospital funding

Tailoring the MCO (Medicine, Surgery and Obstetrics) funding package

Funding for local hospitals has been reviewed ensuing the completion of a study conducted by the Agency for Information on Hospital Care (ATIH) The IFAQ program will make it possible to integrate the quality criteria in the funding model. The Agency has contributed to reducing re-hospitalization rates with a view to driving down unnecessary costs.

Defining the funding models in other areas

Post-Acute Care and Rehabilitation (SSR) : the Agency has worked on a revised approach to data processing of OVALIDE (a data validation tool) SSR and ScanSanté with a view to enhancing its relevance. An indicator summary sheet has also been reviewed for the appropriate institutions. A continued effort has been made in the improvement of descriptive tools for neurological disorders, rehabilitation-adaptation and patient dependence. The Agency has conducted studies to improve the reliability of the cost data available with a view to creating an algorithm to build the Medico-Economic Groups (Groupes médico-economiques - GME).

Psychiatry : Progress in the preparatory work on medical description has continued, while the process of visiting the institutions has begun. A cost study has been carried out; it will make it possible to collect reliable data thereby achieving a comprehensive view of cost accounting.

Home care (HAD) : the exploratory work with a view to overhauling the Home Care classification has been expanded (via site visits). The Agency has also worked with the Directorate of Health Care Supply (DGOS) on early post-surgery Homecare.

Participating in the development of a transversal approach to care A survey of practices and radiotherapy costs has been performed. Analysis and monitoring tools as well as a performance indicator have been developed for outpatient surgery.

Improving the accuracy of pricing tools Three types of studies have been conducted on this theme : the classification of MCO activity, the improvement of the reliability of costs measurement, the launch of a survey on the costs of emergency care.

Participating in SSR care Initiative The Agency has modeled the inpatient course of patients suffering a stroke, on the basis of national analyzes added to inter-regional comparisons.

11Overview of work done in 2015

Ensuring the security and integrity of data managed by the Agency

Countless studies have been conducted on the following issue : main-tenance programs to supply the MCO sector and the Home care sector; the QUALHAS automatic feeder which collects the indicators has been expanded; the development of software provides the institutions partici-pating in multiple national cost studies (Etudes nationales de coûts - ENC) with a single tool. Some progress has been made to incorporate new data in the cost studies, quality of care indicators, and to secure input devices and data control. Last, a transitional device to access PMSI data via downloadable appli-cation has been set up to provide maximum security upon connection and distribution prior to the implementation of the target solution.

Extending the work of the Agency in both health and social sector

Working alongside the Regional Health Agencies (ARS) in the management of health care provision

Progress in the methodological support provided to the Regional Health Agencies has continued. In order to help them, the agency has produced a new device which provides a secure access to the data pertaining to the Program for medicalization of information systems (PMSI). The Agency has also contributed to the workshops “ Relevance of care. ” ATIH also worked with the Regional Health Agencies in the Ile de France region on the coherence and complementarity of Diamant tools and the HealthScan app (ScanSanté).

- Measuring costs - The Agency has launched the first cost study on the Accommodation Facilities for Dependent Elderly (Établissements d’hébergement pour personnes âgées dépendantes - Ehpad).

- Collecting and disseminating management indicators of the medico-social sector -The Agency has called upon a service provider to work on the “ dashboard ESMS ” application which was uploaded in November. Scalability will be gradual.

12

Collecting and returning information with a view to improving hospital knowledge

Positioning the Agency vis-à-vis its partners

Optimizing the internal performance of the Agency

Regarding data collection, the agency has likewise developed the Idem software for drugs investigation. Improvement in costs reduction has continued, while the standard Costs per Unit referred to (Unité d’œuvre - UO) has been set up. The national e-SATIS device which makes it easier to appreciate patient satisfaction with hospital care via the Internet has been implemented. More fluid and ergonomic, the ScanSanté platform has been updated with new and improved applications, which leads to an improvement in both form and content.

The Agency officials have gone beyond their comfort zone to engage their partners, notably through the agency’s annual day of exchanges and its participation in Exhibitions on Health and Autonomy. Multiple leaflets were handed out : the ScanSanté brochure, the itemization of medical information brochure and the ‘Key figures on hospitalization’ brochure. Several agreements were signed with the biomedicine Agency (Agence de la biomédecine), the National Solidarity Fund for Autonomy (Caisse nationale de solidarité pour l’autonomie), and the French National Authority for Health (la haute autorité de santé) and a university-Hospital Centre in Lyons (Hospices Civils de Lyon).

Following the publication of the ATIH decree on July 6th 2015, the Agency has had a new governance body comprising a Board of Directors, a Steering Committee and a Scientific Council. The monitoring device of the objectives and performance contract 2014-2016 was expanded. The scope of the quality approach was extended to four new items. Last, the Agency changed its accounting software to integrate a GBCP (Budget Management and Public Accounting - Gestion budgétaire et comptable publique) module and continued its financial and internal control process.

III. WORK DONE IN 2015

13

14

Overhauling hospital funding

The modernization of the hospital funding provides a clear answer to the first goal stipulated in the 2014-2016 objectives and performance goals of ATIH

In 2015, this goal was centered on the following themes :

• Tailoring the MCO funding package.• Defining the funding models in other areas : Post-Acute Care

and Rehabilitation (SSR), Hospital Care (HAD), psychiatry• Improving the accuracy of pricing tools.• Participating in SSR care Initiative.

1.

Tailoring the MCO funding package

Multiple studies have been conducted within this context. Three of them concern local hospitals, the IFAQ program and the analysis of re-hospitalization rates.

Local Hospitals

The 2015 Social Security Funding Law (*Loi de financement de la Sécurité sociale pour 2015 - LFSS 2015)* included a waiver clause regarding the funding models for local hospitals. In 2015, the Agency struck a deal in order to conduct a study on local hospitals.

This was provided by the Ylios and Frontier Economics firms, from July to December, with three stated objectives:

• Setting up criteria for defining local hospitals which will ultimately draw up a list of those institutions.

15Work done in 2015

• Determining the mission of these institutions, along with their position in the supply care chain and the medico -social offers; their potential role and the scope of their missions shall also be defined.

• Proposing an appropriate funding model for these institu-tions, thereby ensuring their economic viability while taking into account their specific characteristics and low volume of their business.

The results of the studies were presented to the main actors within the groups driven by the Directorate of Health Care Supply (DGOS).It appears that these institutions play a major role in the context of coordinating different players in the provision of care (city, medico-social field, health care) on a given area.

Their presence is justified when proximity constitutes a key factor in the success of some treatments for conditions such as chronic diseases or the care of the elderly. Consequently, their labeling will depend on the idiosyncrasies of the local area; they integrate both the needs of the population and complementarities between the different structures which constitute the treatment offers.

In terms of timing, the State Council decree specifyingthe labeling criteria and the funding arrangement ought to be presented in early 2016 and which was due to be imple-mented by March 1.

Funding for improving the quality of care

One of the measures taken by the 2015 Social Security Funding Law (LFSS 2015) was to set up a financing model which takes specifically into account both the quality and safety of care. An experiment piloted by the French Natio-nal Authority for Health (Haute autorité de santé - HAS), the DGOS and the IFAQ program (Financial incentives to improve quality), has been ongoing for the past two years. It covers a specific, additional compensation on the basis of AC credits for the best performing institutions – a model built on the basis of quality indicators and safety of care and certification of healthcare institutions.This experiment demonstrates that it is possible to integrate the quality criteria in the funding model.

For each institution, the amount of funding will bedecided on a score basis. This takes into accountthe achievement of national targets by indicator, the impro-vement of their results (measured over a two- year period) and their size, the latter being assessed on health insurance revenues for MCO hospital stays. On the one hand, this score is built on the basis of quality and safety of comprehensive care indicators by the Ministry of Health and Social Affairs, and on the other the certification procedure of health institutions.The generalization of the model is scheduled for 2016; The Agency is expected to conduct a study with regard to the technical implementation of this device.

Analysis of re-hospitalization rates

As part of the reform committee on hospital tarification (Comité de réforme de la tarification hospitalière - CORETAH), the prevention of re-hospitalization was identified as an important issue in terms of quality of hospital care, as was the elimina-tion of unnecessary cost overruns for the health insurance.

The Agency has worked in collaboration with the DGOS and with the services of the Ministry (sub-directions PF and R) to come up with a rate of re- hospitalization, the latter depends on a number of external factors. The work has focused on the development of a standardization method. Re-hospitalization is defined on a patient basis : the patient’s fisrt stay in hospital in a given year must be identified, as must his/her possible re-hospitalization according to a timeframe to be precised.

Any other re-hospitalization will not be not taken into account. Though the studies have yet to be finished, however they are sufficiently complete to be presented to the key actors and to be disseminated as indicators for analyzing the structural activity.

Tailoring the MCO funding package

16

The adaptation of the MCO funding model has also been our focus particularly when it comes to the following themes :

• Sliding scale of tariffs along with the publication of a techni-cal information notice on tariffs following the publication of the decree which lays down the parameters of the sliding scale of tariffs

• Separate (Isolated) activities : introduction of the final model as part of the 2015 information notice on tariffs (setting up isolated activities funding package - FAI - in “ funding packages and tariffs ” decrees).

• Support given to “ regional workshops and the pertinence of care being delivered ”.

• Participation in the creation of an atlas based on the changes of medical practices.

• Participation in the study concerning the innovative acti-vities based on the funding model and publication of the nomenclature : descriptive CCAM (Common Classification of Medical Acts -Classification commune des actes médi-caux - CCAM) integrating innovative acts, not published in the CCAM tariff schedule.

Three types of work have been conducted in this area : the development of technical tools; the improvement of the descriptive tools of the medical activity; the funding mechanism defined by the DGOS.

The institutions, the ARS and the Ministry need to be equipped with the appropriate tools to be able to implement the SSR funding reform.

The challenge : Providing the institutions, the ARS and the users throughout the nation with the appropriate information on the best use of the indicators stemming from the PMSI SSR and restituted by OVALIDE (a data validation tool) SSR (e-PMSI) and the countless applications of Scan Santé. In this perspective, ATIH initiated a complete overhaul of these restitutions in 2015 with a view to improving their relevance.The review has two main objectives : refining the calculation methods of the indicators and completing the technical documentation in order to inform the users (on the indicators shortcoming for example). Particular attention has been paid to ensure consistency of the various applications and enhance their articulation with the tools restituting indicators from the PMSI SSR which have been developed for the ARS.

Indicators and/or obsolete applications could be removed if need be. In 2015, further work was achieved in two major areas : the CSARR maintenance (catalog of rehabilitation and readaptation acts - Classification Commune des Actes médicaux - CSARR) and the development of DALIA SSR software for PMSI SSR production.

Last, the Agency made and posted a summary sheet for the institutions which conduct SSR activities. For each institution, the purpose of this summary sheet is to define different types of indicators :

• lD card; • a summary of the SSR activity (especially to establish the health profiles of patients); • the characteristics of the SSR activity (by major category :

number of days and the period of the care of the person); • financial situation; • human resources; • integration into the environment;• the quality of care and safety.

Work in the SSR field

Defining the funding models in other sectors such as SSR, Psychiatry and HAD

Further work on funding models

17Work done in 2015

However, this summary sheet fails to provide a detailed and comprehensive overview. This can be obtained via the ScanSanté applications which provide a more relevant and accurate analysis.

Enhancing improvement of tools describing SSR medical activityThe work leading to a full review process regarding neurological disorders has been conducted, as well as that intended to better capture the intensity of re-education and re-adaptation developed for patients under care. In 2014 a survey on the time and the conditions of the performance of CSARR acts was launched.Its first results were presented to the participants. A similar approach will continue in 2016 and will include the representatives of the institutions, as part of focused working groups.The work initiated in late 2013 on the dependency measure were proceeded in 2015. In late 2014, SOFMER, the French Society of Physical and Rehabilitation Medicine Medicine (Société française de médecine Physique et de réadaption - SOFMER) began work on creating, developing and validating a quite simple dependence measurement scale to be used for the different categories of SSR patients (children, adults and seniors).The goal of the “ Score SSR activity ” is to create a more handy tool than the Functional Independence Measure (Mesure de l’independance fonctionnelle - MIF), used routinely by the professionals on the field, but the tool needs to be sufficiently accurate to be used in medico-economic studies. ATIH is actively involved in the nationwide working group of which SOFMER is part. The pilot study started in 2015, and the work is to continue for many years to come.

Contributing to the implementation of the funding model defined by DGOS.The 2016 Social Security Funding Bill (Projet de loi de financement de la Sécurité sociale pour 2016 – PLFSS 2016) has outlined the contours of the future funding mechanism which should be operational by 2017. During the year 2015, the technical implementation of the new funding arrangements governing the SSR activity was initiated. They focused in particular on the activity of weighing schemes and the modeling of funding packages.Within this framework, the Agency endeavoured to analyze the cost data available in this field. This data is indeed essential for establishing the relevant funding, and it is also useful for building the Medico-Economic Groups (Groupes médicoéconomiques - GME).It is therefore essential that the data be reliable and of good quality. These studies were conducted in two steps - Late 2014 / early 2015 then late 2015 - along with the participants and the institutions participating in the National Cost Studies (Etudes nationales de Couts - ENC). The challenge : developing an algorithm to categorize GME according to the cost measurement reliability in three groups : good, fair and poor. The funding model for a full hospital stay is based on two concepts : the fixed rate and the weighed transactions days. Depending on the length of time, the stay will be valued either on the basis of a fixed rate or a weighed day or a combination of the two modalities. During the year 2015, statistical and medical studies were focused on developing a list of GME called “ flat rateable ”, the aim is to identify a reasonable size window of time within which is found a minimum number of days for hospital stays. Once the list of GME flat rateable has been established, it remains to determine the flat area. This study was presented to the participants in January 2016. Subsequently, the technical valorization parameters of the activity relying on existing tools (Classification and ENC) need to be defined. The working hypotheses and the various methodological scenarios implemented to determine the parameters were shared with the participants during the month of February 2016.As a result of this work or study, a first set of simulations shall be conducted providing the participants with the possibility to measure the full effects of the new funding model. The results of the simulations shall be sent to all the participants or actors (ARS, institutions and federations institutions) during the second quarter 2016.

18

The psychiatric field

The work conducted in this field focused on two areas : to continue the preparatory work on medical description, and to enhance the understanding of the environment via onsite site visits.

In 2015, the work undertaken in coordination with the psychiatric technical Committee helped to :• identify new descriptive areas for the Medical Information

Database for Psychiatry (Recueil d’information médicalisé en sychiatrie - RIM-P) such as “ the resistance to treatment ”;

• clarify the instructions of CIM-10 coding (Tenth revision of the international classification of diseases- Dixième Révision de Classification internationale des Maladies de l’OMS-CIM 10) for various conditions such as behavioral disorders, cognitive disorders, carelessness, and the patient’s environment, etc.

Last, national guidelines for collecting specially equipped hospital units (Unités hospitalières spécialement aménagées -UHSA) activity based on RIM-P were identified.

The “ medico-economic psychiatric restitutions“ of ScanSanté have been equipped with new indicators derived from the new database. This is particularly the case for such apps as “ Data per institutions ” and“ the resident population ” : in 2015, they were complemented with a great many indicators whose purpose is to characterize both psychiatric healthcare and the private sector, as well as the medico-social care.

Furthermore, more work has been conducted with a view to identifying relevant indicators to document long-term psychiatric hospitalization (Hospitalisation au long cours -HLC) and thus build a tab theme in ScanSanté. The main objective was :• to check the threshold relevance of the 292-day stays

used to define long-term hospital stays; • to characterize HLC patients (long-term hospital stays-

HLC) and and to identify the determinants. Last, ATIH has begun to “ visit the institutions engaged in psychiatric activity “ . These visits should enable the Agency to ensure if discriminating factors being taken into account in psychiatric care can reliably and robustly be processed, via the data collected through the RIM-P. If not, modifications of the collection procedure could be envisaged. The visits began in late 2015 on the basis of a list of the institutions identified by the following federations :

The French Hospital Federation (Federation Hospitaliere de France - FHF), Federation of Private Hospital Facilities and Assistance to People (Fédération des établissements hospitaliers et d’aide à la personne privés - FEHAP), and National union of privately-managed psychiatric clinics (Union nationale des cliniques psychiatriques privees - UNC - PSY)

Conducting cost investigations in psychiatry

As part of its psychiatric technical work, ATIH conducted a cost survey in 2015. It was aimed at collecting analytical data concerning 2014 for annual funding allocation (Dotation Annuelle de Financement – DAF) and National Quantified Objectives or target (Objectif Quantite National - OQN) institutions sectors. The sample consisted of 84 participating institutions (70 institutions link to DAF and another 14 link to OQN. Thanks to this survey, access to reliable and good-quality data will be made possible : it is based on the “ Reprocessing Accounting ” tool (Retraitement Comptable -RTC) for the collection of activity data, costs and Full-Time Equivalents (Equivalents Temps Plein - ETP) in a vision of analytical accounting or cost accounting full cost pricing.

A monitoring of all selected structures was organized with the provision of a supervisor. This business expert has several roles : Assisting the institutions in the handling of technical tools pertaining to collecting data made available by the ATIH as well as the implementation of the survey methodology; perform a first verification of the quality of data transmitted to the Agency.The Institutions have also at their disposal control panels or charts which enable them to self-regulate, if necessary, to correct the data with the support of the supervisor. ATIH ultimately judges whether the data is good enough to be included in the cost base. The overall restitution of the data based on the survey dated year 2014 is scheduled for spring 2016. The cost survey was renewed or maintained based on 2015 data according to the same terms and conditions. It will consolidate the data collected.

19Work done in 2015

The work was conducted from different perspectives : proceed with the exploratory work with the intent to overhauling the homecare hospitalization (HAD) clas-sification, monitor the DGOS as part of the experiment within the framework “ HAD early post-surgery. ”

Improving the understanding of the environment via onsite visits

As part of the exploratory work in view of the new classification, ATIH has visited four HAD institutions. These facilities have been proposed by the homecare hospitalization federation (FHF, FEHAP, FHP and Unicancer).The visits took place from June to November 2015. Each institution presented its activity and operations, provided the response to the questionnaire prepared jointly by ATIH and the federations which is subsequently ensued by a multidisciplinary consensus meeting for the visitors.Following these visits, the Agency has put together a summary that was presented and validated by the technical Committee. This overview or summary was then sent to each site visited.

Monitoring the DGOS as part of experimentationto support “ HAD early post-surgery. ”

The objective of this process or approach : producing information to target the surgical activities identified as part of the experiment. The Agency has conducted a data-mining PMSI on the basis of a method of selection of the stays, validated jointly with the learned societies and federations during the working groups organized under the hospices of the DGOS.

For each visit, the activity data were restituted according to the terms and conditions worked out during those meetings (level of severity, duration or length of stay, number of acts, being moved to intensive care, monitoring, intensive care, output modes…).The results were provided for all the target mentioned in the project “ Transfer HAD post surgery ”:• hysterectomies for gynecologic surgery; • rectal resections and major intervention on the hail and

colon for digestive surgery;• knee replacement, hip fracture in elderly patient and

scoliosis surgery in children for orthopedic surgery.

Along with this work, the Agency has also provided the DGOS with the expertise on possible development funding model encouraging the development of these early transfers. She has done the corresponding financial simulations.

HAD scope activity

20

Experimentation in radiotherapy

Within the framework of CORETAH, the DGOS has initiated the implementation of the experiment, recorded in Article 34-II PLFSS 2014, as part of a new model of financing on radiation oncology. As part of this ongoing process, ATIH was commissioned by the DGOS to conduct two investiga-tions, one based on practices and the other, on costs. The goal was to identify the elements that must be taken into account during the elaboration of the funding model based on an assessment of current descriptive practices and the resources made available.From an operational standpoint, work was carried out under the auspices of a national group led by the DGOS. All tech-nical aspects were worked within an ad hoc group driven by ATIH, where the institutional partners along with the different federations and officials in charge of the sector (trade unions and scholarly societies) were represented.

Investigating hospital practices

In January 2014, a collection grid was validated by the profes-sionals in charge. In March of the same year, a call for applica-tions was launched by the DGOS to oncological radiotherapy structures within both the hospital and liberal sector. 63 schools volunteered. The survey was officially launched in May 2014. 40 institutions out of 63 provided data on the platform put in place by the Agency. All the operations and results were discussed and validated by the technical panel and the final results were presented by the Steering Committee on July 8, 2015.The results were released in early 2016. They included a synthesis note, consolidated slideshow as well as a specific restitution scheme for each institution.

Costs Investigation

The purpose of this survey was to gather all the necessary in-formation on the costs of all external radiotherapy techniques in order to initiate the implementation of experimental funding. All the structures (health facilities and private practices) were involved. The methodology of data collection was developed in concert with the participants (four working groups between September 2013 and January 2014). 30 structures, out of 52 candidates were selected to participate in the survey. 26 of them provided data deemed to be sufficiently robust to constitute a sample that captures well the techniques of high-precision.2015 was dedicated to the exploitation and restitution of these data to the participants. They were studied according to different aggregates (cost-per-act and decomposition of costs). All the results were presented within the framework of the technical groups and the personalized restitution was conducted with each participating institution in the survey.

Participating in the development of a transversal approach to care.

21Work done in 2015

Three types of studies have been carried out on this topic : the classification of MCO activity, the improvement of the robustness of costs measurement, and the launch of a survey on urgent care costs.

Classification of MCO activity

The DGOS wished to give to the scholarly societies more visibility on outpatient care activity. In this perspective, ATIH has, for the 2016 campaign, appraised further developments for 23 possible groupings of homogeneous groups of patients (Groupes Homogenes de Malades - GHM). Two other Dia-gnosis Related Groups were also added to the original order, on the initiative of the Agency.

A performance indicator for outpatient surgery

This indicator was developed in partnership with ANAP. It intends to provide additional information pertaining to a better understanding of the overall rate of surgery officially defined by the DGOS.Built from four different variables (outpatient volume, index of organization, outpatient innovation, and casemix) it provides a more accurate picture of the level of outpatient surgery of an institution. It allows the institutions to be compared one against another on an objective basis, and carry out a follow-up within the time of outpatient performance. The work was undertaken by ANAP as early as 2012 to identify the most effective institu-tions in terms of outpatient surgery. In 2015 they resulted to this index of performance, presented to the DGOS, the federations of hospital, as well as a panel of experts of outpatient surgery.

Lastly, with regard to developing a transversal approach to care, ATIH has monitored the following work :

• Mission work of General Inspectorate of Social Affairs (Inspection générale des affaires sociales

- IGAS) / General Inspectorate of Finance an (Inspection générale des finances – IGF) on outpatient surgery and outpatient care;

• The meetings were organized by the DGOS on short stay hospitalization basis and addiction, as well as diabetes;

• The funding of chronic renal failure.

This work covered multiple aspects, including the develop-ment of the surgical dashboards based on specialties and the development of a performance indicator on outpatient surgery in relation to ANAP.

Surgical dashboards based on specialties

In conjunction with the Ministry and the participants, the Agency has developed analysis and monitoring tools for the develop-ment of activity for outpatient surgery. A new application has been developed in ScanSanté grouping different indicators. For example, in case of risk management in outpatient surgery, the activity is analyzed through the following indicators : rates of use of population, comprehensive rates of support of outpa-tient surgery, specific analysis of the roots cause. In addition, models based on specific specialties (Digestive, Gynecology, Ophthalmology, ENT, Orthopedics, Stomatology, Urology) are available. They allow each participant to study the activity over a five-year span, on the basis of the rates of recourse, rates of outpatient surgery, and a detailed description based on the root and medical act.

Enhancing the accuracy of pricing tools

Encouraging the development of outpatient hospital activities and day hospitalization.

22

• Taking stock of the activity and development of outpatient care : It must provide an objective basis for the activity, both from a quantitative and qualitative standpoint, the developments for all sort of activities. The elements from this analysis will provide information on the specific features ofeach type of activity, the typologies of the patients being cared for. They will serve as a basis for potential developments and validation elements for the classification work.

The Measurement of caregiving

The work order based on the measurement of caregiving was expressed at the time of COPIL ENC / RTC in November 18, 2014. The objective was to make sure that the distribution of the cost allocation of individual caregiver is included in the MCO stays cost model, according to their relative weight.This topic is strongly supported by the hospital federations, in particular by the FHF. It concerns an essential sector of the costs measurement, whose distribution between hospital stays can sometimes be described as arbitrary (for example, the distribution in the day).A working group on this topic was constituted. Piloted by ATIH, it was, at first, limited to the federations of hospitals in order to flush out the working method (Scoping meeting held on April 28 2015), then was open to institutions which were participating or not participating at the ENC. Topics to be covered included the collection methodology (SIIPS, PRN, time spent...) and its perimeter (all or part professionals and care services).

In parallel, in order to better respond to the growing needs of outpatient care, ATIH has begun exploratory work bearing on the future evolution of outpatient care within the classification. At first, these studies are to be articulated around two axes :

• A review of the medical literature : it aims to develop an overview of the main options currently used in international classification, when it comes to the perimeter as well as the manner of describing and classifying outpatient activity. The Agency has commissioned an external service provider for the bibliographical research. Based on the listing provided, it then ordered immediately sixty items or articles.

Several steps have been undertaken around this theme. They focus particularly on two areas targeted for improvement : representativeness of the ENC institutions and the cost allo-cation of individual caregiver is included in MCO stays cost model.

Samples representativeness of ENC institutions

In response to one of the objectives of the Agency’s COP, communication channels (actions) and the recruiting of the institutions have been intensified on ENC’s three healthcare sectors, in order to increase participation and to promote diversification. For the ENC 2016, these actions made it possible to recruit nine new structures in MCO, eleven in SSR and six in HAD. If the recruitment of the last two fields are well-balanced between the private and the public sectors, the same cannot be said in MCO where no ex-OQN institution has integrated the sample.The legislative measure makes participation in the ENC compulsory under certain conditions, the primary objective being to improve the representativeness of the samples which should result in addressing this problem as of ENC 2017. Furthermore, technical developments carried out in 2015 made it possible for the first time to open the ENC MCO door to the dialysis structures of both the public and the private sectors. The recruitments are underway on this particular field of activity. About ten structures of the two sectors should be integrated as of this first year of implementation.

Enhancing the reliability of cost measurement incurred

23Work done in 2015

of studies : the first was the analysis of the variability of cost ‘intra- institutions’ for a given activity, the second was the evaluation of the gap in terms of cost between outpatient hospitals stays and short stays (one or two nights). These studies required the expertise of institutions conducting the ENC. In January 2016, a second working group gathered together a few institutions to share with them the first results and explore with them the possible explanations for the dis-parities observed.

In the second phase, the beneficiary must propose a tool which collects data based on cost and activity, along with consistency check and adequate data quality. Secondly, an ad hoc survey could be conducted under the guidance of ATIH.

manny collection tools, activity data and missions of general interests and assistance with contractualisation (Missions d’intérêt général et d’aide à la contractualisation - MIGAC) activity reports are also target for improvements in order to refine the criteria for awarding MIGAC to eligible institutions.

Working groups on the cost of outpatient surgery The development of the alternative care to full hospitaliza-tion requires a precise knowledge of the costs of outpatient surgical intervention. Multiple questions were asked : cost disparities on standardized activities, evaluation of the cost difference between outpatient care and full hospitalization. It is in this context that the Agency has committed itself to carrying out –along with the participants - detailed studies on the costs of these activities. A first working group met in May with the representatives of the institutions. It set the framework and identified two areas

Reanimation and emergency activities suffer from a disparity between their expenses and their financing. This disparity was brought to light by the participants. In order to feed reflection on a funding model, a better understanding of the complete cost of the relevant services is proven to be necessary.Within this context, ATIH has awarded a public contract whose general purpose is to build a methodology for evaluating the complete costs for emergency services and reanimation, based on accounting data. This market comprises two phases : the first is to achieve an up-to-date assessment of the existing analytical accounting tools and to identify the impediments to building a complete or a full-cost services and then propose a suitable methodology.

Last, still within the context of the improvement of the quality of pricing or tariff tools, a data collection platform has been set up. It facilitates the collection of information concerning the survey on the use of medication in hospital and whose mana-gement has recently been entrusted to the Agency. A good

The implementation of cost survey on urgent care : SU / MUG / UHCD and critical care

Other areas of improvement of cost measurement reliability

24

Since 2013, ATIH has been conducting a study on SSR care initiative. The objective is to enlighten their current reflections on the reform of the financing of this sector.

The hospital journey of patients suffering from a stroke or having undergone a complete prosthesis of hip or knee surgery has been modelled thanks the analysis of PMSI na-tional database (OLS, SSR, HAD, psychiatry). Inter-regional comparisons were added to the nationwide analysis.

This work will be followed by the analysis of the information based on the care provided to the patients included in that study who live in the city, information stored in the National Health Insurance Cross-Schemes Information System data (Système national d’Information inter-régimes assurance maladie – SNIIRAM). On this basis, SSR modeling course can be done, integrating hospital care and outpatient care. In 2015, ATIH managed to convince IDS and the CNIL with a view to obtaining permission to access SNIIRAM data which is necessary for this study.

Participating in care Initiative

25Work done in 2015

Participating in care Initiative

Extending the work of the Agency in the realm of health and social sector

2.

In continuation with the two previous cost investiga-tions based on available data from the years 2012 and 2013, which helped establish an average cost per resident and per activity, ATIH launched the first ENC on the nursing homes sector (EHPAD) in 2015. Data were collected from 77 nursing homes selected voluntarily and trained by the Agency.

In collaboration with the DGCS, the CNSA, (French National Health Insurance Fund for Salaried Workers - Caisse nationale d’assurance maladie des travailleurs salariés - CNAM-TS) as well as the federations and associations representative of the sector, a methodology was developed to determine an average cost per type of resident and per activity. The typology of residents is to be built, within the context of the work involving the Agency’s statisticians and medical teams.

Unlike the ENC healthcare institutions and given the specifi-cities of the sector, the implementation of the collection and data processing for ENC nursing homes (ENC EHPAD) spans a two-year period.

Throughout 2015, the nursing homes submitted their quarter-ly activity data. They detailed each minute the caregivers and the hotel staff spent helping the residents, data dependence from the AGGIR grid and medical care data required from the tool PATHOS.

In 2016, the nursing homes will have to reprocess or restate their accounting data for the year 2015, according to the scheme already used in the context of cost investigations.

ATIH has trained a team of supervisors, as part of a public contract, in order to assist each institution in the course of this two-year study. The collection of tools (software and plat-form) have been designed internally by the Agency teams. The results of this first ENC in medico-social sector will be available by early 2017.

Measuring costs : Survey and nursing homes cost study

26

The experimental version of the secure web platform which makes it easier for both the medico-social institutions and services (Établissements et service médico-sociaux - ESMS) to take stock of the major areas they are managing (healthcare benefit and support, human resources and material, financial and budgetary balances, goals) has shown its limits in terms of performance.In 2015, ATIH thus came to the conclusion that the platform needed to be completely overhauled with regard to collecting and disseminating future indicators to all the ESMS. In this context, the Agency has assisted the National Agency for Performance Support (Agence nationale d’appui à la perfor-mance - ANAP) with drafting the specifications.

This concern the monitoring of the developments and accep-tance testing, the implementation of the technical architecture, the hosting and operation of the new platform as well as the evolution of the platform use for the institutional management and users (Beach) to better respond to the specifics of the medico-social field or social welfare.The campaign concerning the 2014 data along with the previous data has been uploaded to this new platform in November 2015 to about 12,000 ESMS and management organizations, an increase of approximately 300% compared to 2014 campaign

Collecting and propagating steering indicators of the medico-social sector

27Work done in 2015

Supporting ARS in the management of healthcare services

As part of the new national recommendations, ATIH has put in place for the ARS a new device which pro-vides a secure access to the data pertaining to the Medical Information Systems Program (Programme de médicalisation des systèmes d’information - PMSI). The Agency, along with the Secretariat General of the Ministry of Social Affairs, has participated in the development or the organization of the trainings for this new tool. These training sessions will continue in

early 2016. The upcoming year will witness the imple-mentation of a forum which will very likely facilitate sharing between the ARS and ATIH on this common platform. ATIH continues to share its expertise with the national working groups. In 2015, it participated in all the workshops “ relevance care ” set up by the DGOS for the benefit of ARS. It has contributed to providing the ARS the indicators data defined in this context from the PMSI database.

3.

Pursuing the methodological support to ARS

Work continues within the technical groups in order to provide the ARS with the necessary expertise in monitoring health insti-tutions and territorial dynamics. The reliability group in financial predictions has defined consistency checks and comparison to relevant thresholds that were integrated in the 2015 campaign. Ideas are currently being discussed with the office of the Obser-vatory of Drugs, Medical Devices and Therapeutic Innovation (Observatoire des médicaments, des dispositifs médicaux et de l’innovation thérapeutique – OMEDIT) to better define and to make available relevant data in the area of drugs and health products.

28

The newsletter to the ARS was launched in 2014. It provides the latest information of the working groups to which the ARS participates, keeps everyone abreast of all ATIH’s recent publi-cations along with the updates of online tools and regional indi-cators. In 2015, the newsletter was published three times, with a wide distribution among the ARS. A special issue, published in March, was devoted to the evolution of ATIH data restitution

platform, ScanSanté (ex SNATIH). Reflection on psychiatric res-titution continued, while a specific group was formed involving ARS on the needs of restitution in the SSR sector. Prepared in 2015, inter-regional training sessions on the use of ScanSanté began in January 2016.

Taking part in the definition and propagation indicators of regional healthcare provision

The strategic assessment of the convergence work of management information systems of healthcare provision available to the ARS, and in particular the diamond tools / ScanSanté, has continued under the auspices of the General Secretariat of the Ministry of Social Affairs.

ATIH and the ARS in the Ile-de-France region have worked hand in hand with an external service provider so as to esta-blish the complementarity of both tools, one by providing or made available the dashboards, the other cubes data-access, with a common control. In 2016 a trajectory will be defined to reach this target, with the support of the contractor or provider.

Contributing to convergence and consistency of the data returned to the ARS

Un nouveau nom

Numéro spécial

Snatih devient ScanSanté

Ce nom ScanSanté véhicule un élément d’identité de la plateforme et porte le projet de l’ATIH notamment l’élargissement du périmètre des données.En complément, la signature, « Les données hospitalières pour décrire et agir », com-plète le nom en précisant sa valeur d’usage et le bénéfice pour l’utilisateur.

La plateforme de restitution des données hospitalières de l’ATIH évolue sur le fond et sur la forme !

Afin de faciliter l’accès aux informations dans un univers de navigation modernisé, Snatih devient ScanSanté.Cette première étape dans l’évolution de la plateforme s’inscrit dans un proces-sus d’amélioration continue avec une perspective plus large d’interactivité de l’outil.

// MARS 2015

29Work done in 2015

Ensuring security and integrity of data managed by the Agency

4.

developed the ARCAnH software (Help the Compendium of Analytical AccountingHospital). It enables the institutions taking part in multiple ENC to be the primary beneficiary of a unique tool covering three sectors (MCO, SSR, HAD).

As part of the automatic input of the SAE drawing from the PMSI, the maintenance programs for the input of MCO and HAD sectors was conducted in 2015. Meetings have been held pertaining to SSR data extension; tests will be conduc-ted in 2016 with a view to generalizing the implementation of the SAE 2017.When it comes to the automatic input of the collection of QUALHAS indicators, multiple assessment meetings with the HAS have helped validate the feasibility of the apparatus provided that the information system of the institutions is suf-ficiently homogeneous. The obstetrics record having been the target of important standardization work by the gyneco-obstetrics community, a test will be carried out during the year 2016 on an HPP (Hemorrhage postpartum) indicator.A significant change was requested by the institutions for the collecting device of cost studies. ATIH has therefore

Doing whatever’s best to integrate the collecting device into the institutions’ information system to lighten up their workload

30

Developments have been carried out to make available new restitutions as part of the monitoring tools of data quality. This is a step which contributes to reinforcing the users’ trust in the data collected from different domains : cost studies (addition of restitution tables on the e-ENC platform), quality care indicators (the IPAQSS platform), and the OVALIDE platform particularly within the context of psychiatry.

When it comes to the reliability of the financial data collection, several actions have been carried out concurrently resulting in securing the devices :

• Automatic integration of debt data (ODT) into the financial account. Data entered into the debt observatory is thus integrated directly as part of the financial account without requiring actions on the part of the institution.

• The work of the dedicated group ‘reliability of data forecast by EPRD’ to which some ARS participated has resulted in the creation of control tabs. These enable the institutions to check the data entered on the one hand (via consistency checks, existence of the data and on data change) and on the other to facilitate the validation of data in a given region. Another objective of this working group has been the implementation of financial indicators and common dashboards to all the institutions.

• Last, additional consistency checks have been implemented within the collection mechanism of financial accounts (CF) ((equilibrium of the balance sheet, recalculation of the FRNG, etc.).

The data collected as part of the experimentation of HR ex-tractor mechanism have been processed and analyzed. This tool enables the automatic extraction of Human Resources data directly from health care information systems facilities. It seeks particularly to replace existing collection devices (social balance sheets, payroll, etc.). These studies have shown the need to continue the experiment to ensure the robustness of the indicators calculated. Indeed, the first calculation of GVT has shown a high sensitivity of the result onthe basis of integrated data. Moreover, the processing of data has highlighted unexplained differences compared with the existing information from the social balance sheet. A second experimentation is therefore going to be conducted within the context of a market. It will be enlarged to more institutions, with the resumption of financial data of previous financial years that have already been transmitted to which will be added a new year of collect.

Developing better documentation on data quality controls

2015 was the final year of a contract struck two years earlier with a company certified in matters of computer security information systems (ISO ANSSI). An audit on the following software OSIS, DIPI, DIPISI, BILANLIN and Concentrator RPU was carried out under the watchful eyes of ATIH, which made all the necessary changes

recommended by the reports in terms of development and infrastructure. As a result, all the Agency’s software or apps were audited and, where appropriate, corrective measures were carried out.

Reinforcing the security of collection devices and propagation of data

31Work done in 2015

In addition to this phase of transition, and in order to streng-then the security of dissemination of PMSI data, ATIH has also implemented a system of access to PMSI data for the ARS and the institutions.

The solution proposed by ATIH is based on a data access via a secure internet connection (HTTPS) with a strong authenti-cation system linked to an OTP (one-time password) issued by a tool (token) provided by ATIH to a specific user. The connection to this virtual machine itself allows connection to a SAS server with SAS Enterprise Guide software. Initially, only the SAS environment is available. Traceability is ensured by an audit mechanism (log system) of all SAS treatments carried out, as well as the establishment of a computer monitoring system (‘key logger’) that records all actions performed by a specific user (Observe IT). The inputs or outputs of data are permitted without any restriction, but can be traced retros-pectively through the mechanisms established. To meet the needs of other users, and in the context of a market with an adapted procedure (MAPA), ATIH has entrusted the CASD du GENES with the implementation of the system of provision of data through a secure device.

When it comes to the dissemination of public data, lthe government has launched the Open Data, a comprehensive policy of open data. In the health sector (PMSI with regards to the Agency) a commission ‘Open Data Santé’, bringing together all the participants, submitted its report in July 2014. This report formed one of the bedrocks of article 193 of the Act leading to the modernization of our health system.The direction taken in terms of access to health data focuses on a complete opening and free of charge for data that are thoroughly anonymous. Data with a risk of being re-identified must for their part be made available under conditions guaranteeing respect for individual privacy.Therefore, in order to continue and to reinforce the policy of access to the PMSI data with respect to the private life of the patients, ATIH, at the request of the Ministry of Health and Social affairs, must put in place a new access mechanism to these data. As of 2015, a transitional arrangement was achieved, in lieu and place of the previous system of dispatch of CD-ROM. Provisionally, a first step in the strengthening of the security enhancement of dissemination was performed with a secure download procedure for accessing PMSI 2014 data.Within this context, and in addition to the opinion of the CNIL, the French data protection authority, users must sign ‘a right to access data’ agreement with ATIH. Anyone wishing to access PMSI data must sign a confidentiality agreement to be transmitted to ATIH. The data are downloaded to a secure platform with an asymmetric encryption mechanism by a duly identified contact person. Data destined for a user are downloadable only once.This mechanism enabled the dissemination or propagation of data PMSI 2014 drawing users’ attention to the risks attaching to their use. Several elements are the vectors of this awareness and this empowerment : the signature of ATIH-agency user agreement, the individual commitment of each user who is able to access the data, the appointment of a representative for each entity in charge of the download of the data, data encryption using an ad hoc mechanism

32

Collecting and returning information with a view to enhancing knowledge of hospital

de l’enquête médicament - IDEM). A platform of transmis-sion has also been set up. For this first year of investigation, the response rate is quite low as fewer than a quarter of the institutions have responded.

The activity data : drugs inquiries

Financial data, budgetary and accounting

The DGOS has transferred the project management of the drugs investigation within the hospital from DREES to ATIH. To collect data on the consumption of medication in health facilities or institutions, the Agency has developed the IDEM software (a medication database - Intégrateur des données

For the collection of financial data, ATIH has put the upcoming decisions under the entry platform with a view to automatically retrieve the EPRD data for the relevant institutions. Among the 2015 novelties, there is also the creation of reporting tables from the Digital Hospital indicators intended for the DGOS.

Information gathering

5.

33Work done in 2015

Cost pertaining to data (ENC & RTC)

Data governing the quality and the security of care

In line with the previous years, the Agency has continued its proceedings in 2015 in order to improve the measurement of the costs analyzed : the aim was to strengthen the samples of the participating institutions to the nationwide cost studies, but also to improve the collection reprocessing accounting mecha-nism of the (RTC) and to harmonize or align the methodologies of both studies, with respect to their mutual goals.As part of the continuous improvement of the ENC methodo-logy, working groups made up of voluntary institutions parti-cipating in the ENC healthcare institutions have been set up.

An alternate collection and new indicators

The indicators of quality and safety of care have become more numerous, and as a result the DGOS and the HAS have agreed on an alternating form of collection which has contributed to reducing the workload related to the health facilities. At the same time, this principle has made it possible for the improvement undertaken to be effective.2015 witnessed the collection of new indicators in all themes related to IPAQSS (stroke, dialysis, management of myocar-dial infarction...) and numerous meetings were held in order to, in the long run, be able to integrate external data into the QUALHAS platform.

The online measurement of patient satisfaction hospi-talized in MCO

The management of e-SATIS, the indicator measuring the satisfaction of inpatients hospitalized more than 48 hours in the MCO sector, was transferred to the HAS. As a result, the mechanism dramatically improved in 2015 with the aban-donment of the mode of telephone administration in favor of web self-administered mode and the continuous collection of questionnaires via the web. To this end, the ATIH has deve-loped and implemented a national e-SATIS mechanism. It consists of two web platforms which enable :• the healthcare institutions to submit via a secure platform,

email files of their patients affected by the collection;

These groups met twice during the year and were allowed to propose and to analyze a certain number of methodological developments. Their work is to continue in 2016.Moreover, the cost accounting collection tool developed by ATIH for the ENC (ARCAnH) has evolved to enable participating institutions on several health fields to make only one entry per National register from health and social facilities (Fichier national des établissements sanitaires et sociaux – FINESS). What’s more, the ARCAnH software was also deployed to implement the RTC.

• an automatic dispatch of e-mail messages encouraging the eligible patients to fill in the e-SATIS questionnaire within 2 to 10 weeks ensuing their exit via a personal and secure connection, as well as a reminder will be sent to the patient (s) who fail to respond in order to increase the participation rate in the investigation;

• the patient must fill in the questionnaire at one or multiple times on the e-SATIS platform via a secure connection.

In June 2015, a pilot phase made of 12 voluntary health faci-lities has contributed to the validation of the whole procedure put in place. Hinge on what we have learnt from this first phase, the national campaign was launched in September 2015.

Scope Health

As in the previous years, ATIH has managed the data and has developed web services for the restitution, among other things, quality indicators that have been submitted for complete dissemination to the public on the Scope Health website. By 2015, the indicator of patients satisfaction hos-pitalized in the MCO sector was added to the long list of indicators already available.

34

Restituting information

Scansanté : Innovations and enhancements

Access to PMSI data

In 2015, three new applications were uploaded online :

• The oncology dashboards :they provide a better picture of cancer research within an institution based on an algorithm that has been developed by the National Cancer Institute (Institute national du cancer – INCa) and ATIH. This algorithm has been helpful in identifying cancer-related hospitalizations within the PMSI MCO database.

• A yearly synthetic record sheet for the institutions with an SSR activity, which restitutes various types of indicators (activity data, financial, HR - Human Resources - and quality).

• A baseline costs per labor unit (Unité d’oeuvre - UO), based on the RTC files (accounting reprocessing) of healthcare settings previously under comprehensive allocation (validated by ARS).

In 2015, as mentioned above, the dissemination of PMSI data on CD-ROM was ended. This was meant to optimize gua-rantees of protection of anonymous individual data likely to be re-identified. An interim mechanism for secure downloading of the database was implemented for the dissemination of the PMSI 2014 (medicalized information system program 2014) database, and a target solution is in the process of being deployed.

Three applications have already been revamped :

• The outpatient surgery (Chirurgie ambulatoire - GDR), along with the indicators to monitor the development process based on specialty: gastrointestinal, Gynecology, ophthalmology, ENT specialist, orthopedics, stomatology, urology; and a performance indicator, developed in partnership with the National Agency for Supporting Medical Institutions’ Performance (Agence nationale d’appui à la performance des établissements de santé - ANAP) and 15 other nationally known experts, who provide expertise when it comes to accessing the volume, the case-mix together with the index of organization and innovation.

• The medico-economic restitutions in psychiatry were endowed with new indicators related to the health care provision, medico-social and liberal.

• HospiDiag includes two new features :- ‘comparison and thematic analysis ‘ which facilitates

the analysis of a theme or an area of performance, developed for two different themes: ‘Surgery’ (available in eleven sub-topics) and “ the funding of public/ private institutions ” (available in six sub-themes);

- “ mapping of the area of attraction ” which makes it easier to visualize the zone of attractiveness or poles of attraction of an institution within each discipline analyzed in HospiDiag (total activity, hospital stays, stays in surgery (HC), outpatient surgery stays, stays in obstetrics, cancer (excluding meetings) stays, chemotherapy).

35Work done in 2015

SNATIH IS NOW KNOWN UNDER SCANSANTE

To facilitate access to information in a modernized browsing system, the Scansante platform now offers :

Through simple queries, ScanSanté among other things enables access to :

> access to data through a unique portal : fusion of apps in open access (statistics, mapping,

cost repository) and apps requiring identification (medico-economic restitution in psychiatry, indicators of the social assessment)

> an organization of information based on theme search (analysis of healthcare provision, analysis of activity) to optimize browsing and online experience.

> a homepage, richer and more dynamic, structured in such a way that it better promotes the most recent updates and innovations (apps, features...)

> the activity of healthcare institutions on all four sectors MCO, HAD, SSR and Psychiatry

> the evolution of specific activities subject to public policies such as outpatient surgery and oncology

> Data on the organization of care such as :- the mapping distribution of the institutions and their local focal points.- their market share, - the rate of access to healthcare in accordance

with several geographical levels - comparing consumption with healthcare provision

> indicators and ratios describing hospital

performance based on its various dimensions

> the possibility to display all available data based on field of activity (MCO, HAD, SSR, Psy)

> a brief description of each app, an enriched glossary and easily accessible documentation for each app.

> displaying a new page of results for each query to compare the results according to different criteria and between different apps.

> hospital revenues, either at the macroeconomic level (piloting hospital healthcare spending) or by institution.

> the consumption of medications and extra-medical arrangements or schemes, per specialty, per institution.

> hospital expenses through the national repository costs or accounting reprocessing.

> the changing of social data of health facilities along with the social assessment indicators (wage for a full-time job, absenteeism rates, staff turnover rate...)

More ergonomic, richer, more dynamic ... ATIH’s restitution platform of hospital data is rapidly changing both in substance and form.

36

Positioning the Agency vis-à-vis its partners

6.

ATIH and its partners

In 2015, the Agency organized theme-based meetings with its target audiences in order to present its work and to engage with the local participants on the ground.

Within this context of exchanges, the ENC annual day was held on Thursday, July 2, 2015. It brought together more than 120 people, coming from a plethora of institutions par-ticipating in the ENC or interested in carrying out the costs studies on the three fields in the healthcare sectors (MCO, SSR and HAD). The morning session was devoted to showing the different uses of the ENC while the afternoon sessions, introduced by the DGOS, were devoted to theme-based workshops.The participants expressed their satisfaction when it comes to the content and the organization of the day’s events; Thus, it will take place again in 2016.

ATIH has also participated, for the first time, in the health and autonomy fairs (Salons de la santé et de l’autonomie - SSA). Every year, the French Hospital Federations organize this event, which brings together many participants from health and medico-social fields. The Agency was present and shared the Ministry’s stand with the National Manage-ment Centre (Centre national de gestion – CNG), the National Solidarity Fund for Autonomy (Caisse nationale de solidarité pour l’autonomie – CNSA), the National Institute for Preven-tion and Health Education (Institut national de prévention et d’éducation pour la santé - INPES) and the INCA. For three days, the Agency answered inquiries from about 200 pro-fessionals. It hosted two theme-based agoras (ENC EHPAD and Atlas of SIH 2015) and participated in the creation of two ‘micro-events’ on the stand (presentation of the Scansante tool and ENC health).

37Work done in 2015

In general, with regards to its publications, ATIH works on a case by case basis to enhance access to information and adapt it to meet the needs of its public. The Agency’s information mechanism has been enriched throughout the year with new support to better promote its mission and its work.

The Scansante brochure

It shows the potential of this data restitution platform of heal-thcare settings: which data are available (in open access or with a password and username), who uses ScanSanté and for what kind of information, what are the various sources of the data.

Brochure on medical information nomenclature

It describes the various nomenclatures such as the Interna-tional Classification of Diseases (Classification internationale des maladies - CIM), Common Classification of Medical Acts (Classification commune des actes médicaux - CCAM), the CSARR, the list of products and services (liste des produits et prestations - LPP) and the acts of anatomocytopathology (les actes d’anatomocytopathologie - ACP) classification system including their complementary tools.

Improving the information materials

www.scansante.fr

LES NOMENCLATURES DE L’INFORMATION

MÉDICALE

CIMCCAMCSARRLPPATC

38

The Fact sheet “ Key data on hospitalization ”It was updated with the 2014 data, and a declination was conducted on field-based activity : MCO, HAD, SSR and Psychiatry.

The Agency’s WebsiteAn organization has been set up internally to continue with the positive contribution to its content and its user-friendliness, in accordance with the expectations of the internet users. This work is based, in particular, on the results of the satisfaction inquiry conducted at the end of 2014, and which shall be renewed annually.

742 000 patients en réanimation, soins intensifs ou surveillance continue

3,4 millions de patients hospitalisés parmi les 12,9 millions de patients pris en charge aux urgences

4,8 millions de patients en chirurgie dont 44,5% de patients en chirurgie ambulatoire

Médecine, chirurgie, obstétrique et odontologie (MCO)

Données issues du PMSI 2014, chiffres arrondis au millier près

12,3 millions de patients

hospitalisés en France

soit 188 pour1000 habitants

787 000 accouchements dont 1,7% d’accouchements multiples

335 000 décès à l’hôpital soit 60% des décès en France (source Insee), dont 6 900 mort-nés

1,5 million de 80 ans ou + soit 408 pour 1 000 personnes 80 ans ou +

2 millions d’enfants - 18 ans soit 140 pour 1 000 enfants - 18 ans

7,1 millions de patients hospitalisés dans le public

5,5 millions de patients hospitalisés dans le privé commercial

1,2 million de patients hospitalisés dans le privé d’intérêt collectif

3 348établissements

de santé

12% de 80 ans ou +

17% d’enfants - 18 ans

1,4 million de patients hospitalisés pour endoscopie

536 000 patients opérés d’une cataracte

135 000 patients opérés pour une prothèse totale de hanche

Quelques exemples de prises en charge

1,1 million de patients hospitalisés atteints d’un cancer : nombre de patients distincts ayant été repérés par l’algorithme cancer de l’Institut national du cancer (Inca) 139 000 patients pour soins palliatifs

1,2 million de patients hospitalisés pour une pathologie cardio-vasculaire dont 65 000 pour infarctus du myocarde

181 000 IVG réalisées en établissement dont 6% pour des femmes de moins de 18 ans 114 000 patients pris en charge pour un AVC

2014

11,9 millionsde patients

10,9 millions de séjours en hospitalisation complète (hors ambulatoire et séances)

5,7 jours d’hospitalisation complète en moyenne pour un séjour

7,5 millions de patients pris en charge en hospitalisation complète

5,5 millions de patients hospitalisés en ambulatoire (hors séances)

Données issues du PMSI, chiffres arrondis au millier près, chiffres 2014 - Version 2 (janvier 2016): mise à jour du nombre de journées en hospitalisation à temps partiel pour les privés d’intérêt collectif et les privés commerciaux

975 000patients hospitalisés

en établissements de santé de soins de suite et de

réadaptation (SSR)soit 15 pour 1000 habitants

578 000 adultes de 18 à 79 anssoit 12 pour 1 000 personnes de 18 à 79 ans

34 000 enfants de - 18 ans soit 2 pour 1 000 enfants de - 18 ans

363 000 adultes de 80 ans ou + soit 100 pour 1 000 personnes de 80 ans ou +

46 % en secteur public

29 % en secteur privé commercial

25 % en secteur privé d’intérêt collectif

394 000 patients hospitalisés dans le public

325 000 patients hospitalisés dans le privé commercial

292 000 patients hospitalisés dans le privé d’intérêt collectif

1 599établissements

de SSR

784 établissements exercent uniquement une activité de SSR

19 % d’établissements publics43 % d’établissements privés commerciaux38 % d’établissements privés d’intérêt collectif

815 établissements de SSR exercent une activité mixte dont 96 % de médecine, chirurgie, obstétrique

72 % d’établissements publics16 % d’établissements privés commerciaux12 % d’établissements privés d’intérêt collectif

Mentions spécialisées les plus courantes

30 % des établissements détiennent au moins la mention affections de la personne âgée polypathologique, dépendante ou à risque de dépendance

23 % des établissements détiennent au moins la mention affections de l’appareil locomoteur

21 % des établissements détiennent au moins la mention affections du système nerveux

Autorisations d’exercice

89 % des établissements bénéficient uniquement d’une autorisation pour adultes

8 % des établissements bénéficient d’une autorisation pour adultes et enfants - 18 ans

3 % des établissements bénéficient uniquement d’une autorisation pour enfants - 18 ans

SOINS DE SUITE ET DE RÉADAPTATION

Activité des établissements

Structuration de l’activité

2014

Données issues du PMSI MCO 2014, chiffres arrondis au millier près

11,9 millions de patients hospitalisés

en MCOsoit 182 pour 1 000 habitants

8,5 millions d'adultes de 18 à 79 anssoit 180 pour 1 000 personnes de 18 à 79 ans

2,0 millions d'enfants de - 18 ans, dont 815 000 naissancessoit 137 pour 1 000 enfants de - 18 ans

1,4 million d'adultes de 80 ans ou + soit 397 pour 1 000 personnes de 80 ans ou +

33% d’établissements publics

35% d’établissements privés commerciaux

32% établissements privés d’intérêt collectif

6,8 millions de patients hospitalisés dans un établissement public

5,0 millions de patients hospitalisés dans un établissement privé commercial

1,1 million de patients hospitalisés dans un établissement privé d'intérêt collectif

1 974établissements de MCO

en France

MÉDECINE, CHIRURGIE, OBSTÉTRIQUE

Financement des établissements

2015

Séances

371 00094 00045 00027 00061 000

en chimiothérapie

en radiothérapie

en dialyse en centre

en dialyse hors centre

« autres »

Tarification à l’activité (T2A)

1 804 établissements 11,6 millions de patients pour des séjours

0,5 million de patients pour des séances

Dotation annuelle de financement

170 établissements 34 000 patients

17,5 millions de séjours

11,3 millions de séances/forfaits

43 600 séjours

(dont 98% en médecine)

et 400 séances

Patients venus pour des séances

Données issues du Rim-P 2014, chiffres arrondis au millier près

415 000patients hospitalisés en

psychiatriesoit 6 pour 1000 habitants

356 000 adultes de 18 à 79 anssoit 8 pour 1 000 personnes de 18 à 79 ans

43 000 enfants de - 18 ans soit 3 pour 1 000 enfants de - 18 ans

16 000 adultes de 80 ans ou + soit 4 pour 1 000 personnes de 80 ans ou +

45% publiques sous dotation annuelle de financement (DAF)

30% privées commerciales sous objectif quantifié national (OQN)

25% privées d'intérêt collectif sous DAF ou OQN

52 000 patients hospitalisés dans un établissement privé d'intérêt collectif

97 000 patients hospitalisés dans un établissement privé commercial

295 000 patients hospitalisés dans un établissement public

573structures psychiatriques

en France dont 63% avec une activité exclusive de

psychiatrie

PSYCHIATRIE

346 000 patients pris en charge à temps complet

> 276 000 patients dans les établissements sous DAF

> 91 000 patients dans les établissements sous OQN

20,3 millions de journées de présence à temps complet

> 15,5 millions de journées dans les établissements sous DAF

> 4,8 millions de journées dans les établissements sous OQN

58,6 journées en moyenne pour un patientà temps complet

329 000 patients pris en charge à temps plein

> 258 000 patients dans les établissements sous DAF

> 90 000 patients dans les établissements sous OQN

18,4 millions de journées de présence à temps plein

>13,8 millions de journées

dans les établissements sous DAF

> 4,6 millions de journées

dans les établissements sous OQN

55,8 journées en moyenne pour un patient à temps plein

Prises en charge à temps complet

dont hospitalisation à temps plein

2014

39Work done in 2015

In 2015, the Agency signed or renewed a certain number of conventions ‘craft’, thus formalizing active partnerships.

French Agency for Biomedicine

A multi-year agreement strengthens the collaboration between ATIH and ABM (the French Agency for Biomedicine – Agence de la biomédecine - ABM) in various domains: organ transplan-tation, removal of tissue and stem cells, chronic renal failure, medical assistance with procreation. An annual convention agreement was signed for 2015 concerning the national costs studies using a common methodology (public-private) in the MCO sector, the funding of health facilities and on the basis of the PMSI outcome.

National Solidarity Fund for Autonomy

In a multi-year framework agreement, a convention is based on various collaborative work done in the medico-social sector: the realization of a cost survey (data 2013) and a national cost study (data 2015); dashboard performance management of medico-social healthcare settings.

The French National Authority for Health (F.N.A.H.)

As part of a multi-year framework agreement, an agreement has been signed with HAS (The French National Authority for Health – Haute autorité de santé - HAS). It defines the terms of collaboration for the development and maintenance of technical tools and facilities enabling the collection of :• indicators of quality and safety of care based on hospital

clinical records and the presentation of the results (QUALHAS platform and Lotas draw software).

• the quality and safety indicators from the PMSI database to complete the quality assessment mechanism of the offer within the health facilities;

• inpatients satisfaction (e-SATIS);• indicators of quality and safety of care from a ad hoc col-

lection carried out by all the health institutions (BILANLIN platform).

The convention also addresses the ongoing maintenance of the Scope Santé website, and the corresponding user’s database.

Civil Hospices of Lyon

An agreement has been signed for the provision of data retrie-ved from the PMSI by ATIH as part of the SHEWHART control charts study coordinated by the IMER platform of HCL (Civil Hospices of Lyon - Hospices Civils de Lyon - HCL).

ATIH Conventions in 2015

40

Optimizing the Agency’s internal performance

7.

New Leadership

ATIH Decree (No. 2015-828) was published on July 6th 2015. The provisions relating to the implementation of the new leadership body came into effect on 1st October. It comprises or includes the Board of Directors, the Steering Committee and the Scientific Council. Their first meetings were held during the course of the last quarter 2015 and the first quarter 2016 (please see the box for more information).

41Work done in 2015

The Board of Directors

• A chairman appointed by a joint decree of the Ministries of Public Health, Social Affairs and Social Security for a three-year term with a possibility to be renewed.

• Eight representatives of the State :

-The managing director of healthcare provider or his representative;- The director of research, studies, evaluation and statistics or his representative;- The Director of Social Security or his

representative - The Budget Director or his representative; - The Budget Director or his representative; - The Managing Director of Social Cohesion or his representative; - A Deputy Director of the Directorate General of

healthcare provision, appointed by the Director General of health care provision,

or his representative;-The Director General of a regional Agency of health or his representative appointed by the Secretary General of the ministries in charge

of Social Affairs;- The Secretary General of the ministries in charge

of Social Affairs or his representative.

• Three highly qualified individuals in ATIH sectors of competence were appointed for a three-year term with a possibility to be renewed.

• Two representatives of health insurance providers

designated by the Director General of the National Union of Health Insurance funds appointed for a three -year term with a possibility to be renewed.

• A representative of ATIH staff elected by the staff for a three - year term with a possibility to be renewed.

• Participants in an advisory capacity :-The managing Director of ATIH and any person of

his choosing;-The president of the committee of orientation and

any person of his choosing;-The Chairman of the Scientific Council and any

person of his choosing :-The authority responsible for financial control;-The accounting officer of ATIH.

The Steering Committee

• A chairperson appointed by a joint decree of the ministers responsible for health, social services and social security; • Eight representatives of the federations’

representative healthcare institutions and medico-social appointed at the instigation of the latter.

- Two representatives of French Hospital Federation;

- Two representatives of the French private hospital federations;- A representative of hospital federations and assistance to the person; - A representative of the National Federation of Home Care Facilities; - A representative of the National Federation of Cancer Centres;- A representative of the National Interfederal Union of Private Health and Welfare Organizations; - A representative of the National Union of the

Institutions and Private Residences for the Elderly.

• Two representatives of Regional Health Agencies appointed by the Secretary General of the Ministries of Social Affairs;

• A representative of the National Solidarity Fund for Autonomy appointed by his Director;

• A representative of the National Health Authority appointed by his Director;

• A representative of the National Agency for Evaluation and the Quality of Social Institutions and Services and Medico-Social appointed by his Director;

• A representative of the National Agency to Support the Performance of Healthcare Facilities and Medico-Social appointed by its Director.

42

In 2015, the Executive Committee expanded the mechanism monitoring the Agency’s COP (Objective and performance contract - Contrat d’objectifs et de performance - COP). It now encompasses the entire work program: routine production activities or in project mode, along with the improvement initiatives and indicators concerning the entire process of the Agency.

Institutional training was also provided to all the managers on the issue of psychosocial risks. Theme-based working groups, outgrowth of the Committee for Hygiene, Safety and Working Conditions (Le comité d’hygiène, de sécurité et des conditions de travail - CHSCT), were implemented regarding this subject.

Internal Management

The Scientific Council*

• Two highly qualified individuals appointed by the Minister of Health;

• A qualified individual appointed by the Minister of Social Security;

• A qualified person appointed by the Minister of Social Action; • A qualified person appointed by the President of the French National Authority for Health -

Haute Authorité de Santé;

• A representative of the National Institute of Health and Medical Research appointed by his President- Director General;

• A representative of the National Centre for Scientific Research appointed by the President;

• A representative of the National Institute of Statistics and Economics studies appointed by his Director General.

* The Scientific Council elected its chairman among its members.

43Work done in 2015

In 2015, the quality coverage system was extended to the Agency’s four new mechanisms:- collecting, processing, and restituting the financial data, and

human resources.- producing the descriptive tools pertaining to hospital activities.- tracking expenditures of hospital field.- managing ATIH, its processes and its projects.

The “ European Statistics Code of Good Practices ” has been tried to analyze the business process. When it comes to the users’ platform, an audit was conducted by a provider in the first six months. In the process, a dedicated project manager has been appointed who will be responsible to coordinate the implementation of the recommendations made.

In accordance with the requirements of the decree n° 2012-1246 dated 7 November 2012, ATIH changed its accounting software in 2015, with a change-over to “ Win M9 "which incorporates a module Budget Management and Public Accounting (Gestion bud-gétaire et comptable publique – GBCP). The Agency has also made all the necessary preparation leading to the upcoming change to the new mechanism, which took place on the 1 January 2016.

In addition, the Agency has continued its efforts to control internal accounting and finance (development of a mapping process accounting issues, development of a purchasing guide, accounting adjustment governing the system of allo-wance/benefit and the accounting for social liabilities etc.).

Continuation of the quality process / risk management

The financial management of the Agency : transition to module GBCP

44

2015Publications

8.

Hospital activities• 2013 comparative analysis of hospital activity between

regions.• 2014 key hospitalization data• 2014 analysis of hospital activity of healthcare institu-

tions• 2014 key hospitalization data - SSR, Psychiatry • Technical product information and methodological

guide, novelties PMSI, SSR/ psychiatry • 2014 key hospitalization data - MCO • Technical product information novelties PMSI.

Financial standing• Indebtedness of healthcare institutions previously

under complete allocation at the end of 2013 • Charges and means of hospital information systems

(systèmes d’information hospitaliers - SIH) in 2013: participation in the drafting of Atlas 2015

• Projected financial standing of the institutions pre-viously under total allocation according to RIA3 2014

• Financial standing at the end of 2013 of healthcare institutions previously under complete allocation - financial account

• Forecast of financial standing at the end of 2015 of healthcare institutions previously under complete allo-cation from EPRD on 2015

Cost and Tariffs• Technical information (all fields), novelties of a

campaign governing the financing of the institutions• 2013 ENC MCO repository costs • 2013 ENC HAD national values of costs • 2013 ENC - PSTN repository units of work • Alternative method to the comparison of costs and

prices • 2013 Ehpad results of costs survey • 2013 ENC SSR repository costs • Report on the costs of managing healthcare institutions

Human resources• 2013 Data analysis of social assessment

45Work done in 2015

IV. GLOSSARY

45

46

ABMAgence de la biomédecine The French agency for biomedicine

ACOSS Agence centrale des organismes de sécurité sociale The central agency for social security funds

ANAP Agence nationale d’appui à la performance des établissements de santé National Agency for Performance Support

ANCREApplication nationale compte financier, rapport infra-annuel, état prévisionnel des recettes et dépensesNational application finance account, infra-annual report, estimates of revenue and expenditure.

AGGIRAutonomie gérontologie groupes iso-ressources Autonomy, Gerontology, Iso-Resources Groups

ARS Agence régionale de santeRegional Health Agency

AVCAccident vasculaire cérébral Cerebrovascular accident

AVQActivités de la vie quotidienneDaily living activities

CASD Centre d’accès sécurisé aux donnéesSecure access to data Centre

CCAMClassification commune des actes médicauxCommonclassification of medical acts

CF Compte financier Financial Account

CIM Classification internationale des maladies International Classification of Diseases

CMAComplications et morbidités associées Complications and associated morbidity

CMDCatégorie majeure de diagnostic Major category of diagnostic

CNAMTSCaisse nationale d’assurance maladie des travailleurs salariés French National Health Insurance Fund for Salaried Workers

CNIL Commission nationale de l’informatique et des libertésFrench data protection authority

CNSA Caisse nationale de solidarité pour l’autonomie The National Solidarity Fund for Autonomy

COPContrat d’objectifs et de performance Objective and performance contract

CORETAH Comité de réforme de la tarification hospitalière The reform committee on hospital tarification

CSARR Catalogue spécifique des actes de rééducation et réadaptation Catalog of rehabilitation acts

DAF Dotation annuelle de financement Annual allocation Fund

DALIA Outil d’aide à l’analyse intra-établissement des informations du PMSI Assistance tool to intra-institutional analysis of PMSI information

DATIM Détection des atypies de l’information médicale Atypia detection of medical information

DG (ex) Dotation globale Global allocation

DGCS Direction générale de la cohésion sociale General Direction of Social Cohesion

DGFIP Direction générale des finances publiques General direction of public finances

DGOS Direction générale de l’offre de soin General Directorate of Health Care Supply

DIM Département d’information médicale Department of medical information

DREES Direction de la recherche, des études, de l’évaluation et des statistiques Directorate for Research, Studies, Assessment and Statistics

DSS Direction de la sécurité sociale Directorate of Social Security

EHPADÉtablissement d’hébergement pour personnes âgées dépendantes Accommodation Facilities for Dependent Elderly

ENC Étude nationale de coûts National cost studies

FAI Forfait activités isolées Isolated Activities Funding Package

FEHAP Fédération des établissements hospitaliers et d’aide à la personne Federation of the medical institutions and assistance to the person

FINESS Fichier national des établissements sanitaires et sociaux National register of health and social welfare institutionsFHF Fédération hospitalière de France The French Hospital Federation

FHP Fédération de l’hospitalisation privée The French Private Hospital Federation

FNEHADFédération nationale d’hospita-lisation à domicile The National Federation for homecare hospitalization

FSM Fédération des spécialités médicales The Federation of Medical Specialties

GENES Groupe des écoles nationales d’économies et de statistique Grouping of National Economics and Statistics Schools

GBCP Gestion budgétaire et comptable publique Budget management and public accounting

GHM Groupe homogène de malades Homogeneous groups of patients

GHS Groupe homogène de séjours Homogeneous stay group

GME Groupes médico- économiques Medico-Economic Groups

HADHospitalisation à domicile Home care

47Glossary

HAS Haute autorité de sante The French National Authority for Health

HPP Hémorragie du post partum Post-partum haemorrhage

HLC Hospitalisation au long cours Long-Term Hospitalisation

IDS Institut des données de santé Health data Institute

IFAQ Incitation financière à l’amélioration de la qualité Financial incentive for quality improvement

IGAS Inspection générale des affaires sociales General Inspectorate of Social Affairs

IGF Inspection générale des finances General Inspectorate of Finances

INCA Institut national du cancer National cancer Institute

INSERM Institut national de la santé et de la recherche médicale National Institute of health and medical research

INVS Institut national de veille sanitaireNational Institute for Health Surveillance

IPAQSSIndicateurs Pour l’Amélioration de la Qualité et de la Sécurité des SoinsIndicators for the improvement of quality and security in healthcare

MAT2A Mesure de l’activité de la tarification à l’activitéMeasurement of the activity of the pricing activity

MCO Médecine, chirurgie, obstétrique et odontologie Medicine, surgery, obstetrics and dentistry

MIF Mesure de l’indépendance fonctionnelle The Functional Independence Measure

MI Mission d’intérêt général General interest mission

OCDEOrganisation de coopération et de développement économiques The Organization for Economic Co-operation and Development

ODT Observatoire de la dette Observatory on public debt

OMEDITObservatoire des Médicaments, des Dispositifs Médicaux et de l’Innovation Thérapeutique Observatory of drugs, medical devices and therapeutic Innovation.

OMS Organisation mondiale de la santé The World Health Organisations

ONDAM Objectifs nationaux de dépenses d’assurance maladie National Objective for Health Care Spending

OQN Objectif quantifié national National Quantified Objective

OSCOUROrganisation de la surveillance coordonnée des urgences Organization of coordinated surveillance of emergencies

OVALIDE Outil de validation des données des établissements de santé Health facilities data Validation tool

PMSI Programme de médicalisation des systèmes d’information Program for medicalization of information systems

PSSIE Plan de sécurité des systèmes d’information de l’État State Information Systems Security Policy

QUALHASPlateforme de recueil des indicateurs de la qualité de la HAS HAS collection platform of quality indicators

RIA Rapport infra-annuelInfra-annual report

RIM-P Recueil d’information médicale en psychiatrie Collection of medical information in psychiatry

RME Restitutions médico- économiques Medico-economics restitutions

RPU Relevé de passage aux urgences Statement indicating time spent in emergency departments

RTC Retraitement comptable Accounting reprocessing

SAE Statistiques annuelles des établissements de santé Annual statistics of healthcare institutions

SFRO Société française de radiothérapie oncologique The French society of radiotherapy and oncology

SFPM Société française des physiciens médicaux The French Society of Medical Physicists

SNATIHSystème national d’information sur l’hospitalisation National hospitalization information system

SNIIRAMSystème national d’informations inter-régimes d’assurance maladie National Health Insurance Cross-Schemes Information System.

SNROSyndicat national des radiothéra-peutes oncologuesNational union of radiotherapists-oncologists

SSA Salons de la santé et de l’autonomie Health and Autonomy fairs

SSIPS Soins infirmiers individualisés à la personne soignée Individualized nursing care to the individual receiving care / Beneficiary

SSR Soins de suite et de réadaptation Post-Acute Care and Rehabilitation

SYRIUS Système de recueil de l’information médicale System of collection of medical information

T2A Tarification à l’activité Activity-based tariff

TIC Tarifs issus des coûts Tariffs resulting from costs

TIM Technicien de l’information médicale Medical information technician

* au 31 décembre 2014

ATIH Headquarters - Lyon117, bd Vivier Merle 69329 Lyon cedex 03Tél. : 04 37 91 33 10Fax : 04 37 91 33 67 ATIH Paris Branch13, rue Moreau 75012 ParisTél. 01 40 02 75 63Fax : 01 40 02 75 64 www.atih.sante.fr

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Technical Agencyfor Informationon Hospitalization Care

ACTIVITYREPORT

ACTIVITYREPORT

28(12 5912x)ƒ(x)

28-520 360 x 25y

34+2x(25 5984)

4+2ƒ(121) = 2213 552ƒ(x)= 125 452 382

ACTIVITY REPORT - Agence technique de l’information sur ... · générale de la cohésion sociale...

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Transcript of ACTIVITY REPORT - Agence technique de l’information sur ... · générale de la cohésion sociale...