Highlights of the 1997-98 Policy
- The 1997-98 budget provides a consolidation of the previous year's throughput fund, with key initiatives to enhance performance and manage demand in a more strategic manner. The 1997-98 budget provides aconsolidation of the previous . The 1997-98 policy stresses the balance of quantitative throughput requirements with qualitative aspects such as emergency waiting times and elapsed time on waiting lists.
- For the majority of rural hospitals and metropolitan Networks, the 1997-98 policy delivers modelled budgets and aggregate throughput levels which are relatively stable. Thus, there is considerable public expectation that Networks, in their third year of operation, will be able to deliver an all round improvement in performance covering quality, efficiency and access to a full range of services. The modelled budgets imply significantly less productivity requirements than in recent years. This is not a signal that continuous improvement should not be sought or cannot be achieved. Rather this is a year where the impact of prior restructuring can be realised and consolidated.
- The broad pricing system introduced last year will continue. This incorporates a strong base level of throughput (Target A) and growth options at three levels: a 2 per cent margin for flexibility; options and a Tender Pool. Options (Option WIES) have been allocated to recognise regional and local growth. To introduce even greater contestability within general planning guidelines, a Tender Pool will be introduced for Networks and rural hospitals to undertake additional throughput volume at price rates specified by them.
- In 1997-98 ambulatory casemix funding will be introduced to all major (that is, Group A) hospitals. These hospitals provide about 75 per cent of all outpatient services. This system will pay on the basis of encounters in clinical specialty categories. The new ambulatory classification and funding system has been developed and agreed over the past few years with significant input from clinicians and hospitals.
- As part of the introduction of the ambulatory classification and funding system, the funding of emergency departments has been partially shifted from an historical basis to one based on current costs and activities. A discussion paper Paying for Hospital Emergency Care was circulated to the industry in March 1997 for comments. For 1997-98 ambulatory funding purposes, the fixed component of emergency department funding has been identified and standardised according to cost/activity categories. This will be reviewed and revised by a specific Taskforce in 1997-98.
- Aggregate throughput targets for metropolitan Networks will continue and aggregate rural regional targets have been introduced this year. This allows greater attention to local differences and complexities within Networks and within rural regions. All hospitals however, will identify and report performance against campus targets for monitoring across the system. This will ensure public accountability to guarantee that services are distributed in the most effective and efficient manner across Victoria.
- A major emphasis on rural hospitals will continue. The Rural Specialist Services Grant, will increase to $7.2 million. The payment for each specialty has increased by 20 per cent to $60,000. Eligibility requirements for the Rural Specialist Services Grant have been changed to enable hospitals to have greater flexibility in accessing this funding. There is a continuation of funding for rural hospital self-sufficiency ($3.5 million) and new developments through the Healthstreams program. Healthstreams is a service and funding model that encourages flexibility in the design and delivery of a diverse range of primary health services. Agencies approved for conversion to Healthstreams include the Port Fairy Hospital; Yarram and District Health Service; Beaufort and Skipton Health Service; Tallangatta Hospital and Mt Alexander Hospital. Conversion of a further 11 agencies has been approved in principle.
- The Emergency Services Enhancement Program has been extended with a $10 million increase in funding. This Program is designed to improve access to services and prompt treatment including hospital admission for those who need it. Performance criteria have been strengthened. Targets have been refined and there will be an increase in penalties for those hospitals not meeting targets. This program is output based, through achieving specific treatment time criteria.
- The Elective Surgery Enhancement Program continues with its major objective to decrease waiting times with special attention to clinical priority of patients. Funding for this Program has also been increased by $10 million. This program is also output based, through achieving specific waiting times and waiting list reductions. Major changes include the allocation of funds on the basis of volume and complexity and bonuses for reductions in postponement surgery. The key criteria include:
- No category 1 patients (urgent patients) on waiting lists who have been waiting for more than 30 days.
- Reductions in category 2 patients (semi-urgent patients) who have been waiting more than 90 days; and
- Reduction in overall waiting list numbers.
- Additional funding of $4 million will be provided to improve infection control and clinical risk management procedures.
- The innovative Hospital in the Home Program, launched in 1993-94, is continued in 1997-98 as Phase 3. Funding of $5 million will be available this year with payments made on a per diem rate.
- The AN-DRG Version 3 was introduced on the 1 July 1996 and will continue in 1997-98. A number of refinements have been introduced. An industry report to improve elements of clinical costing systems has been undertaken and will be released in August 1997.
- There has been a limited extension (four extra categories) of same day weights. Ceilings for same day medical throughput for metropolitan Networks and other non-metropolitan hospitals have remained at 1996-97 levels. The same day caps will be reviewed in 1997-98.
- A second coding audit, including targeted audits, has been undertaken with the active support of hospital information managers. Data from the second audit suggests an overall improvement in data quality, with the level of AN-DRG change (audit compared to original hospital results) falling from 13.5 per cent for 1993-94 to 11.7 per cent for 1995-96. However, there is greater divergence of results for hospitals. A third audit will be undertaken in 1997-98 with a smaller number of hospitals with larger random sample sizes. Financial penalties are under consideration for hospitals with high levels of upcoding.
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