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Northern Territory Department of Health Library Services Historical Collection
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February, March & April 1998 Issue
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I I I i I I \ \ \ \\
A View of THS Health Information Reforms
s
February, March and April 1998 - Edition No. 16
A view of THS Health Information Reforms
I N ' S I I > E
Information Technology In
the Bush ... Pg 3 Pension Concession Information
System ... Pg 4 HBM3 ... : ... Pg 5, 6 & 11 The Scenario Planning Workshop for Acute & Specialist Services ... Pg 7, 8 & 9 Clinical Initiatives ... Pg 1 O HCA - Murray Taylor ...•... Pg 11 Acute & Specialist Care ... Pg 12 Education - Health Planning & Support (HPSS) Divisional Forum ... Pg 13, 14 & 15 Coding Update ...•... Pg 16 Marketing - The Tenth Casemlx
Conference ...•...•... Pg 12
FRONT COVER:
SHANE MARTIN(AHW)
+O+
CAROLYN WILSON
&
DEBBIE CURRAN OUTSIDE BAR UNGA COMMUNITY HEALTH CENTRE
BARUNGA'S FIRST BIRTHDAY
The System went 'live' in March 1997 ... Page 3
PENSION CONCESSION INFORMATION SYSTEM
Peter Kerr gives an overview of this new
development ... ... ... ... Page 4
THE SCENARIO PLANNING FOR ACUTE & SPECIALIST
SERVICES
This article will give readers an overview of the 43 Endstates ... ... Page 7
HEALTH CARE AGREEMENT NEGOTIATIONS
Murray Taylor provides information on the
current status . ... ... ... ... Page 11
EDUCATION
An overview of the HPSS Forum in
Katherine .... ... ... Page 13
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velve months ago on the 26 March 1997, The Barunga Test System (BTS) went "live" at the
BarungaHealth entre. The BTS which is now known as Coordinated Care Trial Information System (CCTIS) was developed as an information tool for the needs of the Coordinated Care Trial.
The past year has been full of changes at the Barunga Health Centre. While Barunga is not a (CCT) Coordinated Care Trial site, it has been upgraded as our pilot site in line with the other CCT sites in the Katherine region.
Frequent visits from the CCTIS Project staff have provided upgraded releases and technical advice for the software, while trainers supported clinic staff in the navigation and use of the CCTIS.
Clinic staff have been very patient with the teething problems and disruptions that have occurred during installation and training.
Itis hoped that these changes will pave the way for the long term benefits that CCTIS will provide for the health of the community.
Some key functions of the application include :
• Chronic disease management
• Keeping track of immunisation records • Medications
• Reporting functions for Health Boards and Community Councils.
The Barunga staff have designed building modifications to their health centre which will assist with changes in their
(xk practices and service delivery
The CCTIS Project team would like to thank and congratulate the dedicated pioneer users at Barunga for their good nature and persistence in the process of development and NOT "Turning the system off at the wall".
Many thanks to:
¢= Jo (Health Worker) and Marie Paulette (Data Entry)
Jo Berry (Health Worker) =>
• Peter Wordsworth -RN • Anne- Maree Lee - AHW • Shane Martin -AHW
• Charlotte De-Satge - AHW • Peter Winsley - AHW • Andrew -DMO
• Heather & Jim Collins (Original users) now in S.A. • Joanne Berry - AHW (Future user at Manyellaluk) PAUL KAMLER - CCTIS PROJECT - TRAINING
&
SUPPORT TEAM -TELEPHONE89 9926282
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PENSION CONCESSION INFORMATION SYSTEM
The Pension Concession Scheme provides a range of financial concessions for eligible pensioners who reside in the Northern Territory. The concessions involve subsidies of costs for power and water, motor vehicle registration and licences, spectacles, rates and travel.
The role of Territory Health Services includes the assessment and registration of eligible pensioners, the direct payment of concessions and reimbursement of external agencies who participate in the Pension Concession Scheme. There are approximately 10,000 current clients of the scheme and the information system will support in excess of 50,000 concession transaction per year.
The Pension Concession Scheme has been supported for many years by an information system known as On-line Client Information System (OCIS) which has become difficult to maintain due to its dated technology and is not Year 2000 compliant.
Development of a new Pension Concession information system commenced in March of this year and is due to be completed in August. Implementation of the system is planned for September 1998.
The new system will utilise an Oracle database and an Oracle Web Server Interface. This means that useh.
will access the system using a standard web browser such as Netscape or Microsoft Internet Explorer over the government intranet. The advantages of this approach mean significantly reduced software licensing costs and reduced maintenance as no additional software, other than a browser is required to be installed on the user's computer. The browser will be supplied as part of the standard THS desktop package and will not be an additional cost to the user.
The Pension Concession information system will include electronic interfaces to information systems operated by the Power & Water Authority, Motor Vehicle Registry, Local Government Agencies, Department of Social Security and also to the Government Accounting System. The interfaces will facilitate a high level of automation of the administration of the Pension Concession Scheme and will support the initiation of direct payments and reconciliation of expenditure.
A broadly representative User Group has been established and will play a key role in providing fe edback to the development team regarding screen design, system navigation and other system features.
PETER KERR - COMMUNITY CARE SYSTEM MANAGER - TELEPHONE
89 992648
NATIONAL CENTRE FOR CLASSIFICATION IN HEALTH (NCCH)
Speakers are required for the NCCH Conference in Alice Springs on 23 to 25 September 1998.
If you can supply an 'NT Flavour' about Clinical Classifications and the use of Morbidity data, please contact Janine Cassidy
on telephone 89 517866 or through cc:Mail.
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'Hospital JJudgflt
Mod~l
Eienllration 3
CONSTRUCTING THE HOSPITAL BUDGET MODEL The Hospital Budget Model establishes a relationship ( between hospital's historical budget and
the anticipated number and types of patients in the coming budget period. To do this, the model has to distinguish between budget amounts which are for of patient care and those which are not. In addition, the model uses measures and standards which have been developed using national information. For these two reasons the HBM must identify budget figures for activities which are not related to patient care, items which are unique to the Northern Territory, costs which were not included in the national standards, and services for which hospitals receive special separate funding from the Commonwealth, the Territory or some other external source.
THE BUDGET EQUATION
The HBM distinguishes between components of the budget which can be assigned to hospital patient care and those which should be treated separately.
( SPECIFIC NT COSTS
To use National standards and to remain comparable to other States and Territories, we need to separate costs which are unique to the Northern Territory. For example, we segregate some electricity costs which are considered excessive compared to other States. The Territory's additional 2 weeks annual recreation leave also falls into this category.
NON-PATIENT COSTS
Some hospital expenditures are used in non-patient activity including teaching, community health services, providing meals, laundry, cleaning and utility services to non-hospital facilities and so on. The HBM separates a fixed budget for those costs not associated with patient care so that they are not included in a budget which depends on patient volume.
FIXED COSTS
The costs of some hospital services do not depend on the volume of patients but more on the nature of the services
themselves, such as Emergency Departments and Special Care Units. The costs of these services are considered fixed and are accounted for in HBM by a fixed budget.
SPECIAL GQ.ANTS
There are certain services provided by hospitals which are paid for by a grant from the Commonwealth, the Territory or some external source. These grants are included at 100% in a fixed payment.
PATIENT ACTIVITY
A budget for providing various categories of patient care is also calculated.
The final hospital budget model will include amounts for each of these elements. The total budget for all
components of the HBM should match the historical budget as closely as possible. The detailed method used in the analysis of the budget is provided to all hospitals in a series of papers. The chart below shows the
approximate breakup of a total hospital budget.
NT1p1ciflc 1%
Sp1clalPurpo1t 5%
Make-up of the Hosplt~ Budget Model
Outpatient 11%
Inpatient
-
CREA TING THE PATIENT ACTIVITY COMPONENT OF HBM3
The patient activity component of HBM3 comprises several components, including:
• Admitted Patients
• Acute Patients
• Sub-acute Patients (Nursing Home Type)
• Rehabilitation Patients
• Non-Acute Patients
• Boarders
• Non-Admitted Patients
The Hospital Budget Model creates a new patient measure which has been the basis of budget calculations in each generation of the Model called an Inlier Equivalent Separation (IES). When an individual patient stay is much shorter or much longer than the average length of stay of similar patients, the episode of that patient is converted to a measure which is equivalent to the episode of the average patient.
Contpage6 .
Continued from previous page
STEPS IN CALCULATING THE PATIENT ACTIVITY BUDGET
Several steps are needed to construct the patient activity portion of the HBM.
1. Analyse the characteristics of each admitted patient episode.
Each patient episode exhibits certain characteristics which determine how that episode will be budgeted. For example, uncoded patients receive no budget; boarders, non-acute and rehabilitation patients receive per diem amounts; renal and acute patients receive a Casemix budget; and step-down facility patients receive no amounts in the model since their funding is provided to the hospital through separate historical budgets. Patients who are transferred between psychiatric or step-down facilities and the acute wards of the hospital qualify for Casemix payments for any acute portion of their stay, even though their stay in hospital may represent a single episode of care under the episode of care policy.
2. Apply the HBM3 Patient Transfer Policy
Where a patient is transferred to a hospital for recuperative or less intensive care both the transferring hospital and the receiving hospital will attract a normal Casemix budget.
However, where a patient is transferred to receive more intense care, the transferring hospital will attract a budget amount less than it would have received if it retained the patient for the complete stay. Patients who are transferred from a non-teaching hospital to a teaching hospital, and all patients transferred interstate (except to several small specified hospitals) are considered transfers for more intense care.
3. Apply the HBM3 Outlier Policies.
The average length of stay figures for HBM3 have been updated so that more patients now fall within that average.
Patients whose length of stay is less than one third of the average length of stay will be converted to an inlier equivalent separation whose value is less than 1 (and will attract a smaller budget amount). Patients whose length of stay is greater that three times the average length of stay will be converted to an inlier equivalent separation who value is greater than 1. Formulas have been provided to perform this conversion.
4. Apply the DRG Weights.
DRG weights are applied to the inlier equivalent
separations.. The weights are a set of relativities which make an episode in one DRG equal in value to an episode in another DRG. For example, the weight of a hip replacement is 5.4454 compared to .8551 for a normal delivery; which means that a hip replacement is expected to be 6 times more expensive than a normal delivery. A renal dialysis treatment has a weight of .2804, making it one third the value of a normal delivery, and so on. The product of an IES and the weight of the DRG to which it belongs is called a weighted inlier equivalent separation or WIES.
Admitted patients which attract per diem amounts do not need to be converted to IES and WIES, as the budget amounts for these patients is a simple application of a per diem amount to the number of days in the patient's episode of care. Non-admitted patients are measured by weighted occasions of service. These occasions of service are
classified according to the South Australian classification of outpatient services and receive the weights from this system.
5. Apply HBM Prices to Patient Activity
The budget amount for a WIES is determined by applying the benchmark price to the WIES. There are certain adjustments made to the benchmark price for teaching hospitals. In addition, the theatre component can be separated out from the benchmark price to allow for it to be paid at 100% to every patient. In HBM3, there is no adjustment for the medical costs of private patients of the hospital.
There are three other adjustments which can be made to the value of an episode including an adjustment for smaller hospitals which applies to Katherine, Tennant Creek and Gove Hospitals, a diseconornies of scale factor which recognises the higher cost of providing needed but low volume services, and a severity socio-economic adjustment factor for certain DRGs whose longer length of stay is associated with aboriginality, co-morbidities and disease patterns.
Each of these steps, and the technical issues involved with each is described in detail in documents which will be available at your hospital.
CURRENT STATUS
At this stage of implementation, staff from the Acute and Specialist Care Branch of Territory Health Services are beginning discussions with each hospital regarding the shape and size ofHBM3. Items in these discussions include:
• Apportionment of General Ledger costs among the various components of the Model. This will form the basis for reporting ongoing expenditure;
• Anticipated patient activity according to the various patient categories which are relevant to the Model (admitted, non-admitted, rehabilitation, non-acute, etc);
• Hospital monitoring and reporting of ongoing activity against the model;
• Hospital needs for information and education on th implications of the model for the hospital.
Two major publications will be provided to hospital during the corning months. These include a final policy document and accompanying technical papers which describe the model and its purpose, and a manual for hospital personnel outlining the potential management uses of the model and the way in which it analyses hospital financial and activity data.
Discussions and recalibrations of the Model for each hospital will be completed by the end of May, allowing for
negotiation of performance agreements based on the Model to be completed in June.
FUTURE PLANS
HOSPITAL EDUCATION
In the coming weeks, staff from Acute and Specialist Care will be conducting on-site hospital education sessions for staff interested in learning about the Hospital Budget Model in greater detail. These sessions will last for two hours, and
• Cont page 11
I
t---.;...;;...._
THE SCENARIO
PLANNING WORKSHOP
FOR ACUTE & SPECIALIST SERVICES
A scenario planning exercise was held during February this year with senior THS staff, Dr David Meadows, President of Australian Medical Association (AMA) and Professor Jenny Watson, Menzies School of Health. Carol Gaston and Julie-Anne Farrer facilitated the day.
This workshop was critical for the development of the Acute & Specialist services Strategic Plan.
( A. scenario offers a different way of thinking about the future. The workshop was highly interactive, intense and imaginative.
he day began by isolating the decision to be made (such as what will be the future of technology in the health industry) and the likely endstates (where do we want to get to).
These Endstates were identified into six streams : 1.
2.
Funding
Information Management
3.
4.
Infrastructure
Leadership & Management 5.
6.
Service Delivery Woriforce
The Endstates were written to be deliberately provocative, to capture differing points of view and to highlight the major industry forces at work. The next step was to agree on how to get to the Endstates. Information on cards was given to each table and this contained information which came from priority issues raised at previous workshops with the community, internal and external stakeholders, General Practitioners and clinicians.
The day was filled with debate and discussion. The process assisted participants to think deeply about health priorities and highlighted the complex nature of health services. It became clear that Acute & Specialist Services could not be considered in isolation of Community Service and Corporate Services. For example, if we use a scenario that ( ve were to provide acute services in a remote community, we then need to consider community the resources and workforce.
The draft Endstates/events which follow will be modified further and responsible areas assigned to ensure that the Acute & Specialist Care Services Plan does not become a plan that "merely sit on the shelr'.
FUNDING
ENDSTATE FOR FUNDING:
Group work for identification of Endstates A&SC Workshop
Funding on population health status and needs and service delivery costs. Focus on outcomes taking account of
"program" policy I objectives. Purchasing appropriate services from the local level.
1. THS achieves a new hospital funding agreements with the Commonwealth Government which encourages integration and co-ordination of care and takes account of isolation and disadvantage
2. THS succeeds in maximising revenue from MBS/PBS 3. THS has introduced purchaser/provider arrangements
4. Funding agreements have been signed with the regions which focus on health outcomes
5. Funding to areas is based on Northern Territory population profile, including isolation and disadvantage 6. Communities have the capacity to choose to be effective purchasers
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Continued from previous page
INFORMATION MANAGEMENT
ENDSTATE FOR INFORMATION MANAGEMENT
Networked, integrated clinical, activity & financial information systems with a data repository to provide a continuous record
& support research & education.
7. Critical information for management and clinical decision making is available quickly and accurately and on a 'need to know' basis
8. Whole oflife patient information is now on line across the Territory
9. The management and use of clinical and management data has been improved including strengthened capacity for statistical analysis
10. Coordinated multi-disciplinary patient management systems are electronically accessible 11. THS has developed expertise in forecasting demand and resource requirements.
12. Implementation of order entry, results reporting and automated discharge summaries has occurred throughout THS
INFRA-STRUCTURE
ENDSTATE FOR INFRA-STRUCTURE
Well-coordinated culturally appropriate, environmentally sustainable, flexible infrastructure which is networked and linked to remote communities and other service providers by multi-media interactive, networked telecommunications.
13. THS works with communities and accommodation providers to ensure a range of supported accommodation options fi pre and post care and rehabilitation.
14. An integrated, staged major capital works and capital equipment program support priority health services in the Territory 15. NT hospitals focus on the delivery of acute core services and develop formal networks with Primary/Post acute and
continuing care providers
16. Hostel type facilities for minimum care and boarding are located near to, or on the sites of, all hospitals
17. All rural and remote health facilities now have reliable and adequate telecommunications equipment, software and infrastructure to support telemedical services
18. THS puts in place an asset management plan; asset registers and asset maintenance programs 19. Availability of Nursing Home Accommodation has increased
LEADERSHIP AND MANAGEMENT
ENDSTATE FOR LEADERSHIP AND MANAGEMENT
Cooperative management of services to improve health status, with cross sector planning and continuing innovation.
20. THS has developed integrated corporate, business, program and planning including individual and team performance appraisal linked to agreed outcomes
21. To achieve clarity of roles and responsibilities in respect to policy and operations 22. THS uses flexible program and cross program arrangements
23. THS leads the way in integrating health service priorities with housing, education and other relevant departments 24. All training and development strategies are linked to the Corporate Plans, goals and outcomes
25. THS becomes a leader in risk management and re-engineering work processes to focus on priorities
26. THS has determined a policy development framework which ensures all policy development relates to Corporate Directions
SERVICE DELIVERY
ENDST ATE FOR SERVICE DELIVERY
Comprehensive fully integrated network of services appropriate to the needs of population groups with a shift in emphasis to prevention. Increased accessibility to defined specialist services at the local level.
27. Primary Health Care services have been extended to ensure better focus on health gain 28. There are now more people with Chronic illness maintained in the Community
29. Aboriginal People are involved in the planning and delivery of culturally sensitive community based services 30. THS is now providing outreach services in an integrated and coordinated manner
31. Strategies are being implemented uniting the efforts of Aboriginal-specific and mainstream services to address lower life expectancy and high rates of disability in Aboriginal and Torres Strait Islander people
32. Nutrition health promotion programs for Aboriginal and Torres Strait Islander men, women and children are continuing to be heavily resourced and culturally specific
33.
34.
Incentives have been established for managers and clinicians to monitor the quality and effectiveness of their services Clinical services are integrated across professional disciplines and throughout urban, rural and remote locations
lllill~---c_o_n_t•p-ag•e~9
Continued from previous page
Group work for identification of Ends tat es A&SC Workshop
WORKFORCE
ENDSTATE FOR WORKFORCE
(
35.
36.
37.
38.
39.
40.
41.
42.
43.
Fully integrated network of long stay flexible public and private sector providers who are culturally sensitive, evaluate their own performance and engage in research and innovation.
All remote communities now have greater access to Allied Health services
Recruitment and retention of Aboriginal staff to adequately fill existing positions has improved Aboriginal communities report evidence of hospital staff implementing the Aboriginal Health Policy Patient focussed multi-skilled teams now operate in all health services
Primary carers and GP's responsible for the case management and coordination of care of people with chronic illness, mental illness and disabilities
THS staff turnover has been reduced
A comprehensive orientation program has been developed for all staff working in the service delivery area
A greater number of professional staff at smaller hospitals understand how to work with people with mental illness and disabilities
Staff evaluate their own performance against the objectives of the Corporate Plan and understand methods to continuously improve their own performance
As you c.an see from the forty-three Endstates, the exercise was very productive and credit should go to the participants who worked intensely on the activities. The complete Acute & Specialist Strategic Service Plan will be available soon.
If you want further information please phone MARY TAYLOR -DIRECTOR, ACUTE AND SPECIALIST CARE BRANCH - TELEPHONE 89992778.
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CLINICAL INITIATIVES
CLINICAL DATA
REVIEW OF DISCHARGE SUMMARIES, PRACTICES AND DOCUMENTATION
The project to develop a formal implementation strategy for all THS hospitals to progress the implementation of the Policy on Written Communications for Inpatient and Outpatient Separations from Northern Territory Hospitals came to a close last November. A final draft report was completed and presented to the THS Casemix Clinical &
Resource Management Project (CCRMP) Steering Committee.
Letters were sent to the Chairs of the Hospital Executives showing the implementation strategy is seen as a
revolutionary process that recommends specific action for the next six months and actions for the following twelve to eighteen months. The recommendations have been grouped into three streams:
• Hospital clinicians
• Urban and rural community clinicians
• Non clinicians.
A seeding funding of $120,000 has been made available from the Commonwealth Performance Improvement Pool and because of the magnitude of issues faced by the two larger THS hospitals. At this stage only RDH and ASH are eligible to compete for this funding. This does not mean that future implementation funding will not be available for the smaller hospitals. This is subject to the new Health Care Agreement with the Commonwealth.
Kerry Hanrahan will meet with the General Managers to discuss plans to form working groups within the two hospitals to discuss issues and develop a project plan focusing on their requirements and priorities. Diane Styant and Kerry Hanrahan will work with each group to assist in the development of project plans and Cabinet Submissions.
INTRODUCTION OF EPISODES OF CARE CLASSIFICATION SYSTEM
Communications continue with various groups involved with Episodes of Care Classifications, especially in the areas of rehabilitation and unqualified neonates. These groups have been : Patient Services, Health
Information Management, Epidemiology, Hospital Budgeting Model, Hospital Information Management, CNCs, Ward Clerks, Coders and Nursing Staff from all THS hospitals.
Work continues in these areas with key people to encourage correct classification, coding and payment for each patient episode. Audits will be carried out on
COLLECTIONS
files of discharged patients in the area of Inpatient Rehabilitation. Reference charts/posters have been designed to assist nursing staff and ward clerks when recording patient data for all classifications. These include flowchart, criteria, definitions and business rules for each classification. A new chart is at present being developed looking at all possible scenarios for newborns.
This will be produced hopefully within the month and sent to all hospitals to assist staff in classification issues.
Work has commenced on the creation of a new Episodes of Care for THS called Posthumous Care. This will include patients cared for in ICU for organ and tissue procurement and patients in the mortuary for example, involved in Coroners' inquests. This information needs be captured on CareSys to show the work provided by hospitals. A working group will involve staff from IT, Epidemiology, Patient Services, Information
Management, medical, nursing, clerical and Pathology.
NATIONAL QUALITY INDICATORS AND OUTCOMES MEASURES
The poster for Wound Classifications has been sent to all THS Operating Theatres to assist surgeons in
documentation of wound classifications. A two-day workshop will be held in June 1998 to debate/discuss and resolve wound classification issues. Key stakeholders have been notified for suggestions and presentations. A project plan is at present being developed and will be presented to executive after consultation with working group.
A report has been produced by Coopers & Lybrand Consultants on the Development of Agreed Set of National Access Performance Indicators for:
• Elective Surgery
• Emergency Departments
• and Outpatient Services.
Appropriate indicators for these areas have been
recommended from the identification of two main issues that needed addressing are :
• Inappropriate waiting times across elective surgery, emergency departments and outpatient services; and
• Promotion of efficient resource utilisation.
It will be necessary for all key stakeholders in THS to be involved in the review of this report and assess the implications for the NT.
KERRY HANRAHAN
CASEMIX CLINICAL PROJECT MANAGER TELEPHONE:
89228258
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WHAT'S HAPPENING WITH THE HEALTH CARE AGREEMENT NEGOTIATIONS???
As you have probably heard, the Health Care Agreement negotiations have reached a temporary stalemate, which resulted in Premiers and Chief Ministers walking out on the Prime Minister and Treasurer at the recent Premiers Conference.
Why did they do that? Essentially it boils down to an argument about the adequacy of the Commonwealth's funding offer. The Commonwealth view is that they have made a reasonable offer and the States and Northern Territory should be happy with it.
In fact, it is the "take it or leave it"
approach being taken by the
Commonwealth that the Premiers and our Chief Minister have taken exception to. Their view is that in any negotiation there has to be give and take on both sides in order to reach an outcome.
The Commonwealth's hard-line attitude and refusal to negotiate is the cause of ( , current impasse.
What has the Commonwealth offered ? The Commonwealth says that it is offering $5.5 billion dollars nationally for 1998/99 rising to $6.5 billion per annum in 2002/03.
They claim that this represents a $2.9 billion increase in funding over the next 5 years.
What do the States and the Northern Territory think ? They dispute the Commonwealth's claim that there is a $2.9 billion increase, pointing out that:
• About half billion dollars is merely the continuation of current funding for Mental Health Reform and Palliative Care
• The Commonwealth is attempting to count in $750 million for Veterans Health Care that has nothing to do with the Health Care Agreement and could go to private hospitals anyway
• Most of the remainder to the "increase", comprises one-off project type funding that cannot be used for recurrent operating costs
The States and the Northern Territory say that they need Commonwealth funding to be increased to $6.4 billion in 1998/99, not in 2002/03. Even at these levels of funding the Commonwealth offer represents less than half of the national costs of running public hospitals.
A Senate Committee of Inquiry is now looking into this issue, which is providing States and the Northern Territory with an opportunity to put their case on the Parliamentary Record. They remain willing to compromise. Negotiations will resume when the Commonwealth is willing to do likewise.
MURRAY TAYLOR - PLANNING & FINANCING BRANCH - TELEPHONE 89992632
(_
Continued from page 6
will be suitable for all levels from all disciplines interested in obtaining a general overview of the model and how it works, as well as exploring some of the finer points of Casemix and budget modelling.
TRENDSTAR
\
In the coming months, the financial and patient activity components of the Model will be installed in TRENDSTAR, the patient costing system which is available to each hospital.
TRENDSTAR will then provide the capability for hospitals to monitor their performance against the expectations of the model, in terms of:
For further information on HEM contact:
9
• patient activity,
• budgeted versus actual,
• expenditures by the model cost categories, budget versus actual,
• expected costs per DRG compared with actual costs per DRG, etc.
Over time, it is anticipated that the full potential of TRENDSTAR will be brought to fruition in providing hospital management with detailed patient costing at an episode and DRG level. This data will provide enhanced capability not only for day to day hospital management and planning, but also for improved capability for budget modelling and forecasting .
ART HUSTON, - MANAGER CASEMIX POLICY, HOSPITAL FUNDING & PURCHASING - TELEPHONE: 889992895
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Acute & Specialist
care prancti llo1e
The Acute & Specialist Care (A&SC) Branch recently had their Branch planning two day workshop. The workshop was facilitated by Julie-Anne Farrer and Kay Cook and input form the Branch's staff was valuable.
A&SC Branch have now developed their Role Statement which includes :
To determine the appropriate range of Acute
&Specialist services for the NT and develop strategies for their provision-
0 To meet the needs of a changing health environment this will entail
0 Implementation of an approved and agreed Acute & Specialist Services Strategic Plan 0
The development of a framework to align policy and operational issuesTo further develop and communicate output-based management techniques to achieve greater resource equity, efficiency and effectiveness in NT hospitals involving-
0 Expansion of the Hospital Budgeting Model policy
0 Incorporation of routine reporting of the Model in Trends tar 0 Implementation of a non-admitted patient classification
0 Continuation and expansion of the Hospital Performance Agreements
Fiona Murphy, Dianne Styant & Mary Taylor, A&SC Planning Day
=>Art Huston, Margaret Foley & Helen Morton, A&SC Planning Day
, · . . C<pm~rqtEilqtiq.ns ·
t5 f. ~qr>1'.··~ ~&<IG)rc~n0 . b. ccts···oeen ... ,,,.r··
.tr:/<···•··· ···· · ··· ·•s\!.JycessfiJ· 1 .• : t0r.:. tne.••··P©sitiC?n· . 0f ·
· +r
/--,.~,>):'.,0: :tDit~~fc)'f:~
;:,._.</ ~· '_,_", '·'·<'Ac'
. . ·...,CJte+
._, . •,;_<-';&
- '· Speck~list Cc;:u~;
... - .- ~---
( Michelle Fidock,, Kevin Williams, Kay Cook and Shirley Tollennaar
THE ENVIRONMENT FACING THS
Is
ONE WHERE WE EXPECT:+ Continuing expansion of demand on our acute care systems, eg.
average 5% pa growth in hospital services over last five years.
+ Rising costs of medical technology and specialist services.
+ Exponential growth in demand, and capacity to deliver, complex medical procedures.
+ Challenges in redesigning health services to provide for greater integration and coordination.
+ Challenges in addressing the primary and public health requirements of remote dwelling Aboriginal people.
+ Pressures for THS to conduct its business in an accountable and transparent manner that ensures the delivery of government's commitments to its constituents.
HPSS Division held its inaugural 'Divisional Forum' in Katherine on Wednesday 1 April and 2 April 1998.
The forum included THS Secretary, Mr Peter Plummer who opened the forum with Kevin Williams, Assistant Secretary- HPSS Division highlighting many areas in the presentation 'Emerging Challenges' for HPSS Division.
Peter Plummer introduced in his opening presentation 'Emerging Visions', the challenges facing the Healthcare industry in the next decade. These challenges involve the changes brought about by the following
Move from: Move to:
~
Treatment
~Wellness
~Hospital ~Non-Hospital
~
Inpatient/Outpatient
~Continuum of Care
~
Individual Patients
~Defined Population
-
Mary Taylor presenting A&SC Strategic Plan
Cont page 14
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Continued from page 13
THS
HAS ADOPTEDA
RANGE OF STRATEGIC INITIATIVES, INCLUDING:+ Strengthening of public health services, with an emphasis on prevention and health promotion.
+ Enhancing early intervention and primary level health services.
+ Quality acute and specialist care services.
+ Supporting families and individuals through integration of community services.
+ A supportive THS for results driven staff.
Peter Plummer emphasised that THS has progressed in a number of strategic project areas associated with its commitment to improving the health status ofTerritorian. Some of those project areas are:
1.
COMMUNITY BASED PROJECTS•
Coordinated Care Trials in Tiwi Islands and Katherine have commenced.• Community Care Information System is progressively being developed.
• Develop policies/strategies to encompass community and public health.
2.
PREVENTATIVE HEALTH STRATEGIES• Successes include the Strong Women, Strong Babies, Strong Culture program.
• The Food Use Nutrition program
.• Cooperative Research centre for Aboriginal Tropical Health.
3.
WORKFORCE STRATEGIES• A THS recruitment and retention strategy .
• Development of a Clinical School in conjunction with Flinders/NTU.
• Creation of a Chair of Nursing.
4.
OPTIMISING FUNDING• Aboriginal employment and career development initiatives.
• Aboriginal Health Worker career plans.
• Casemix funding has been implemented in acute care settings.
• Introduction of new charging policies and protocols for primary care referrals.
• Successful negotiations to date in the Health Care Agreement.
5.
CHRONIC DISEASE STRATEGIES• Completion of Central Australian Renal Study.
• Linkages established through the Coordinated Care Trials in screening for chronic disease.
• Recognition within Government of the costs of treating renal disease.
• Cooperative research with Menzies on renal failure and preventative programs.
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Ill
Cont page 15Continued from page 14
PLANNING PROCESS - CREATING OUR FUTURE
+
THS has entered a process of reviewing its activities in order to align with what is a rapidly changing health environment.+
The planning process, which is geared to be a highly participative and consultative one, will build upon our current Plan.+
We will need to reflect on where we've been, highlight where we see ourselves going, and+
to plan and strategise for this within the real constraints ofresources that will accompany our journey.+
Our new plan won't be a wish list but a pragmatic statement of what we realistically believe we can achieve.+
We expect to introduce the Plan in January 1999, to inform the incoming program planning and budgetary cycles, and.to run 1999-2003.STAKEHOLDERS:
Several internal and external stakeholders were invited to participate in the forum on the first day by providing feedback of their perception on how effective, the HPSS Division, was, and/or how effective THS was as a whole.
The stakeholders were :
( Jim Forscutt, Mayor of Katherine
+
Professor John Mathews, Menzies School of Health+
Michael Martin, Deputy Secretary/General Manager -RDH+
Trish Angus, Assistant Secretary, Aboriginal & Community Health Policy+
Dr Shirley Hendy, Assistant Secretary, Public Health, Family & Childrens Services+
Bruce March, Director, Family & Community ServicesOn the second day, Kevin Williams facilitated the forum, which provided interaction between Branch Heads in the following:
+
Determining roles and responsibilities of each Branch+
Identifying major programs and projects+
Prioritising these programs and projects with either a high and low urgency categoryFeedback from participants has been excellent by commenting that the forum was extremely valuable and beneficial and stronger collaboration of Branches has noticeably increased.
( • look forward to another forum in 1999.
KAY COOK -HEALTH PLANNING & SYSTEM SUPPORT DIVISION - TELEPHONE 899927 49
Mary Mckay from Gove District Hospital (GDH) was re-elected to the Clinic Coding Society of Australia as a Board member for Northern Territory last October.
.,o Mary is also chairperson of the Rural Advisory Sub-committee for the
~ Clinical Coding Society of Australia (CCSA). This sub-committee has to
~~c-... present an options paper to CCSA in July 1998 to provide strategies for assisting rural and isolated coders in Australia.
~
Topics of focus include:- Education or lack of it; Communication;Recruitment & retention; Access to funding and Coding quality
Also GDH has a staff member who has successfully completed & passed the Distance education ICD9 coding course - Congratulations Marion Matthews
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... •
It's going to be a very busy year for all Clinical Coders in the NT with the Implementation of ICD-10-AM.CODING UPDATE
Earlier this year we said farewell to Elizabeth Moss who was coordinating ICD-10-AM Implementation. We now welcome Amanda Wilson-Hill, a Health Information Manager from NSW who as part of her role in the Epidemiology Unit, has taken overthe Co-ordination of ICD-10-AM Implementation.
NT Coders were very excited to receive their copies of the five volume set ofICD-10-AM in February 1998. As soon as the coders received their set ofICD-10-AM, certain Alice Springs coders spent two hours looking over the new codes to see where improvements had been made in the ICD classification.
Acceptance testing ofICD-10-AM codes in CareSys began in March with Andrea Morrison, Jill Burgoyne and Janine Cassidy working on some "live" patient data. This is where "real" patients diagnoses and procedures were coded in ICD-10-AM and then entered onto a testing environment in CareSys, to see if there were problems. Of course, a few problems have been identified and these are currently being worked on. More testing will take place before Implementation in July
1998.
In March, Janine attended the ICD-10-AM Trainers workshop in Sydney. Janine will conduct the first ICD-10-AM Workshop for all NT coders in Darwin on 7 and 8 May 1998.
In other news, the National Centre for Classification in Health (NCCH) Conference is being held in Alice Springs from 23 to 25 September 1998 at the Rydges Plaza Hotel. Guest speakers who can supply an
"NT flavour" about Clinical Classification and use of Morbidity data are still needed, so if you wish to be a speaker at the conference please contact Janine Cassidy on the telephone number shown below or I can also be contacted through cc:Mail.
JANINE CASSIDY
HEAL TH INFORMATION MANAGER ASH TELEPHONE89517866
HORIZONS BULLETIN PRODUCED BY:
BUSINESS INFORMATION MANAGEMENT BRANCH HEAL TH HOUSE, MITCHELL STREET DARWIN DIRECTOR
EDITOR/PUBLISHER DESKTOP PUBLISHING ENQUIRIES
PRINTED NEXT EDITION
STEPHEN MOO KAY COOK MICHELLE FIDOCK STEPHEN Moo 89992847 OR KAY COOK 89992749 GOVERNMENT PRINTER OF THE NT MAY I JUNE 1998 - EDITION No. 17
'LOOKING BACK, MOVING FORWARD' The Tenth Casemix Conference in
Australia 6-9 September 1998 Melbourne Convention and Exhibition
Centre
The 1998 Casemix Conference in Australia will be the tenth in the series of Conferences held nationally in the country.
The focus of the Conference on looking back and moving forward will provide an
opportunity to reflect on the gains made by those who first introduced Casemix on to the agenda but more importantly will also look to the future.
The Conference will allow you the opportu1 to discuss:
• Coordinated Care
• Information Technology developments
• Classification updates
• Quality
• Continuity
• Ambulatory Care
• Costing
• Using Casemix information To register your interest, contact :
The Casemix Conference Secretariat conference Logistics,
PO Box 505 Curtin ACT 2605 Telephone (02) 6281 6624
Fax (02) 6285 1336 E:Mail [email protected] For further information you can contact me on telephone number 89 992749 or cc:Mail KAY COOK- EDUCATION & MARKETING COORDINATOR
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Government Printer of the Northern Territory