Health System Funding Reform (HSFR)
A significant focus of the Ontario government’s Action Plan for Health Care is health funding reform to support the move away from a provider-centred model toward a patient-centred system. Health System Funding Reform (HSFR) is based on the key principles of quality, sustainability, access and integration.
Historically, health service providers received an across-the-board funding increase annually. Health service providers now receive funding based on how many patients/clients/residents they look after, the services they deliver, the evidence-based quality of those services, and the specific needs of the population they serve. This began on April 1, 2012 in a phased-in approach over three years.
HSFR consists of two funding models: Quality Based Procedure (QBP) funding and Health Based Allocation Model (HBAM) funding:
- Quality Based Procedures are identified by the Ministry of Health and funded on a formula (price x volume) for providing selected services.
- For year 1 in 2012-13, four QBPs were implemented: primary hip replacements, primary knee replacements, cataract surgery and chronic kidney disease (CKD).
- In year 2 (2013/14), six additional QBPs were added: colonoscopy, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), stroke, chemotherapy-systemic treatment and non-cardiac vascular.
- In year 3 (2014/15), six additional QBPs were added: Pneumonia, Hip Fracture, Tonsillectomy , Neonatal jaundice, Bilateral Hip and Knee, Non Cardiac Vascular - Aortic Aneurism (excludes advanced pathway).
- In year 4 (2015/16), three additional QBPs were added: Knee Arthroscopy, Prostate Cancer Surgery, and Colorectal Cancer Surgery.
- With HSFR fully implemented 30% of hospital funding is based on QBPs.30% on HBAM, and 40% global base generally.
- HBAM is an evidence-based funding model that considers factors such as age, gender, socio-economic status, rural geography and patient flows. It compares actual costs and volumes to expected costs and volumes.
The Valued Role of the NE LHIN Local Partnership Group
The Partnership Group, co-chaired by NE LHIN Senior Director Kate Fyfe and Tiz Silveri of the North Bay Regional Health Centre, is looking at the implications of Health System Funding Reform across the NE LHIN. Part of the Group’s role is to work with a subcommittee that examines performance indicators associated with QBPs such as wait times and volume to increase access for patients. The group meets quarterly and reviews data as part of its efforts to ensure best quality care practices are used throughout the region. The group also provides briefing notes to the Ministry of Health and Long-Term Care in relation to issues that affect the implementation of HSFR in our LHIN.
Membership is representative of hospitals across the North East, and the NE CCAC (North East Community Care Access Centre):
- Tiz Silveri - NBRHC, Kate Fyfe - NE LHIN
- Robert Burnett - NE CCAC
- Christianne Monico - NE CCAC
- Mark Hartman - Health Sciences North/Cancer Care Ontario (HSN/CCO)
- Paul St George - HSN
- Dr. Sandra Cameron - HSN
- Lise Pothier - HSN
- David McNeil - HSN
- Paula Sharpe Collins - North Bay Regional Health Centre (NBRHC)
- Joanne Laplante - NBRHC
- Jennifer Plaunt - Timmins and District Hospital (TDH)
- Joan Ludwig - TDH
- Brenda Smith - TDH
- Josee Jean - TDH
- Cynthia Desormiers - West Nipissing General Hospital
- Pierre Ozolins - St. Joseph’s General Hospital Elliott Lake
- Margaret Beatty - Temiskaming Hospital
- Anne Litkowitch - West Parry Sound Health Centre
- Stephen Bellinger - NE LHIN
- Carol Halt - NE LHIN
- Marc Demers - NE LHIN
NE LHIN Process – QBPs (Clinical Services Review)
In the NE LHIN, a Clinical Services Review was completed in 2013/14 which helped the NE LHIN, hospitals and the NE CCAC develop a future vision for the delivery of QBPs across our region. The recommended model in this report was approved by the NE LHIN Board of Directors early in 2014.
Dr. David Boyle, from Health Sciences North (HSN), and Nancy Jacko, formerly with North Bay Regional Health Centre (NBRHC), are leading the implementation of QBPs across our region. Throughout the process, they’ve met with many care providers: EMS, ER physicians, medical and administrative leadership.
Hospitals decided to start the implementation of a few QBPs, learn from the process and continue with implementing the remaining QBPs. We are starting with COPD, hip fracture and vision care (cataracts). Work groups have been established in each area and include physicians and front-line staff.
Clinical Services Review
Community-Based Specialty Clinics
Quality-Based Procedures Clinical Handbooks
Quality-Based Procedures Newsletters