Section A - Policy
10. Continuity of Care
The Department continues to have a strong commitment to help acute health service providers develop innovative services to respond to changing patterns of demand and improve continuity of care for patients. The major new program established in 1998-1999 was the Effective Discharge Strategy which will continue for a further four years.
In 1999-2000 the funding and administration of a number of programs will change or be reviewed. In changing arrangements for established programs, the Department aims to maintain improvements in service delivery while adopting funding arrangements and levels of reporting in keeping with mainstream purchasing practice.
10.1 Effective Discharge Strategy
Funding was provided through the Australian Health Care Agreement in late 1998 for a period of five years for the Effective Discharge Strategy. This is a joint initiative of Acute Health and the Aged, Community and Mental Health Divisions. In the first year of the Strategy, 1998-99, all hospitals, aged care services and Multi-Purpose Services (MPS) developed Discharge Improvement Plans; there was an audit of patient records for evidence of discharge activities; and financial bonuses were allocated to the top performing agencies based on results of the audit.
The total 1999-2000 budget for the Effective Discharge Strategy is $8 million - $6 million from Acute Health and $2 million from the Aged, Community and Mental Health Division. The Strategy is guided by an Expert Advisory Group. The 1999-2000 budget allocation reflects the intention to make the allocation of funds increasingly contingent on performance.
The following is an overview of the Effective Discharge Strategy in 1999-2000:
- Discharge Process Improvement ($2.7 million):
The implementation of Discharge Improvement Plans will continue to be supported in 1999-2000. Funds will be allocated according to separations but will be contingent on achievement of objectives identified by hospitals in the 1998-99 Discharge Improvement Plans. Progress reports on the Plans are expected in December 1999. The Department will provide a proforma to guide reporting.
Half of the funding will be paid by the end of August and the remaining following receipt of Progress Reports due 31 December 1999. The Department will withhold funding if final plans submitted to the Department on 30 June 1999 and/or the Progress Reports are unsatisfactory.
- Measuring and Rewarding Good Performance ($2.4 million):
A Patient Record Audit will again be conducted in 1999-2000 to measure and reward performance improvement. The results of the 1998-99 Audit will inform the method used in 1999-2000. Hospitals will receive bonuses on the basis of performance as measured against the results of the Patient Record Audit in 1998-99.
- State-wide Initiatives ($0.9 million):
Funding will be directed to initiatives with state-wide application. Areas of particular interest are performance indicator development; community provider feedback; and patient and carer experience of care.
The Post-acute Care (PAC) Program is a joint initiative of the Acute Health and Aged, Community and Mental Health Divisions of the Department. For Program Guidelines see appendix 6.
The PAC Program began in 1996-97 with $3 million to establish six pilot projects. The Program now has a total operating budget of $8.2 million and, in 1998-99, was expanded to further extend coverage in metropolitan and rural areas, with a total of 16 projects. In addition, some projects have significantly expanded their geographical coverage, accepting clients from an increased number of acute care facilities.
The PAC Program is well supported by the acute health, aged care and community sectors and has moved beyond the pilot phase. Program objectives have been adjusted to reflect this. Discharge planning is an integral part of the day to day operation of every hospital - the resources allocated to PAC projects are dedicated to coordination and service provision following discharge.
There will be no major changes to the operation of the Program during 1999-2000. PAC projects will be allocated similar budgets to those allocated in 1998-99. However if a project is significantly underspent, the budget may be varied accordingly.
Work has begun on a model for allocation of Program funding to ensure equitable distribution of available resources. A Working Group with representation from key stakeholders has been established, and there will be consultation during the development of the model. The new resource allocation model will be completed by October 1999 and implemented from July 2000. All projects will be given adequate notice of any changes that may result.
Additional funds will be available for PAC projects for DVA clients. Details are currently being negotiated with DVA and PAC projects will be notified of the new arrangements by the end of June 1999.
A Study of Health Outcomes and Cost Benefit of PAC has been contracted to the Bundoora Centre for Applied Gerontology in collaboration with the Centre for Health Program Evaluation and will be completed by June 2000. The outcomes of the study will inform future strategic directions.
Over the next year, the Department will examine the possibility of output based funding for PAC and address issues around the interface of the PAC program with the Primary Health and Community Support reforms and the Effective Discharge Strategy.
The Hospital in the Home Program (HITH) provides consumers with more health care options by incorporating a home based component in, or providing a complete home based alternative to, an episode of acute care. For Program Guidelines see appendix 7.
In May 1995, $20 million was allocated over a period of four years to provide incentives to Healthcare Networks and hospitals to develop HITH. The 1999-2000 year is the fourth and final year of this funding commitment. HITH is now provided by 42 hospitals across the state and has become a recognised alternative to hospital-based care.
The 1999-2000 budget for HITH is $5.4 million. This comprises $4 million in incentive funding, $1 million for service development and $0.4 million for statewide initiatives. No major changes will occur in the operation of the program. The number of bed days provided through HITH has steadily increased, and in 1998-1999 there were substantial increases in some hospitals. As a result the per diem incentive rate has decreased and will be approximately $40 in 1999-2000. As in previous years, adjustments will be made according to actual bed days provided and funds will be redistributed from hospitals that have failed to meet their targets to hospitals that have exceeded their targets.
The Department will use the outcomes of the HITH Costing Study, due for completion in October 1999, and the outcomes from the 1998-99 sustainability projects to develop options for the continued support of HITH. The HITH Advisory Committee, with expanded representation from the field, will provide advice to the Department on these issues. Hospitals will be notified in December 1999 of the arrangements for HITH in future years.
The Home Enteral Nutrition program (HEN) began in October 1997 following recommendations of a Ministerial Working Party. The program has a recurrent budget of $2 million. It is expected that HEN providers continue to follow the guidelines in appendix 8.
Four research and development projects were funded in 1998-99 to formally evaluate the outcomes and cost effectiveness of HEN and the development of best practice protocols for the delivery of HEN services. These projects are due to be completed by 31 January 2000. Funds for HEN are provided to Networks, selected non-networked hospitals and rural hospitals on a regional basis. In preparation for mainstreaming the program, HEN funding in 1999-2000 will be provided as a specified grant. Budgets may be adjusted following receipt of final Income and Expenditure Reports for 1998-99 due by 30 July 1999. Unlike previous years, budgets will not be reviewed on a quarterly basis, but will be reviewed at the end of the financial year to inform the determination of the following years funding allocation. Hospitals will be expected to manage and maintain their own HEN database, and provide data to the Department if required.
10.5 Continuous Positive Airways Pressure (CPAP)
The CPAP Pilot program was introduced in July 1997 to provide assistance to patients with severe obstructive sleep apnoea. It is expected that CPAP providers continue to follow the guidelines in appendix 9.
The budget for the CPAP program for 1999-2000 is $0.5 million and is allocated to fourteen hospitals. In preparation for mainstreaming the program, funds for the CPAP program will be provided as a specified grant.
Budgets may be adjusted following receipt of final Income and Expenditure Reports for 1998-99 due by 30 July 1999. Unlike previous years, budgets will not be reviewed on a quarterly basis, but will be reviewed at the end of the financial year and will inform the determination of the following year's funding allocation.
Due to developments in CPAP equipment and the range of companies supplying equipment and support services in Victoria, the Department no longer considers it necessary to have an approved supplier arrangement with CPAP suppliers. Subject to CPAP machines meeting TGA requirements, Sleep Centres can determine the make and type of CPAP machine they prescribe for patients.
In 1998-99, the Department funded a Sleep Disorders Consortium to examine the performance, cost-effectiveness and quality of life outcomes of the provision of services through the CPAP Program. The study aims to develop a minimum dataset to form the basis of clinical practice guidelines for the management of obstructive sleep apnoea. The study will be completed in January 2000.
10.6 Victorian Artificial Limbs Program
Artificial limb services are integral to the amputee rehabilitation process and need to be linked more closely with the service delivery processes to enhance continuity of care. As indicated in the 1998-99 Policy and Funding Guidelines, the Department has reviewed existing purchasing arrangements for the Victorian Artificial Limbs Program (VALP) with a view to streamlining program administration and funding arrangements. In 1999-2000, funding for artificial limb services will be reviewed with the aim of incorporating it within the rehabilitation funding system in the following year.
In 1999-2000, funding for artificial limb services will be provided as a block grant based on expenditure in 1998-99. Budgets may be adjusted following receipt of final Income and Expenditure Reports for 1998-99 due by 30 July 1999. Unlike previous years, budgets will not be reviewed on a quarterly basis, but will be reviewed at the end of the financial year. The schedule used for reporting expenditure and adjusting funding in previous years will no longer apply. This enables providers to prescribe more flexibly on the basis of assessed clinical need within the total budget available.
Hospitals providing artificial limb services are required to operate within the program guidelines. See appendix 10.
Organ donation rates in Victoria are low when compared to the rates of some other Australian states and countries which have introduced integrated system wide approaches to organ donation. Long waits for donor organs substantially affect the quality of life of potential recipients and also increase the cost of care.
In 1999-2000, funding to establish a central coordination service for organ donation will be provided. The aim of this service is to increase organ donation rates; to provide effective and caring services for donors, recipients and their families; and to ensure dedicated support for organ donation centrally and at hospital level. A positive environment and a systemic approach to organ donation is fundamental to increasing organ donation rates in Victoria.
The Department will be tendering for the establishment of a statewide organ donation coordination service, which is expected to be in place by January 2000. The key roles of the coordination service are to:
- Provide a statewide organ procurement service;
- Provide a statewide bereavement counselling service;
- Support hospitals in developing organ donation systems and processes including medical records review and donor family support;
- Provide training and support for health professionals and community groups in organ donation;
- Conduct and coordinate public promotion and education activities with other relevant organisations; and
- Coordinate the development of policies and protocols for organ donation in consultation with all interested parties.