Outstanding Care ~ People Focused

2013-2014 Budget Consultation

PROVINCIAL FINANCEWhy is change happening now?

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Ontario – Surplus/Deficit History

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2012 Ontario Budget

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2012 Ontario Budget

• “Total hospital operating funding is the largest area of health spending and has increased by an average of 5.1 per cent annually since 2003”

• “This Budget will help maintain excellent health care for Ontarians while slowing the overall growth in health spending in Ontario to an average of 2.1 per cent annually, over the next three years.”

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Health System Funding Reform

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Health System Funding Reform Cont’d

Health Based Allocation Model (HBAM)Formula driven - Price X Volume – Based upon population characteristics– Evidence-based activity – Funding rates informed by best practice

Provides 40% of MAHC Funding– Acute and Day Surgery– Emergency Department– Complex Continuing Care

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Quality Based Procedures Hospital funding is reduced at the hospital’s average cost per procedure/weighted case

The hospital then receives new funding at the 40th percentile cost of performing the procedure

This will account for approximately 30% of MAHC Funding by 14/15

Health System Funding Reform Cont’d

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Cataract FundingBased on 409 procedures Carve Out

2012/13 Funding

Unmitigated Funding

Rate per Procedure $970 $825 $497

Total Funding $397,014 $337,442 $203,317

Funding Lost ($59,572) ($193,697)

Excluding bi-lateral procedures/funding

Quality Based Procedures Funding

Health System Funding Reform Cont’d

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Quality Based Procedures for 2013/14

2011/12Cases

Weighted Cases

Congestive Heart Failure 135 208

COPD 193 256

Stroke 126 217

Cardiovascular Surgery 3 5

Colonoscopy 2,765 184

Chemotherapy – Systemic Treatment 0 0

Total 2011/12 Volume 870

Health System Funding Reform Cont’d

PROPOSED SOLUTIONS FOR 2013/14

Closing the Funding Gap

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Planning and Decision Guides

Rural and Northern Healthcare Report (2010)•90% of residents in a community or local hub will receive specialty inpatient hospital and tertiary diagnostic services within four hours travel time from their place of residence.•90% of residents in a community or local hub will receive emergency services (24/7/52) within 30 minutes travel time from their place of residence•90% of residents in a community or local hub will receive basic inpatient hospital services within one hour travel time from their place of residence

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Planning and Decision Guides Cont’d

2012 Ontario Budget•“The [funding reform] model will drive provincial health care funding towards better patient outcomes by:– directing funding to efficient providers who

provide better or more efficient services or treatments; and

– improving quality through specialization.”

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2013/14 Budget

2013/14 Budget Changes ‘000$

Reduced Revenue * (150)

Cost increases (2,160)

Identified Savings 1,060

Deficit/Further Savings Required ($1,250)

* MOH/LHIN funding is unknown at this time, but is expected to decrease from 2012/13. $150k reduction in revenue is revenue from all other sources.

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Proposed Solutions for 2013/14

Funding Reform is shifting funding to community providers, so some patients previously cared for in the hospital will now receive care outside the hospitalAcute Care Bed Reductions–we can continue to service the same volumes with the same quality care with planning and process transformation Complex Continuing Care–Single siting Complex Continuing Care allows efficient utilization of staff and resources

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Proposed Solutions for 2013/14 Cont’d

Integrated Stroke Rehab Beds– there is a high need for Acute Stroke Rehab Beds in

Muskoka – HDMH has been identified as a stroke unit site– MAHC is working to establish a ten bed unit to

serve the population of Muskoka

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Bed Reductions

BED COUNTCurrent Beds Proposed Beds

HDMH SMMH HDMH SMMH Acute Care 37 48 32 38Complex Continuing Care 10 18 0 24

Proposed Integrated Acute Stroke Rehab

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TOTAL 47 66 42 62

Proposed Solutions for 2013/14 Cont’d

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Single Siting Services•It is believed that single siting services and combining the volumes will enhance clinical competency, patient outcomes and improve the operating position of MAHC

• Ophthalmology• Chemotherapy (day clinic)

Proposed Solutions for 2013/14 Cont’d

CURRENT PROGRAMS/SERVICES SMMH HDMHUrology Dialysis Ontario Breast Screening Program Nuclear Medicine Seniors Assessment & Support Outreach Team Pacemaker Clinic Histology Microbiology/Cytology

PROPOSED PROGRAMS/SERVICESOphthalmology Chemotherapy Day Clinic

Programs & Services Across MAHC

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• The proposed budget solutions are not about reducing or cutting services, they are:– intended to find a more efficient way of

providing and preserving these services in our communities;– creating capacity for other services;

• MAHC must balance the level of those services within defined fiscal resources

Proposed Solutions for 2013/14 Cont’d

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Thank you!

Questions?