Consultation on a joint ACC and Ministry of Health Funding Model for Emergency Ambulance Services...
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Transcript of Consultation on a joint ACC and Ministry of Health Funding Model for Emergency Ambulance Services...
Consultation on a joint ACC and Ministry of Health Funding Model for
Emergency Ambulance Services
Stakeholder WorkshopsNovember 2010
ACC and Ministry purchasing
National Ambulance Sector Office Looks after contracts for both ACC and
the Ministry for emergency ambulance services (road, air, communications-111)
Aligns purchasing where possible Reviews joint service specifications
(road, air, communications-111) Facilitates new initiatives Administers the New Zealand
Ambulance Services Strategy
The Starting Point: NZ Ambulance Service Strategy
Initiative 2: Develop transparent, sustainable funding model(s) that link external drivers to agreed service expectations
Objective: a consistent agreed basis for funding Road and Air ambulance providers
The case for change
Why do we need a new approach to funding emergency ambulance services?
ACC and the Ministry have different approaches to funding emergency ambulance services
Providers have consistently identified that having 2 funding models is an issue
Critical issues
Different approaches lead to:– higher compliance costs for providers – perverse incentives associated with ACC’s
fee-for-service– perverse incentives associated with
Ministry contracts for air transports– a lack of ability to plan for the future
Challenges with the current funding model
Question 1: Have we identified the critical issues with the current funding models? If not, what are they?
The Emergency Ambulance Service
Emergency ambulance services – key functions
Communicationsincluding initial call
taking and determining priority
and response needed
Dispatch of vehicle and crew, including resourcing decisions around what is most appropriate to send (crew, vehicles, proximity)
Triage including decisions regarding
whether to treat, transport or not, and where to transport
Transport: provision of
appropriate and timely transport where required
Handover: to emergency
department or Accident and
Medical Centre
Reporting and monitoring of
key performance information to
funders
Scene management
Treatment according to
scope set through standing orders and delegations
Emergency ambulance services – key functions
Communicationsincluding initial call
taking and determining priority
and response needed
Dispatch of vehicle and crew, including resourcing decisions around what is most appropriate to send (crew, vehicles, proximity)
Triage including decisions regarding
whether to treat, transport or not, and where to transport
Transport: provision of
appropriate and timely transport where required
Handover: to emergency
department or Accident and
Medical Centre
Reporting and monitoring of
key performance information to
funders
Scene management
Treatment according to
scope set through standing orders and delegations
Goals for a new funding model
The goals of the successful funding model are to:– deliver a single funding model for emergency
ambulance services that meets the needs of both ACC and the Ministry
– provide value for money for the Government, tax payers and levy payers
– support decision making consistent with clinical priority and need
– allow evolution into the future for the whole sector – the Government and providers (eg, allow for changes in purchasing of ambulance services across the wider health sector)
– reduce compliance costs for providers and support longer term capacity building within the sector.
Goals for a new funding model
Question 2: Do you support the goals for the new funding model? Do these goals address the critical issues?
Assumptions
the model must work within current funding levels (taking into account inflationary pressures and any funding for one-off initiatives)
funding for Emergency Ambulance Communications Centres will continue on the current basis
the model will have no effect on ownership (ie, the Crown is not seeking to own the service)
the model will not include DHB funded inter-hospital transfers at this point in time as the first step is to align the ACC and the Ministry models.
Range of funding models
Purely fee-for-service based funding Blended bulk funded/ fee-for-service
model Status quo Blended capacity/ fee‑for-service
model Bulk funding/block contracts Pure capacity-based funding
Proposed high level funding model
For example sponsorship, fundraising, part-charges
Provider sourced funding ACC and Ministry funding
Total emergency ambulance funding
Bulk-funded/capacity-funded component
Fee-for-service component V
olu
me
Blended funding model, combining bulk-funding or capacity funding with a fee-for-service component
Proposed high level funding model
Question 3: Does the proposed high level model meet the needs of the Government, ACC, Ministry of Health, emergency ambulance providers, tax payers, levy payers and patients? Why or why not?
Question 4: – 4(a) Does the proposed high level model address the
problems with the current funding model? – 4(b) Why or why not? – 4(c) What are the benefits and risks, incentives and
disincentives from your viewpoint? Question 5: Are there any other funding model
options you would have expected us to investigate? Please describe the model and how it will address the issues that have been identified.
Three variations of the blended modelVariation FeaturesBulk funding with a tolerance zone and fee-for-service above and below tolerance zone
the total funding per contract period for a specified level of service is agreedtolerance zoneservices above the tolerance zone attract fee-for-servicefunding cap and funding floor
Capacity-funded fixed costs and fee-for-service variable costs
Contribution of capacity funding for fixed costs for an agreed service levelACC and Ministry would also pay fee-for-service for each and every service provided, based on variable or marginal cost of providing service
Capacity-funded fixed costs and fee-for-service variable costs with a maximum funding cap for fee-for-service
contribution to capacity funding for fixed costs for an agreed service levelfee-for-service for each and every service provided based on variable or marginal cost of providing a service, up to an agreed service level; above that service level a lower fee-for-service could be paida maximum cap for fee-for-service could also be specified
Option 1: Bulk funding with a tolerance zone and fee-for-service above and below tolerance zone
Funding floor at agreed level
Wash up payment
Provider returns agreed amount of funding
To
lera
nce
zone
No extra FFS payment
FFS at agreed rate
Provider -sourced funding
(eg, fundraising,
sponsorship, part -charges)
Total ambulance funding
Funding capped at agreed level
Vol
um
e
Agreed bulk funding level
No wash up
Agreed bulk
funding level
Question 6: What are the benefits and risks of this variation of the blended funding model (Option 1-bulk funding)? What incentives or disincentives are there in this model?
Question 7: What would need to be done to make this work in practice for emergency ambulance providers?
Option 2: Capacity-funded fixed costs and fee-for-service variable costs
Fee-for-service for all volumes = agreed variable
cost for each and every service
Capacity-fundedfixed costs by theCrown
Total ambulance funding
Vol
ume
of s
ervi
ces
Provider-sourced capacity funding for fixed costs (eg, fundraising, sponsorship)
Tot
al c
aapc
ityAgreed line
for proportion of capacity
funding
Question 8: What are the benefits and risks of this variation of the blended funding model (Option 2)? What incentives or disincentives are there in this model?
Question 9: What should be classified as fixed costs and variable costs? Have we classified these correctly? What changes would you make? (see handout)
Question 10: What would need to be done to make this work in practice for emergency ambulance providers (Option 2)?
Option 3: Capacity-funded fixed costs and fee-for-service variable costs with a maximum funding cap for fee-for-service
Fee-for-service for all volumes = agreed variable
cost for each and every service
Capacity-fundedfixed costs by theCrown
Total ambulance funding
Provider-sourced capacity funding for fixed costs (eg, fundraising, sponsorship)
Tot
al c
aapc
ityAgreed line
for proportion of capacity
funding
Funding cap
Lower fee for service
Vol
ume
of s
ervi
ces
Question 11: What are the benefits and risks of this variation of the blended funding model What incentives or disincentives are there in this model?
Question 12: What would need to be done to make this work in practice for emergency ambulance providers?
Comparing the three variations on the high level blended funding model
Question 13: What should be the service components in a blended funding model (eg transport, call out, attendance, treatment etc)?
Question 14: Do you prefer variation 1 or 2 or 3? What is your first choice? Second choice? Third choice? Why?
Question 15: If you prefer Option 1(bulk-funding/fee-for-service) then what should be included in the bulk funded component? What service components should be fee-for-service?
Question 16: If you prefer Options 2 or 3 (capacity-funded/fee-for-service) then what should be included in the capacity funded component? What service components should be fee-for-service?
Next steps
Key themes from Stakeholder meetings will be put onto NASO website (www.naso.govt.nz)
Consultation period closes 5pm 15 December 2010
Send your submission to [email protected]
Funding model implementation anticipated through road and air ambulance contracts December 2012