Department of Health

Funding Models Forum 2017 - Specialist clinics (WASE1)

  • Duration: Length 1.04:21
  • Transcript

    Can everyone hear me, everyone hear me all right, let's presume we're going through to the people online okay I can see your questions or you your tests coming up in front of me. Thanks Denise and thanks for a good opening, thanks everyone that's made it down here today, it is an awful day particularly to be riding public transport in to get to the city and thanks everyone that's joined us by webinar. I can see we've got at least 30 people so that's really good um I'd like to begin first by recognizing the traditional owners of the land in which we're meeting today people of the Kulin Nation, pay my respects to elders both past and present.

    I'll probably also begin by introducing myself, so my name's Ben Whitton I'm a member of the funding policy team in the policy and planning branch, I've been with the department a few years now and I've been working on the specialist clinics model for the last two years including the 2016 - 17 Shadow Funding Report. I actually began my sort of health-related career working at a public hospital in Sydney as a ward assistant I don't know if you have ward assistants here basically prepared me with all the skills I needed to develop funding policy including mastering Hospital corners and how best to use lamex to clean beds, so today I'll talk you through the different components of the WASE funding model and the department's policy objectives here, we'll start by going through the policy objectives of the model give you a bit of an overview of the model and will also go through calculating targets and how they are calculated, get into a bit more detail in the model so the cost weight calculations the review discount, excluded activities and finished with prices and recall.

    At the end of today I hope you're going to have a better understanding of how the model works and particularly what we're trying to achieve with the model. You'll also get a chance to ask some questions and provide us with some feedback and we'll get questions from the floor, we'll get questions from the webinar and we'll all be around as Denise mentioned to take questions if you don't get the chance or if you want to come up to us later. Before I get into the overview a couple of things I wanted to start with just three things I wanted to mention:

    A reminder with the 17'- 18' implementation of the WASE model, your budgets are still your budgets, are still your budgets, all health services have the same budgets they had last year with indexation and some targeted growth we're aware of the need to go lightly and while we have a we have a new model the aim is not to reduce anyone's budget, it's about aligning budgets with the cost of activity.

    The second thing and the biggest imperative for the WASE model is a drive for us to align our Victorian Funding Model with the National Funding Model. So the WASE model is very similar to the national model we've got the same classification tier 2- we've got the same activity count service events and we're using cost weights to drive the funding allocation the activity-based funding model is also trying to achieve technical efficiency as with any ABF model, trying to minimize cost and allocating efficiency, which is based where we're allocating funding based on the efficient cost of providing a service We're also trying to encourage better patient access to specialist clinics provide funding transparency and accountability both for health services and for the department as a purchaser and we're also trying to improve the data reporting of aims VINAH and the Victorian cost data collection.

    The third and final thing I'll mention before we get into the model is this is WASE one it's not WASE 24, So WIES on the other hand is a funding model that's been refined over 24 years, I'm not sure how many of you were around for WEIS one I won't get you to put your hand up, I don't know even Dr. Dan was here and the follow-up question is I'm not sure if anyone knows who that is, Richard does, though yeah so Marie Tehan was the Health Minister between 92'and 96' that oversaw the implementation of the WIES Funding Model back in 93' /94' Dan? So since then we've had obviously 24 iterations of WEIS and we've had six Premiers and even more Health Ministers. So this is a reminder that we are at the beginning and it's just an important thing to remember as we get into some of the details.

    As I mentioned this is the first year of WASE with moves one step further down the implementation path following two years of shadowing similar models and working with Health Services to refine the model, as I mentioned there's been no change in funding to Health Services this year with all Health Services maintaining their current level of funding, but this is the first year we're really asking you to become involved by providing you with targets you have to work toward achieving. While there's an imperative to implement the national model for non- admitted activity we're taking a careful approach providing stability in cost weights and minimizing financial impacts. I'll talk about this in more detail but we've provided stability and predictability in the way we calculate cost weights, rather than throwing you in the deep end and just implementing the national model, as is, we're trying to give you a more stable approach and give you some certainty particularly in the cost weights. There have been really minimal changes in the cost weights from our shadow funding model to the implementation year where the national model there are huge swings with some of the cost weights there were 41 tier 2 classes that had cost weights with swings of 20 percent and another 65 tier 2 classes with cost weights that swung between 5 and 19%, So we were as I said we're providing you with stability rather than throwing you in the deep end with this.

    We're also borrowing concepts from the WIES model where we can to ensure you are familiar with the mechanisms there may be a small amount of recall applied at health services who don't achieve their target and there may be additional funding for health service that do activity above their target. Like the WIES model we envisage making refinements and adjustments to the model each year however there are some sort of I mean if you think about WIES as well we still used DRG's, we're still counting WIES, we still use cost data to calculate the cost weights so I think in the short term we might be making changes to the WIES models more refinements and adjustments but the overarching principles are enduring. Before I move on to the overview model there's a couple of things I wanted to mention will shortly be making available to health services a WASE calculator and I'll if technology helps me out here give you a bit of a demonstration, this will hopefully help you more easily reproduce the calculations of the WASE model and give you a better understanding, we're also providing thebe providing a detailed technical specifications document that details all different elements of the data that are used to calculate WASE and finally we'll be providing quarter reports for 16-17 so you can have a look at your data for 16' / 17' and like we did last year we provided quarter 1 quarter two and quarter three reports. We want we want to do what we can to enhance your understanding in the model and help you to reproduce the calculations with your own data if there's anything else we can provide to help please let us know and we'll always do our best to provide it.

    The key changes as I mentioned from last year is that now you've got to do activity in order to retain your budgeted funding the WASE targets have been published in the PFG this year the mechanism for calculating targets is borrowed from the WIES model and how public and private WIES targets are set. To calculate targets you divide your total budget by essentially a weighted price which is weighted based on your public and private split of activity the weighted price is calculated by multiplying your proportion of public WASE by the public price and multiplying your proportion of private WASE by the private price. I will go through this in more detail but just to mention quickly when I say private activity and I'm referring to MBS clinics we've used the terms public and private is to be consistent with WIES. The targets published in the policy and funding guidelines were calculated calculating, using public private WASE split from the 2016 year to date quarter three WASE reports, so you'll be able to find this in the quarter three reports that were distributed with the embargo copy of the PFG. Targets will be recalculated at the end of 2017/18 year using your actual public private WASE split, you can calculate your targets based on year-to-date activity using the WASE calculator, which we will have a look at shortly, so just to summarize what does this all mean, the things to take away here is how public and private activity is counted and how this contributes to targets and achieving targets in the WASE one funding model. The one public WASE equals one private WASE there is no discount applied to the actual WASE the similar with WIES, one private WIES equals one public WIES. Health services can reach their targets by doing either public or private activity, however if you're split between private and public WASE changes, then the target will change, however as I've said no change in funding. IF the Health Services increase their proportion of proportion of private WASE, your target will increase and if you increase your proportion of public WASE your target will decrease, and as I said to reiterate the budget is the budget is the budget.

    I'll give you a quick demonstration of how targets are calculated in the, all right so here's how you can calculate your targets using the WASE calculator. You can put your budget here, so let's just put million dollars give you a 50/50 split between public and private activity. That's really calculation so here you can see sorry leaning away from microphone, you can see you've got a 50/50 split in your public and private activity and that will flow through to a target of forty thousand WASE units, with obviously public and private targets, public WASE target of calculation doesn't look right but we're talking about your overall target which is forty thousand. If we change the split to more public, we'll see you split then goes from 85/15 and your target comes down to 37000, same thing happens if we increase our private activity, but there you can see the splits sorry ninety-eight percent to 2 percent and your target goes up to 45 so increase your proportion of private activity your target goes up increase your proportion of public activity your target comes down.

    Maybe you might have to help me which one am I going to? I wasn't going to be able to do that without stuffing it up was I? Thanks. So this slide here gives you a beautiful diagram, diagrammatic look at how the WASE model works and how the data flows into the WASE calculation, there are some of that here these are some of the key takeaways from today underpinning the WASE model is the not admitted clinical management system. Health Services must register their specialist clinics in NACMS where they're mapped to a tier 2 class the model uses aggregate service events counts which is obtained from the AIMS S10 form and that's the basis used to count activity, the model also uses the Victorian cost data collection to calculate cost weights and the model also uses VINAH data to calculate the review proportion. This diagram also gives you it shows you some of the important concepts of the model so that include the counting unit the classification the prices and the review adjustment.

    This table gives you an indication of the changes from the 2016-17 shadow funding model to the WASE1 model there are a few changes to the model from last year but by and large most things haven't changed so we're still classifying activity using the tier 2 classification. We're still counting activity as service events, there's still six cost weights that are used and calculated using the Victorian cost data collection and there's still a 20 % discount for review activity which is calculated the same way it was last year using VINAH data. There are three key changes from the shadow funding model the first is that the department's using adjusted contact purpose rather than contact purpose to calculate the review proportion and I'll go through that in a bit more detail. Secondly there are now two prices so there's a price for public activity and the price for private activity and the final change is that the VACS teaching ground is now included in the funding. So the cost weight calculations, the cost weights have been calculated as I mentioned using Victorian cost data out of scope activity was excluded and out of scope costs were excluded for calculating the cost weights, as in 16/17 there are six cost weights which is to provide you with a stability year-on-year as we improve are not our non-admitted cost data collection. We're working with health service to improve cost data so we can walk towards more than six costs weight that recognize variation and resource utilization allocating funding and allocating funding based on the efficient cost of providing a service. This is contrary to the national model that has a cost weight for every tier two class and has a resulted as I mentioned in large variations in cost weight which in turn would have significant impact on funding allocations, if we would go to a tier class for every cost weight, sorry a cost weight for every tier 2 class. To calculate the17/18 cost weights the 15/16 cost data collection was used Tier two classes will group together the same way they were in the shadow funding model, the average cost of a service event for the group of tier 2 classes is then then divided by the average cost of all service events and then these weights that were calculated were then rebased against last year's weights to ensure that movements weren't too big.

    The review proportion, as in the shadow model the WASE 1 has a discount for review activity and the discount is to encourage better access to specialist clinics and it's also to encourage better reporting of the new and reviewed data field just to signal to you that this is the data field that we want to collect and we want to collect accurately and that's one of the reasons it's been included in the model. The department defines a new service event as a clinician seeing a new patient for initial assessment or treatment, a new service event must meet this definition and be the first service event of an episode in a particular program stream. Health Services not reporting VINAH will be given the statewide review proportions in the funding model. Regarding how the review discount is applied I personally think it's easier to sort of not think about calculating a discount but to actually think about calculating the review proportion as part of the WASE formula. We just we just have a quick look at a formula and we'll get to that at the end but there are three inputs to the formula, those inputs are the number of tier two service events reported the in aims S10, the tier 2 cost weight which can be obtained from the policy and funding guidelines and the review proportion which we're going to calculate and I'll go through that now. The proportion is calculated using VINAH data, which is at a contact level rather than a service event level, there is also new and reviewed data reported in the AIMS s10 form this is the first year AIMS it's the first year you've been able to report new and reviewed data in the AIMS s10 form and we don't know yet how accurately that data is going to be reported so until we know that we won't be using that field in VINAH for funding purposes. To calculate the review proportion there are five broad steps. The calculation begins with the contact purpose which is obtained from patient level data submitted to the department through VINAH. Contact purpose is then adjusted where reporting is inconsistent with the department's business rules for new and review activity, as I mentioned a new service event has to meet the definition and be the first episode for that sorry, the first contact in a particular program stream in an episode, while it is the department's preference to use data reported by health services feedback on the 2016/17 Shadow Funding Report was that this was a field that health services have trouble reporting accurately. While the department works with health services to improve reporting in this field adjusted contact purpose is being used as an interim step. Once we've got adjusted contact purpose, we then roll contacts into service events, where a contact occurs on the same date with the same patient in the same clinic, they roll into a service event and this will provide us a count of new and review service events at Tier two classes are grouped up to ensure we're not dealing with low numbers, this also solves a problem where a Health Service reports activity for a tier two class in aims but doesn't report activity in VINAH. So as I said new in review service events are grouped into review proportion groups and you can find those groups in the policy and funding guidelines and a review proportion is calculated for the whole group of tier two classes and it's applied to every tier two class and that group.

    The next few slides go through in a bit more detail and how we calculate the review proportion, I won't go through them but there is it there will be even more detail in the tech specs, that will go out in the next few weeks and I'll just actually, I'll just take you through a quick example that'll hopefully help. The main thing to remember is just focus on the review proportion calculation remember that we're using VINAH data to collect to calculate the review proportion and we're using adjusted contact purpose as an interim step. They'll quickly take you through this example that steps through the five steps so if we have a look hopefully you can understand this, we take a look, we've got some contact data on the far left there for three different patients, in three different tier two classes 2003, 2004, 2005 and they're all in the same review proportion group. The first patient had a new contact and a review contact, the second patient had a review contact and another review contact and the third patient had two new contacts in a review contact. So the first thing we do is in adjust the contact purpose where and the data reported is inconsistent with the business rules, so down the bottom you can see patient number three had two new contacts in the same program stream, so we changed their second new contact to a review contact, this is the same thing we do for the specialist clinics wait time reports. The next thing we do is roll the contacts into service events, so where a patient has two contacts on the same day in the same clinic, we roll this into an into the one service event, so the top two patients they've had two contacts in the same clinic on the same date, so the first the first two contacts become one new service event and for patient number two, the two review contacts become one review service event. So now we've got service event data we can calculate our review proportion so obviously we've got two new service events and three review service events, so if we calculate this through, we've got three over five, will give us a review proportion of 60% for that review proportion group and we can do this for all our tier two classes and we can do this in the WASE calculator, sorry if I can do this without stuffing it up. If we go to our review proportion sheet it's got a list of all the tier two classes and it's got a list of all their proportion group, so all we have to do is enter the number of service events that review in the first column and the number of service events that are new in the second column, so if we go to 2003 I've just discovered it up there without turning around, we had we had one new service event in 2004 we had one review service event and in 2005 we had one new and two review service events. But scroll across here it'll calculate our review portion of 60%, it's also got the statewide review proportions so if you don't enter any data in there you'll end up with the statewide review proportions.

    Oh brilliant, just checking if I've gone through everything, public and private service events you would have noticed in the in the calculator they're both used to calculate the review proportion and again this is to ensure we're not dealing with low numbers and it's also to ensure we only have five proportions instead of ten there are also 4 tier 2 classes with no review adjustment there's our maternity tier two classes they're excluded from the review proportion calculated and given a review proportion of zero and this is so we don't in disincentivise multiple appointments for mothers and support the department's other policy goals. Excluded activity, so there is some activity reported the AIMs S10s and there's also some activity reported in other data sources that are excluded from the WASE funding model, firstly any clinics that aren't registered in NACMS won't be counted and they also won't be funded through the WASE funding model, there also a number of tier 2 clinics that are funded by other MOP models for example HEN, TPN genetics and some radiotherapy tier 2 classes that are funded through the Wow model. DVA activity is funded by the department under another grant line and I know Phuong is going to talk a bit later about funding for DVA patients this year. TAC Work Safe other compensable patients or third party payers or Medicare and eligible patients, health services the bill them directly and again they're not funded in the WASE model.

    Now I'll come back to this calculation, this is how we calculate WASE for an individual tier 2 class, as I said before there's three things just three things we need it's not the WIES calculator, there's only three things we need we need a total number of service events for the tier 2 class and that's calculated from data reported in the AIMS S10 form, also important to remember we calculate public and private WASE separately, we need tier 2 cost weights and as I said that's in the policy and funding guidelines and we need the review proportion which we just calculated as I've said for non-VINAH reporting Health Services, the statewide proportions are published in the policy and funding guidelines. I'll now try again to not stuff this up, and show you how the calculator works for non-tier 2 class, so we go to the WASE calculator and slide we can select the tier 2 class that we want to calculate WASE for so let's go to 2003 since I've already been talking about it, the 2003 a pain management clinic, we just need to enter our total number of service events, both public and private so let's just say we did a thousand service events for 2003 and a thousand private service events so a thousand public a thousand private it tells us that 2003 has a cost weight of .96 it also tells us that is in proportion group 1 and has a review proportion that we've already calculated of 60%. Go down there so as you can see we've got the thousand service events multiplied by the tier 2 cost weight .96 multiplied by the proportion review 60% multiplied by 80%, so that's the review discount we then add that to the total number of service events again a thousand times the cost weight of .96, times one minus the review proportion so 60% one minus sixty percent is forty percent and that will give us a public WASE of eight hundred and forty-four, we'll also have a private WASE of 844. We can do that on this sheet for all our clinics, we can select another one select one in the 40s so 40.03 aids and appliances it's got a cost weight of .41, and it's in proportion group 4 and because we haven't put any review proportion calculations into that review proportion spreadsheet it's giving us 78% percent of statewide average and as you can see a thousand service events for this tier 2 class come through as 346.

    So we can do this for all our tier 2 classes in this total WASE spreadsheet, I've already put in some numbers here so as we said let's go up to 2003 put our 1000 public and private service events in here, that gives us 844 public and private service events again. So what I've done there. Oh we got there alright the price, there are two prices in the WASE funding model there's a public price which is two hundred and seventy five dollars and there is a private price which is two hundred and twenty dollars. The public price has been set to align with the average cost of a service event it's also set to align with the average national price for non-admitted activity. The private price is set at 80 percent of the public price and what we're trying to achieve here is revenue neutrality between a public and private clinic. The discount acknowledges that health services receive additional revenue for MBS clinics, the discount also acknowledges that MBS revenue does not cover the full cost of running an MBS clinic the $220 price is to cover the non-medical cost of running an MBS clinic, this activity is included because MBS funded clinics are a significant and important part of the Victorian specialist clinic service system, we don't have a robust cost or revenue data to accurately set the discount and we'll be monitoring activity this year to see how private activity is tracking compared to public activity and see if we need to review the discount if we think we're over incentivizing private activity, Private activity is activity reported in the AIMS S10 form as an MBS service event, private clinics must wait meet the NACMS sorry it must meet the NACMS rules in order to be registered and funded under the WASE model these rules are quite robust in that they is that a hospital must hold the patient medical record in order to be registered and counted, under the WASE model, patients receiving care in doctors private rooms will not be funded. By including a private price in the model we are better aligning funding with the system-wide cost of specialist clinics activity. Recall, the final thing to mention is recall and I won't go through it in too much detail but essentially recall will be calculated based on the relative the relevant price there will there may be a small amount of recall applied for under performance, with the cap being one and a half percent of your funding and there may be some funding for health services that perform activity above their target and that could be up to an additional 2% of funding. to wrap up before I go to questions I'll just want to reiterate a couple of things as the slide with Marie Tehan says this is WASE one it's not WASE 24 it's the first year and we'll continue working with you towards achieving our funding policy objectives. The second thing is that we want to do what we can to help you to be able to reproduce these calculations yourselves and this includes over the next month as I mentioned providing you with the WASE calculator, providing you a detailed technical specs for the model and providing those quarter four reports. We've also probably with that provide frequently asked questions so we'll probably summarize the questions from today and the questions that would have come through and just provide that so that you've got those answers.

    We'll go to questions now, Denise do you want to moderate and as I said and as Denise said I'll be around at morning tea Denise will be around at morning tea and lunch there's the rest of us are here around if you've got any questions that we can't answer so if you don't get the chance to ask a question now and we'll be around.

    Rhonda Carol from Melbourne Health -- Just that new review proportion and calculating that will you be doing that on a year to date basis or a month by month basis?

    No year-to-date basis

    Can you hear me?

    So the new and reviewed proportion in one month won't stay fixed to the long term

    That's right yeah.


    Other questions from the floor?

    Hello I'm Lucy from Peter Mac - will there be additional funding for activity above 100% or is it still only a possibility?

    It's a good question Lucy, Phuong do you want to talk to that or throwing you under the bus?

    Just wait for the mic Phuong so we have it on the record.

    The answer is per the policy guidelines is that there is a 50% payment for activity between 100 to 104 but in saying this we have made a commitment to talk to the CEOS and review it mid-year, the whole recall approach for the model. And we will advise to set accordingly.

    I've got a question here about whether or not, try to find out who it is from, Clair Hawk, as to whether or not there will be a way to upload data as opposed to the form completion from health connect?

    Is there a technical person in the room that might be able to help with that one? I can see some people but not quite sure they know the answer to that one. So that one we will take on notice. I have got a few things on make sure we have focus on the slides, also explaining the price difference between public and private activity on the model, you might just want to talk to that again. So that is from Monica, so Monica if we haven't responded to that question we might have another go at it.

    Ys so as I mentioned there's a price for public activity which is two hundred and seventy-five dollars, it's set to align with the average cost service event, it's also set to align more closely with the average price of a non-admitted service event in the national funding model. The discount of 20% is set is set of in absence of any robust cost or revenue data, to acknowledge that MBS clinics receive additional funding not from the state and it's also an acknowledgement that this funding does not cover the full costs of running an MBS clinic, we sort of like I said we're trying to achieve neutrality a sort of a revenue neutral decision between whether you run a public or MBS clinic and whether we've got it right with twenty percent or not we'll be we'll be monitoring the activity to see if we're getting any on getting sort of if we think we're over incentivizing MBS clinic with well we've set the price. Did you want to add anything Phuong?

    We just wanted to say that there was lack of data available we do know what the standard payments are for short extended consults and review consults, we took that into consideration, we did do some data analysis and we believe that as the 20% is a fair and reasonable adjustment, as the data evolves it will refine that.

    Yep sorry I should have mentioned as well, so that analysis sort of showed us that the average MBS, average MBS appointment rebate was about $46 so the discount is fifty five dollars so we think it's a reasonable start.

    Couple questions up there.

    Leah from Monash Health and just wanting to know why we're still using AIMS data?

    Good question Leah and as I mentioned there's an imperative to align with national funding model and the national funding model is all about patient level data at the moment we only have an Marina can correct me if I'm wrong 26 health services yeah only 21 out of the 26 health services that get specialist clinics funding report AIMS and look we're, sorry report VINAH and or even of the 26 health services that do I will admit it gets better every quarter that I look at it, the there's still more data reported in aims than VINAH so there's the issue that not everyone reports VINAH and there's also the issue that not everyone report that does report VINAH reports that as well as they report their activity in AIMS.

    And I might just take that other question I think the point you are getting is why isn't VINAH available everywhere? And that is probably not a funding policy question that we can answer, but I think it is absolutely a question in terms of, whether or not we are moving towards a wider spread of the VINAH data collection. And noting that it has been ongoing issues in the department in terms of, work in the department to try roll that out, so it is probably a question for others, but we recognize that it is an issue but certainly with the national funding model approach and our obligation to move to patient level data we are going to have to get things moving.

    There is a question in behind you as well, and then there is one, well take that one you have the mic all ready to go.

    So with the issue, obviously you know budget, if we wanted to meet our targets this year will obviously that affect our funding next year and their targets be reset and our funding reduced on the back of those produced targets?

    Ye that is a good Question.

    So I might answer this one and take some heat off Phuong around budgets and funding. That is probably also a question for the funding guys also in terms of your budget set. But look this is the question in terms of how we approach the recall policy this year as Ben said and we said at the beginning you know part of this is about taking a light approach, but we actually need to take this first step, so we are putting it out there and saying it is subject to that we'll review it as we go we'll stop making decisions case-by-case, but like what you know your WIES model in terms of budget setting it's about targets for revenue and making sure that over time you're actually aligning your budget to your target into you implementation activity. So you know I guess it's about implementation speed and scale, that is sort of the real issue here, we want to make sure we get it right we this isn't the first step in the journey but again as part of kind of ongoing budget negotiations it'll be about you know how much we can work with you individually as a health service to think about is the budget actually matching the activity keep in mind that the sort of drive here is to align cost and activity and budget. I see you have grabbed the mic.

    I think that some of the anxiety stems from how we introduced subacute WIES1 which is totally understandable. At this point in time there is, no decision has been made whether or not we will change budgets but I think the message that I've been giving to all the regional services as well as for those who have spoken to me is over the next 12 months one of the goals of this implementation of this ABF model is for you to review the amount of activity that you reported, try to understand are you reporting everything that comes to the department, so that we have got the full gamut of activity been captured and secondly look at the cost data giving you an opportunity to make sure that the cost weights are reflective of resource utilization once and also understand what, what other things is this funding envelope being used for once we've got all the pieces of the puzzle thing we'll sit down with you and the funding policy and work out what the next stage of the implementation will be for WASE2.

    Yeah I was just going to comment a little bit further as you know part of our role as system leaders is to make sure it's fair and equitable across organizations so people are just saying hold we're not going to deliver the activity we'll keep the money all those sort of the things and of course we're going to have a look at saying well as we said there's limited resources across the system if someone else can use it better is it better to allocate that money. Saying that, you know, especially in some of the rural services it's been a historic grant this would have been out there and we haven't been monitoring versus activity some of those is actually mal have been actually more better funded as community health or some other sort of bucket and as we do in you know, when I have a chat to a lot of the CEOs have a look at is this the way the best sits or should it have been actually funded as acute or should have been funded as community health, are the discussions that we'll have in the year as we get the data and learn more and chat with those sort of discussions with health services.

    And that was Adam from Mildura for the record.

    Thank you, one here and then there is one up the back.

    Ruth Saywin from Barwin health- I just have a question regarding the MBS does that apply only to a hundred percent pay over model because there are different models for the private practice and some of them like BMO might have a different models, so is this just for the hundred-percent pay over and if it is not is there a different model for that?

    It's a good question when, yeah that's a good question and, Ruth was it, yeah sorry I can just see popping your head out there and yeah and it goes to the question about what do we mean by a private service meant what do we mean by an MBS service event so the rules are set out in the NACMS manual, if the hospital owns a patient record it can be reported as an MBS service event in the AIMS S10 form and the clinic can be registered in NACMS whether the clinic is 100% donation 100% retention somewhere in the middle, we don't collect data on that so we're sort of agnostic to that but it's about whether it meets those rules to be registered in NACMS, does that answer your question?

    Yes it answers the question, but obviously the profit or the you know how much is going to cost it's going to vary probably if it's a pay over model it might not be a cost of 20% it might be a lot more.

    Right okay.

    So I might just get Phuong to have a quick chat, he is just chasing up the microphone.

    The model has currently developed which will refine over time is based on there was no differentiation between whether or not it's a hundred percent donation model or a hundred percent retention and I understand that even within a particular health service you might have a gamut of different arrangements with every different neurosurgeons etc. so the model recognizes that there's no differentiation and the way that we approach is that we recognize that if you're an MBS participation there will be a third party payment from MBS, which is the discount. If we assume that if there is a retention the cost that you pay are less therefore it should work out mathematically, if it is a retention model the cost to you were different, if it's a 100% donation model means that you're probably paying their salary the costs different and the models been calibrated so that it is equitable to most services.

    And I think that is why we are taking a pretty generic approach, and I guess to that we do recognize that there are differentials in that and I might just go to a question just before I go to the question off the floor. There are a couple more questions on here related to that, one around whether or not it might be better to actually have a discount closer to the national 67% percent from the start, so not sure how people feel about that.

    Phuong is shaking his head.

    There are a few people shaking their head so I am just going to say to that noted and thanks for your suggestion.

    The 67% discounts is for the admitted model.

    That's right. So we are probably been quite calm about that at this point. The other one was around the use of one single price rather than a rural metro price so I might flick to Phuong, is that one for you? In terms of price setting metro / rural.

    I think, at the moment the only model, funding model that has a metro / rural, metro and sub-regional price is the WIES, all the other funding models don't have a differentiation, I think we're constantly reviewing the data if there is a material difference, we will consider it but I think at this point in time the data is inconclusive to introduce a price for regional hospitals.

    One here around whether or not a contact, so just reading this one, Sue Smith from West XXX has asked about whether the first contact or first service contact is deemed to be the first face to face event or the first point of contact which is often made by the telephone.

    So this is sort of getting to the national definitions of what a service event is, if and Iain you might have to talk to this yeah.


    So if it's not a face, I mean to meet the definition of a service event it has to, I'll let Iain talk to it.

    So we're for face-to-face it has to be a substitute for a sorry, a telephone call has to be a substitute for a face-to-face service event to be counted.

    .So if it was a purpose of a face to face consult or a telephone call to make your first appointment, then that consult would apply as a service event would apply, but if it was a face to face consult done by telehealth mode then I think that meets the definition.

    And there's a bit more information in the tech specs about what a service event is and what you can count.

    Two more questions up there and one down here, so I might just go there, there and there, Thanks.

    Thanks Oh Mark O'Connor Mercy Health - how is the department intending to incentivize services that under FY17 shadow modeling would appear to have over-delivered and to maintain that service?

    Yeah so I think that probably gets back to the recall, I don't know if you want to talk to this Phuong again? But whether there's funding for activity above performance so I think one of the levers is the recall policy so we've set a payment of 50% percent of the relevant rate between 100 and 104, this is despite potentially having limited Commonwealth revenue under the new arrangements of 17-18 onwards. The second thing is if you over perform, when we then sit down with you during budget discussions, yeah there's a potential for you to get extra money so there is an incentive to maintain activity and that's an ongoing discussion during performance meetings as well.

    There is another one at the back, do we want to go this one here since we have the microphone.

    We have a mic here ready to go and I will come back to the back.

    In the latest version of the PFG document isn't inconsistency with two tier 2 categories, 20.01, 20.02, in table 3.17 they are labeled portion 35 in table 342 they are labeled as proportion 42.

    That's really good question, so there are not less than I mean there are more errors than one in the PFG of that by saying that, and I think yeah there is an amendment going out soon and we think we've found all the errors but there's about six all up an errata has been published, it is on the PFG website which is health.vic.go/policyfundingguidelines. We will circulate it after this. One so there's that typo, there's a typo in one of the boxes, there's a typo with how to adjust for and subacute early days which I'll touch on in my presentations as well, they're the only typos that I know of so far if there is any other ones please let us know and we'll issue one final addendum on Monday next week. I will say so in the tech specs that we'll release surely and in the WASE calculator everything in that is right as far as I know and we will be triple quadruple checking so I'll give you a proper answer about what 2001 and 2002 is maybe offline, but whatever we whatever we provide in the WASE calculator in the tech specs will be right. Does that help?

    There is an amendment coming.

    I think there was a lot more in the embargo copy and I know that, the other part of that, will these slides show after the presentation?
    Ye I think so. Is that right Amy? Ye.

    I am just going to take this one more question here and then I am going to go to the back.

    Rhonda Carol Again -- I think we might be a bit, a bit penalized by your definition of XXX event, so what you try to do for the patient's convenience is to have them attend a number of clinics on the one day and because you're rolling up the tier 2 into a service group like that then where that's only going to count once for the day, and I think that is a disadvantage to us. so you try to make the patient journey as smooth as you can go to a number of clinics you try to schedule them all on one day yeah so that would penalized us.
    Ye so, 2 parts my response to that, it's a really good question and it's not the first time it's come up. The first thing I'll say is it's only rolled up into a service event if it's the same patient same date and same clinic, so if you go to multiple clinics with multiple different clinic IDs that's multiple, Marinas nodding at me, that's multiple service events, we don't roll those up . If you go to the same clinic and see three different people it might be a multidisciplinary clinic so you might have three contacts with the same clinic are they on the same date, Iain did you want to talk about multidisciplinary clinics?

    That it's rolled up as one service event you know it's a good model of care and it's maybe one that the model doesn't incentivize very well, it's unfortunately, the definitions are from the developed by the IPA they are sort of what they are and which align ourselves with a national model so there's probably not much room to move there. But did you want to talk about multidisciplinary clinics and what IPA are doing, or is there much to say, sorry, it's okay.
    So at the moment IPA provides an unloading to the model, their model for multidisciplinary care that's something that we need to consider over the next twelve months
    So what are the things that is an issues, is to identify the multidisciplinary clinics, So where we are able to identify multidisciplinary clinics as being that, again keep in mind that what you are whilst your also contributing to developing the model, is the costs, to help drive the cost weight, so as you understand what the costs are of those multi-disciplinary clinics compared to the cost of single disciplinary clinics, that will affect the model in the future as well, so as Ben said, if it is attendance at different clinics on the same day they would be recognized so it's important to get your IDs right and make sure the clinic IDs are right and where the costs are, actually kind of increasing, because of the multi-disciplinary approach, then that will be reflected in the model immediately, cause we don't have enough of that information
    Yes that's right and this is why we're going sort of WASE 1 because as Ben said the cost weights both in Victoria and nationally new the swings in the cost weights are massive year-on-year so to try and stabilize that we have grouped them up to actually get the six cost weights to try and stabilize, if we actually just applied it across the board then you will get swings and roundabouts quite big swing and roundabouts year on year making it really hard to budget and understand kind of what that looks like in terms of the distribution in funding fee, for each of the clinic types. So that is one of the disadvantages and as we mature the model you know those cost weights will become kind of you know bigger groups, be able to spread it out but until we are kind of comfortable that there is some stability in that, then this is kind of our approach to mitigate that risk, I think. So ye it is an evolving model, and that's the sorts of things that we will track as the cost data gets better and we start to understand that more, the we can make sure that we are actually flowing it through to the model.
    Question at the back

    Shannon Lange from Easton Health, I think I know the answer to this question already, but I'll ask it, I told my CFO last night I would, is there any room for adjustment to the target or will that be considered wrapped up in how you're going to treat people?
    So it's a good question, so in terms of whether the target changes, so the targets published in the PFG are based on your private public split last year, at the end of the year they'll be recalibrated or recalculated based on your actual private public split, so if you drastically change your private public activity split or private public WASE split your target will change. I'm not sure if that's what you're asking you might be asking whether you can negotiate a change to your target, that's a question for Phuong.

    Or I'd like to hear your answer.

    That's not a question for Peter, I guess if you're willing to provide money back to the department well of course we were happy to reduce the target, but in honesty I think what will happen now is the budgets of the budgets, that we issued as part of the policy funding guidelines we, we will review the mid-year and we'll be in discussions with your CEO regards to how we apply recall and any other adjustments that do occur in line with normal practice.

    Is that similar to the answer you expected?

    Yes it is Thanks.

    Andrew is just up the back there and wants to add something.

    Again this is as we said it is WASE 1 you know the targets are there, the budgets there, we've got a recall that is light like it's half what we would normally do from everything and normally if you know if you a 90% would normally take off seven percent of your funding altogether we're not doing that one. We understand it's the first year, this is a topic that we'll have on performance meetings with you CEO CFO's to those four things to actually try to really understand it, as we learn more as you do as well.

    Ye and we have run our figures for July and we are not concerned about recall it is the other end of the spectrum.

    Ye I think overs are just as important as unders in be able to sort that out,

    Just one question I have here that might be useful to just kind of just redirect, I'm trying to make sure we've covered off all of these as was around the WASE reports being circulated around for tracking purposes and how regularly they might be circulated. So if one of the team could answer that.

    Okay I can start and so um the plan is to keep producing those same reports that we did last year we might sort of modify them a little bit to make them easier to understand. In terms of sort of other tracking we're sort of working with what is now the Victorian agency for health information to provide WASE information back to health services the same way and we track WIES and that's a's a discussion that's happening at the moment. Phuong or Stephen I don't know if you wanted to add anything else about providing reports back to health services, have covered it off if? If there's anything you want let us know and we can do our best to provide it.

    I am mindful that morning tea will be in about 4 min, and we have about 3 questions I am going to read from here and one from there.

    Thanks Jimmy from Melbourne Health. I just wanted to confirm that multiple clinics happening in the same day can add to service files because last year when we were doing the tier 2 there was record patients from regional, there were multiple clinicians seen on a different day in the funding model he says it's all different events on that one day will be wrapped up into one, so it's all recorded in one clinic?

    Yeah so...

    We can, we have an opportunity to split that into different if you recorded in different clinics because it could be allied health the clinician and then the pharmacy etc. it could be multiple events?

    Yes so if it happens, if its three different contacts on the same date with the same patient in three different clinics its three service events.

    Thank you.

    Is that right Iain? Iain is there anything else you wanted to add to that definition?

    It is also important to understand the business rules as well in terms of what actually constitutes a clinic, and I won't comment on your ability to do that. But I think you know they need to be mindful that although this is a technical solution in terms of making sure there's a clinic ID that is different there's business rules around how you do that
    If those three clinics were in the same funding stream only one of those would be in you?

    If they're in this, if they're in the same program stream.

    Yes Sorry that is what I meant.

    Again part of the challenge in terms of trying to find the difference between new and review in rolling out contact to service events. But again that is one of the things that we will monitor and come back and ask people about what is the proportion of those sorts of clinics and how we pick them up, and are you better in that situation to consider multidisciplinary clinic over time and is that way to record it, as a cost weight. Cause there are other ways of thinking about how we are evolving the model.

    Ok a couple of questions from the floor here.

    Question around Can and will nurse practitioners led clinics attract funding under the WASE model? I am looking at Iain and he is nodding his head because I believe that is part of the model.

    Yeah as long as they're so as long as they're registered in NACMS they'll be counted and they'll be funded.

    We had a questions about...

    This is a question for you Phuong I think and potentially Andrew again around transitional compensation allowed if the regional health services have trouble meeting targets under the new activity model?

    So again no transitional grant but we'll have a look at them you know as I said discuss with each health service but the expectation is that people you know we have been shadowing for a couple of years and expect activity to be delivered but we'll have those discussions at performance meanings.

    Other questions from the floor? We will come back and there will be time again morning tea, lunch, before you leave, whether or not we have some more time at the end of presentations for some more questions to come, but I am kind of getting a sense that they are slowing down off the floor and the webinar, might break for morning tea thanks very much, please thank Ben for his presentation as well.

Presentation from the Funding Models Forum, 17 August 2017.

Reviewed 18 October 2017


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