Section A - Policy
16. Specific Programs & Technical Details
Appendix 7-Hospital In The Home
1. Background
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.
The government allocated $20 million over a period of four years for the development of HITH in May 1995. 1999-2000 represents the fourth and final year of this funding commitment.
The majority of HITH funds have been provided to Health Care Networks and hospitals as incentive funding to develop and provide home based acute care. Incentive funding will continue to be the focus of the HITH Program. As HITH activity continues to rise the level of incentive funding per bedday will be reduced.
Therefore, Health Care Networks and hospitals should continue to systematically review and refine HITH programs to ensure that they are clinically appropriate, cost effective, high quality and offer a sustainable means of acute care substitution.
2. Program Objectives
The objectives for the 1999-2000 HITH Program are:
- To facilitate home based acute care service development;
- To provide incentive funding for the provision of home based acute care;
- To implement strategies for the sustainability of HITH; and
- To continue to refine home based acute care policy through program monitoring and learning from the outcomes of funded service development projects and service audits.
3. Program Components
A total of $5.4 million will be allocated to the 1999-2000 HITH Program. The Program will be made up of the following funding components :
- Incentive funding - $4 million will be provided as incentive funding for the provision of HITH services. These funds will continue to be provided in addition to casemix funding to support the development and provision of home based acute care services.
- Project funding - $1.4 million will be allocated to:
- Special projects;
- Continued seed funding for the Victorian Centre for Ambulatory Care Innovation (VCACI);
- Payments for Service Development Projects (in progress); and
- Payment for the Costing Study.
3.1 Participating Hospitals
The 1999-2000 HITH Program will continue to be available to all hospitals participating in the Program during 1998-99.
3.2 Patient Eligibility
The HITH Program is available to public patients, DVA, TAC, and Work Cover clients.
Patients in residential care (nursing homes, hostels, supported accommodation) may be treated in HITH providing that appropriate protocols and arrangements have been established and agreed with each of the participating agencies.
For patients to be eligible to be treated under HITH, they must:
- Be assessed as clinically suitable for home based acute care;
- Have appropriate support in the home;
- Have a suitable home environment;
- Be fully informed about HITH, their rights and obligations and those of the providing hospital;
- Choose to be treated in HITH and provide written consent to be treated in HITH; and
- Be registered as admitted patients who are transferred to HITH care.
3.3 Provider Arrangements
Hospitals participating in the Program must ensure that they have appropriate patient selection, admission, treatment and discharge protocols.
Participating providers may either provide HITH services directly or purchase services from health and community care providers as appropriate.
3.4 HITH Bed Day Targets
HITH bed day targets are determined at a Health Care Network level. This is to encourage Health Care Networks to establish inter-hospital collaborative arrangements and explore the feasibility of Network wide services. As a result, performance against bed day targets is assessed at a Network level rather than at an individual hospital campus level. For hospitals outside Health Care Networks, performance against bed day targets is assessed on an individual hospital basis. The Department has negotiated with Networks and rural hospitals to determine bed day targets based on actual HITH bed day activity during the first six or nine months of 1998-1999 plus a maximum allowance of 20% for further growth.
3.5 Incentive Funding
Incentive funding payments will be made as part of fortnightly cash flows according to targets and adjusted at the end of each six months following analysis of actual activity reported on the VAED. Failure to meet six monthly targets will result in subsequent reduction by an amount reflecting unmet targets. Unspent funds will then be available as bonus payments to those Health Care Networks and hospitals which exceed targets. Bonus payments will not exceed the standard per diem rate and will be paid on a half yearly basis.
Health Care Networks and hospitals are expected to direct all incentive payments to the promotion and development of home based acute care.
3.6 Reporting and Accountability
All participating hospitals are required to record patients treated under HITH on the VAED as Accommodation Type 4 in accordance with the PRS2 Manual Version 8, July 1998. Additional information may be sought from hospitals in the form of progress reports for the purposes of continuing policy and program development.
3.7 Monitoring, Evaluation and Review
Hospital activity will be monitored via the VAED on a half yearly basis. The Department will distribute HITH activity reports to participating Health Care Networks and hospitals, and the HITH Advisory Committee.
Participating Health Care Networks and hospitals are also required to collaborate and where necessary participate in projects commissioned by the Department. Key projects include :
- Service Development projects (in progress); and
- HITH costing study.
4. Contact Persons
Vivien
Adler, Manager Continuity, Acute Health
Tel: (03) 9616 7100 Fax: (03) 9616 8347 e-mail: vivien.adler@dhs.vic.gov.au
Amos
Yee, Senior Project Officer, Continuity, Acute Health
Tel: (03) 9616 7322 Fax: (03) 9616 8347 e-mail: amos.yee@dhs.vic.gov.au
Deirdre
Willis, Project Officer, Continuity, Acute Health
Tel: (03) 9616 7932 Fax: (03) 9616 8347 e-mail: deirdre.willis@dhs.vic.gov.au