Published on March 10, 2014
New South Wales State HITH Services Update by Annette Marley Principal Project Officer System Relationships Branch NSW Health 13th Annual Hospital in the Home Conference, Novotel on Collins, Melbourne, 23rd May 2013
Summary • Demand and Capacity • NSW HITH Program overview • HITH Guideline • HITH Revenue opportunities • HITH Costing
⅓ of Australia's population lives in NSW Source: Australian Bureau of Statistics, Regional Population Growth, Australia, 2009-10
NSW Health Overview • NSW Population 7.3M (14% aged 65+) • 15 Local Health Districts / 3 Specialty Health Networks • 226 public hospitals / 500 community health centres / 14,000 GP locations • Annual NSW Health activity (Source: AIHW (2012) Hospital Statistics 2011-12) • • • • 2.235M ED presentations Over 1.6M acute separations 21.5M non-admitted occasions of service 101,819 acute potentially preventable hospitalisations
Hospital admissions are the highest volumes ever Australian Public Hospital Separations by State and Territory 6,000,000 31% increase in Hospital admissions since 2001/2 5,000,000 4,000,000 3,000,000 2,000,000 1,000,000 0 2001-2 NSW 2002-3 Vic 2003-4 Qld WA 2004-5 SA 2005-6 Tas ACT Source: AIHW Australian Hospital Statistics 2001/2 - 2011/12 2006-7 NT 2007-8 2008-9 2009-10 2010-11
The strain on NSW hospitals is continually increasing NSW Public Hospital Separations 2001/2 to 2011/12 1,800,000 1,600,000 1,400,000 1,200,000 1,000,000 800,000 600,000 400,000 200,000 0 2001-2 2002-3 2003-4 2004-5 2005-6 Source: AIHW Australian Hospital Statistics 2001/2 - 2011/12 2006-7 2007-8 2008-9 2009-10 2010-11
NSW Hospital in the Home • 66 services delivering HITH care • Range of service delivery models Achievements to date Increased service numbers 18,000 HITH admissions 52,505 episodes in 2011/12 (33,902 in 07/08) Reduced ALOS
Key drivers for change In the current climate of state and national health reform, NSW is leveraging key strategies to drive change for HITH Local Health District Service Agreement measures NSW 2021 Goal 11 – Keeping people healthy and out of hospital National Emergency Access Target (NEAT) Activity Based Funding (ABF) Equivalent or better care, at better value
Whole of system approach General Practice Quick Triage ED Streaming Emergency Models and Units Out of Hospital Care Hospital in the Home · Planned Admission Inpatient Wards Daily or intermittent · Home or ambulatory ComPacks · Non-clinical services to support early discharge Community Nursing Primary & Community Care 3 Door Options Inpatient Short Stay Units Chronic Care eg. Medical Assessment Units, Urgent Care Centres rd Aged Health Palliative Care Hospital Substitution (Hospital in the Home) General Practice
Hospital in the Home Program Objectives • NSW HITH services have consistent, measurable and clearly defined service delivery models • NSW Local Health Districts and Specialty Health Networks have a clearly defined strategy to increase their HITH capacity to meet the needs of specific target patient groups and their broader community
Hospital in the Home Program Strategies • NSW HITH Guideline • Revenue opportunities • HITH Costing study
Program status Clinician led Working Group commenced June 2011 Work plan for 2012/13 developed Guideline in draft May 2013 High level implementation plan drafted May 2013
NSW Hospital in the Home Guideline What we want to achieve • To provide clear, standardised guidance regarding definitions, key elements and principles • Consistency of reporting, defined data measurable data-to enable coding counting & costing & enable ABF • Improved HITH service planning • Local development of service delivery models to meet local needs • Reduce variation, to achieve best practice across the state • Incremental increase in % acute separations admitted to HITH
NSW Hospital in the Home Definition Hospital in the Home (HITH) services provide acute and post-acute care to children and adults residing outside hospital, as a substitution or prevention of in-hospital care. The place of residence may be permanent or temporary. • A person may receive their care at home (including Residential Aged Care Facilities), in a community setting, at school or in the workplace. • HITH care is short-term and preferably interdisciplinary
NSW Hospital in the Home Definition Daily HITH • • • An individual requiring at least daily clinical care and assessment of their treatment needs - clinically equivalent to an admitted patient Daily HITH substitutes for inpatient care Meets the national definition Intermittent HITH • • An individual with predominantly post-acute care needs who requires less than daily clinical assessment of their treatment needs Intermittent HITH is clinically equivalent to non-admitted care.
NSW HITH Guideline Implementation We are here ID 1 Hospital In the Home Program : Phase Two HITH Program Working Group meetings Apr 2013 Start May 2013 Jun 2013 Jul 2013 Aug 2013 Sep 2013 Oct 2013 Nov 2013 31/3 7/4 14/4 21/4 28/4 5/5 12/5 19/5 26/5 2/6 9/6 16/6 23/6 30/6 7/7 14/7 21/7 28/7 4/8 11/8 18/8 25/8 1/9 8/9 15/9 22/9 29/9 6/10 13/10 20/10 27/10 3/11 10/11 17/11 24/11 12/12/2011 31/03/2014 2 HITH Program Sponsorship Group meetings 12/12/2011 31/03/2014 3 NSW HITH Guideline Finalization & Dissemination to LHDs for implementation phase 02/04/2013 24/05/2013 4 HITH Revenue survey & evaluation 29/03/2013 17/04/2013 5 NSW HITH Guideline summary page development, printing and distribution 1 Key Deliverable 2 24/05/2013 28/06/2013 6 Dissemination of NSW HITH Guidelines & toolkit to LHDs for implementation phase 14/05/2013 26/07/2013 7 Supporting Communication to LHD’s (letter to CE’s-ref to ABF, Data mgt, toolkit ?workshop nominees 24/05/2013 31/05/2013 8 9 HITH Costing Study -Site nominations HITH Costing Study in collaboration through the ABF Taskforce Dec 2013 Jan 2014 Feb 2014 Mar 2014 Finish 06/05/2013 13/05/2013 03/06/2013 27/09/2013 10 Toolkit development to support LHD’s in monitoring & Evaluation of HITH program (disseminated via CEs) A) Data, evaluation and Service Agreement measures (suite of measures) B) Costing / ABF implications C) Clinical target groups 11 ½ day Workshop planning HITH Self Assessment tool Present: A) Guideline B) Data, Evaluation and Service Agreements C) Costing / ABF implications Explore opportunities and barriers in relation to: Service Delivery Model – key elements + admission criteria/Target groups 31/05/2013 30/10/2013 12 Monitoring, evaluation and reporting 02/09/2013 28/03/2014 06/05/2013 26/06/2013 3 Key Deliverable 13 Post Implementation survey 03/02/2014 28/02/2014 14 Agency for Clinical Innovation handover 02/04/2014 02/04/2014 4 1/12 8/12 15/12 22/12 29/12 5/1 12/1 19/1 26/1 2/2 9/2 16/2 23/2 2/3 9/3 16/3 23/3
Hospital in the Home Revenue • In NSW, HITH Financial classes include only • Medicare • DVA • Reciprocal • Working within Ministry of Health to establish gazetted rates for HITH in NSW • Seeking revenue from Private, Motor Accident Authority, Workcover, overseas patients
Hospital in the Home Costing • Recommendations from a preliminary study will be progressed to establish an ABF methodology for HITH • The range of HITH models in NSW will be costed • Daily vs Intermittent • Home vs Clinic • GP vs Specialist led • If approved, data collection to commence in June 2013
Hospital in the Home – Future Directions • Targeted models of care – Paediatrics / RACF • GP management – remuneration • Blended funding models • Ongoing governance – linking with Agency for Clinical Innovation • Expansion of service capacity across the state
NSW HITH Contact details Rachel Nash Principal Project Officer System Relationships & Frameworks Branch http://www.health.nsw.gov.au/performance/pages/HITH.aspx firstname.lastname@example.org (02) 9391 9632 Annette Marley 0477 351 723 email@example.com
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