Smaller | Larger

Funding Publications

1993 | 1994 | 1995 | 1996 | 1997 | 1998 | 1999 | 2000 | 2001 | 2002 | 2003 | 2004 | 2005 | 2006

2006

Evaluation and Selection of a Grouper and Weighting Methodology for Adult Inpatient Rehabilitation Care Summary Report | Technical Report Ontario hospitals with MOHLTC designated inpatient rehabilitation beds have been collecting inpatient rehabilitation activity data using the CIHI National Rehabilitation Reporting System since 2002. These documents review the approach used by the JPPC Rehabilitation Technical Working Group to develop a case mix system for adult inpatient rehabilitation in Ontario.

2006 TABLE OPTION

2005

Multi-Site Hospital Issues & Impact on Rate Model of Funding Formula  Document This report describes the outcomes of a process of due diligence launched by the JPPC in 2002, to address the perceived inequity within the Rate model regarding the treatment of multi-site (MS) hospital facilities. Ultimately the JPPC did not endorse a formulaic approach. However, it did support continued work by the MOHLTC to develop a non-formulaic tool to facilitate a transparent and standardized process for enhancing funding equity for these hospitals.

^ Return to top

2004

Hay Level of Care Methodology: 2002/2003 Version using AARV Weights Appendix This document updates the assignment of weights based on 2002/2003 data. For more information, see 2001 Hay Report. LINK

Hospital Funding Report Using 2002/2003 Data Document | Appendices 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11| 12 | 13 | [NEED LINKS AT END OF DOC] This report describes the methodology for the implementation of the JPPC volumes model using 2002/03 data. The methodology first estimates population volumes and then allocates these volumes to hospitals. The model predicts the number of inpatient and day surgery (medical and surgical) weighted cases that would be used by a population with given population characteristics at the average Ontario rate of utilization. Population characteristics used in predicting weighted cases include age and sex of the population, income, mortality, aboriginal population, and rurality. These volumes are then allocated to hospitals based on historical market share. Growth volumes are also predicted for a population and then allocated to hospitals. Separate methodologies were derived for the allocation of tertiary and local growth. The hospital predictions can be used as the basis for evaluating a hospital’s relative utilization or it can be used to approximate funding.

^ Return to top

2003

Hospital Performance Committee Report Document | Appendices A | 1 | 2 | B | G | C | D | F1 | F2 | 9 This report summarizes the JPPC Hospital Performance Committee's work related to the development of the Hospital Indicator Tool subsequently adopted by the Ministry of Health and Long-Term Care and available on the FIM website. The committee fulfilled its mandate by identifying and publishing 29 global and 31 functional centre indicators through a rigorous method that included literature reviews, consultations and data analyses. In order for hospitals to better select comparable hospitals when choosing indicators, preliminary work was undertake to create descriptors for individual hospital profiles.

^ Return to top

2002

Hospital Funding Report Using 2000/2001 Data Summary | Document | Appendices This report builds on previous reports and provides the results by individual hospital based on 2000/2001 data. It also describes the enhancements to the funding formula based on Spring 2001 consultation process and the issues raised by the committees. 

Hay Level of Care Methodology: CMG 2000 Appendix This document updates the assignment of Case Mix Groups (CMGs) to a level of care using 2000 data. For more information, see 2001 Hay Report (LINK). 

How Should Hospitals Respond to Performance Under the Funding Formula  Summary | Document The purpose of this paper is to provide hospitals with some methods to respond to their performance under the funding formula.  It is intended as a resource for staff at most levels of management within the hospital, particularly in the areas of decision support and finance, to increase understanding of the formula, and strategies to change performance results.

Funding Hospital Based Ambulatory Care Summary |  Document | Appendices This paper is the third report in the Funding Hospital Based Ambulatory Care series. It focuses on hospital readiness for the implementation of hospital ambulatory clinic visit data capture. It is the accumulation of information from a series of interconnected evaluation activities that attempt to describe: hospital readiness to use the NACRS MDS to collect ambulatory clinic data; current hospital ambulatory clinic activity reporting via the MIS chart of accounts; hospital based ambulatory clinic data capture models; and hospital ambulatory clinic reporting data capture cost components. The report provides information and general guidelines for reporting ambulatory clinic activity it does not attempt to prescribe any one particular data collection method or solution. It is a planning tool for hospitals, the MOHLTC, the OHA and CIHI in moving towards a provincially coordinated reporting solution that accurately describes and measures hospital based outpatient ambulatory clinic visits.    

Evaluation and Selection of a Classification Tool for Rehabilitation Care in Ontario Summary | Document  The MOHLTC has mandated the implementation of the CIHI Rehabilitation Reporting System for the reporting of adult inpatient rehabilitation activity effective October 1, 2002. The report, prepared in 2000, includes findings and a series of recommendations to the MOHLTC including the mandating, funding, implementation and ongoing collection of rehabilitation care data using the CIHI FIM-based data set for patients in MOHLTC designated inpatient adult rehabilitation beds in Ontario hospitals. Both the summary document and report will assist hospitals in understanding the criteria used by the JPPC Rehabilitation Advisory Committee in making its recommendations. 

^ Return to top

2001

Hay Level of Care Methodology: CMG 1999. The assignment of CMGs into Tertiary, Secondary & Primary categories Document | Appendix The categorization of hospital activity by level of care can be used to support planning for the number of service delivery sites within a geographic area. During the Metropolitan Toronto Hospital Restructuring Project, Hay consultants developed a new mechanism to assign CMGs to a defined level of care. This was necessary since there was no pre-existing, universally accepted, objective approach to assigning level of care. Since the initial development, the level of care assignment methodology has been updated each year as the CMG methodology is updated. This document describes the initial development of the level of care methodology and lists, as Appendix A, the assignment of each CMG 1999 category to level of care.

Hospital Funding Report Using 1999/2000 Data Document | Appendices  Report describes the components and results of the IPBA Rate and Volumes Models. The Volumes Model predicts the number of weighted cases which the hospital should treat.  It includes Medical/Surgical Volumes, adjusted for age/sex makeup of the population, excess mortality by age group, socio-economic status (as measured by average income), percentage of Aboriginals living in the geographic area and percentage of the area deemed rural; Pregnancy and Childbirth Volumes, adjusted for age/sex makeup of the population, Fertility Rate) and Newborn and Neonatal Volumes, adjusted for age/sex makeup of the population, % babies weighing <2,500g at birth. The Rate Model predicts how much the hospital should be paid for each case; that is its expected cost performance measured by unit cost, or cost per weighted case. It was applied to all of the activity in small hospitals; Acute, day surgery and chronic care activity in large hospitals; and Chronic care activity in stand alone chronic hospitals, with adjustments made for isolation, size, teaching role, neonate tertiary activity, non-neonate tertiary activity, and free-standing chronic facility status. 

Integrated Population Based Allocation (IPBA) Formula Document | Appendices  Application of formulae, such as the adjustment factors and growth funding formula, has improved relative funding equity by rewarding providers that are low cost providers and have communities with substantial growth. However, a number of enhancements are needed to improve the fairness, responsiveness and scope of relevance of these formulae, including: 1) the measurement and inclusion of all components of the hospital system (e.g., chronic care, rehabilitation, outpatient, etc.); 2) the integration of all funding formulae (e.g., small and large/community hospital formula, acute care and chronic care funding); 3) a methodology that is sensitive to both relative population needs and population growth; and, 4) a methodology for the evaluation of base Ministry of Health and Long Term Care funding and the ability of hospitals to generate revenue from other sources. The Rate x Volume Model presented in this report is based on a "pie sharing" exercise. Once the Ministry of Health and Long Term Care (MOHLTC) determines the amount of money to be applied under the model (whether that be new funding, or the total hospital allotment), the model determines how that money should be distributed most equitably among hospitals.  It does not determine the appropriate level of funding for the hospital system in total. This report provides the detail on the JPPC committee processes for developing the model, the hypotheses justifying specific rate and volume adjustments, and the rationale for their application. It also provides detailed technical information on the methods employed to derive the expected rate and volume levels calculated for hospitals.

Ontario Hospital Cost Distribution Methodology This document sets out, in detail, the calculations made in the OCDM methodology using 1999/2000 data, including financial exclusions and adjustments applied at the departmental and facility level; the derivation of allocation proxies from statistical information and the calculation of ACPWC and per diems by patient activity category. 1999/2000 was the first year for the implementation of the Ontario Reporting System Version (OHRS) 4, which introduced several major changes to the reporting requirements. The impact of these changes is briefly reviewed in the document.

^ Return to top

2000

Methodology used to Calculate Adjustment Factors Model and Small Hospitals Funding Model Report updates the Actual and Expected Cost per Weighted Case using the 1998/99 CIHI and MIS Data and applying the Adjustment Factors Funding Model and the Small Hospitals Model. The Adjustment Factors model provides a way to understand cost variation between Ontario hospitals that result from the presence of factors beyond a hospital’s control. Together, three factors account for approximately 80% of the variation in hospital cost per weighted case: 1) Adult Tertiary Activity; 2) Teaching Activity; and 3) Neonate Tertiary Activity.  In 1997, it was found this Adjustment Factors Formula used for funding “larger” sized acute care hospitals was inappropriate for funding smaller sized acute care hospitals (i.e., largely peer group 7 hospitals) due to diseconomies of scale, remoteness, isolation, lack of community resources and special needs populations.  The Small Hospital Funding Methodology uses two key components: an actual cost per equivalent weighted case and an expected cost per equivalent weighted case. This formula provides a way to understand cost variation among small acute care hospitals due to the presence of factors beyond their control such as hospital size and isolation. Also released were the detailed Facility Costs per RUG-lll Weighted Day based on 1998/99 data.

Ontario Hospital Cost Distribution Methodology This document describes in detail the calculations in the OCDM methodology based on the 1998/99 year end Trial Balances and supplementary information. For the first time, RUG-weighted patient days (RWPD) were used to calculate a hospital specific Actual Cost per RWPD. As a result, it will now be possible to expand the comparison of relative efficiency from the Acute Inpatient category to include Chronic Care.

^ Return to top

1999

Funding Hospital Based Ambulatory Care in Ontario  This report summarizes the work of the JPPC Ambulatory Care Implementation Team regarding the implementation of CIHI’s National Ambulatory Care Reporting System for Emergency Services Reporting (NACRS) as a basis for hospital ambulatory care funding in Ontario. Based on survey responses from 190 hospitals, the report reviews a number of challenges to implementation (including time, cost and data quality), and makes 11 recommendations, chief among them that the Ministry of Health mandate the collection of emergency visit data in Ontario.

Cost per Case-Mix Weighted Activity for Complex Continuing Care in Ontario Summary Report | Technical Paper  Summary report provides comparative provincial and facility-specific 1997/98 costs per RUG-III weighted  patient day to Ontario hospitals with Ministry of Health designated chronic beds. The information was released to obtain feedback from the field on work completed to date and to assist facilities to identify data quality and reporting issues and use the insights gained from this information to make any necessary final changes to their data from 1998/99 and beyond, for both cost and patient activity. Technical Paper provides additional background on the Resource Utilization Groups (RUG-III) case mix classification system and methodology to calculate Cost Per RUG-Weighted Patient Day (RWPD).

Predicting Hospital Volumes for Communities   This report describes the activities to date of the JPPC Volume Subcommittee regarding the development of a method to estimate the expected volume of hospital activity, given the characteristics of the population served by the hospital and the impact of other health service providers on the hospital activity rate. The purpose of a population based funding formula is to distribute volumes of health services to communities equitably, taking into account the factors that legitimately affect utilization of health services. These factors may be population factors such as health or socioeconomic status or they may be related to the supply of alternatives to hospital care. The Volumes Subcommittee concluded that age and sex, excess mortality, aboriginal population, fertility, the incidence of low birth-weight newborns and neonates, and average household income represent appropriate factors for inclusion in an equitable formula for the allocation of volumes to populations. These factors are measurable, beyond management control, and have a measurable and significant impact on population volumes. The model has two limitations. First, the methodology sets equitable volumes for Ontario residents and does not account for out of province cases. A comprehensive funding formula must account for out of province and out of country activity. Second, the methodology is limited to inpatient and day surgery volumes and does not account for ambulatory and non-acute inpatient care.

Methodology Used to Calculate Small Hospitals Funding Model Report contains comparative 1997/98 data on Actual and Expected Cost Per Equivalent Weighted Case in Ontario small acute care hospitals.  The Small Hospital funding formula is applied to  Ontario hospitals that meet all three criteria in the current Small Hospital Definition: 1) <3,500 equivalent weighted cases, 2) ESI referral population <20,000, and 3) single, provincial community provider. The formula provides a way to understand cost variation among those Ontario small acute care hospitals that results from the presence of factors beyond their control, including diseconomies of scale associated with low patient volumes and geographic isolation. 

Methodology for Costing / Funding Pacemakers and Implantable Cardioverter Defibrillators Report summarizes work of the JPPC Pacemaker and Implantable Defibrillator Working Group  to: 1) develop costing and funding methodologies for various pacemaker and ICD implantation and extraction procedures; 2) determine options for and recommend the most appropriate and cost-efficient funding methodology for pacemakers and ICD services; 3) explore the financial implications of new technologies and advances in knowledge; 4) Identify linkages between funding options and clinical issues, such as critical mass and clinical expertise; 5) Develop a reconciliation/settlement process for pacemaker and ICD funding in the future and 6)  recommend a method of bridging the old funding methodologies with the new recommended funding methodologies.

Methodology for Costing / Funding Anti-Cancer and Supportive Care Drugs Report presents findings from a survey of the approximately 200 hospitals in Ontario, undertaken by the JPPC Anti-Cancer and Supportive Care Drugs Working Group to estimate expenditure on anti-cancer and supportive care drugs in the hospital setting. It also includes recommendations regarding hospital funding methodologies for anti-cancer and supportive care drug costs in both inpatient and outpatient settings taking into account increasing growth, other sources of funding in the system, changing patterns of practice in systemic therapy and changing models of delivery; data collection requirements; and potential improvements to the funding formula in the future.

Ontario Hospital Cost Distribution Methodology The purpose of this document is to set out, in detail, the calculations made in the Ontario Cost Distribution Methodology (OCDM). The latter allocates a hospital’s costs across discrete and comparable patient activity categories at the facility and departmental levels, including: Acute Inpatient, Newborn and Same Day Surgery, Rehabilitation, Palliative Care, Chronic and Respite Care, ELDCAP, Hospital Outpatients and other Hospital and Community Operations. Specifically, it outlines: 1) financial exclusions and adjustments applied at the departmental and facility level, 2) the derivation of allocation proxies from statistical information, and 3) the calculation of Actual Cost Per Weighted Case (ACPWC) and per diems by patient activity category using 1997/98 data.

Methodology to Distribute Emergency Room Funding  In 1998/99, $35 million, representing the first of a committed two year investment strategy for Emergency services, was distributed to Ontario hospitals. This report describes a recommended “data driven, transparent” methodology for the dissemination of year two of the emergency services funding announced by the Minister of Health.

^ Return to top

1998

Understanding the Financial Pressures of Ontario Hospitals This report includes a series of recommendations related to operating and capital financial issues, as well as accountability and reporting issues. The JPPC Financial Issues Advisory Group developed these recommendations within the context of identifying solutions for short term financial relief as well as longer term systemic solutions that will establish a foundation for monitoring and enhancing hospital accountability. The recommendations range from new monies for an equity fund to fostering strategic alliances with corporate partners to ensure an effective hospital system.

Funding Hospital Based Ambulatory Care in Ontario Report reviews the findings of the Ambulatory Care Funding Working Group regarding  the feasibility of using CIHI’s National Ambulatory Care Reporting System (NACRS) as a means of funding hospital based ambulatory care in Ontario. It includes highlights from a telephone survey of CIHI ambulatory care pilot site participants and OCCP ambulatory care costing sites, as well as focus group sessions with hospital stakeholders in Ambulatory Clinics, Emergency, Rehabilitation, Mental Health, Health Records and Administration.  Based on this evaluation, the Working Group concluded that it was feasible to use NACRS as a means of funding hospital ambulatory care (excluding qualifying day surgery), in Ontario. It also proposed that: 1) ambulatory care reporting should be mandated; 2) an implementation team should be established; 3) hospitalsbe provided with detailed implementation timelines; 4) Emergency Services data be reported in 1999 with clinics to follow in 2000; and 5) the data be used for funding.

Understanding How Ontario Hospitals are Funded The JPPC Adjustment Factors Formula has been used to allocate billions of dollars in hospital funding. However, since its introduction in the mid 1990's, significant confusion has resulted regarding how the formula is used to calculate adjustments to a hospital’s annual budget. The purpose of this document is to provide readers with an introduction to understanding how hospital allocations are calculated. This document is meant to serve as a public resource for matters related to hospital funding developments. It explains both the history and technical information necessary to understand how Ontario hospitals are funded. Also included is a glossary of terms that defines clearly the many acronyms and terms used in health care.

^ Return to top

1997

Funding Ontario Hospitals in the Year 2000  This paper provides context for the work of the JPPC funding committees as they begin their workplans for the next two years. The vision of the JPPC Hospital Funding Committee is to develop a single comprehensive funding methodology for hospitals. The paper describes three potential health system configurations under which the proposed funding methodology would be used. Each system configuration describes the flow of health care funds from the Ministry of Health to either Autonomous Providers (option 1), Regional Health Authorities (option 2) or Integrated Health Systems (option 3). For each option a brief overview will be followed by descriptions of system funding and the role of hospitals. The paper will conclude with a discussion of the implications for the Hospital Funding Committee. The objective of the paper is to illustrate the utility of the JPPC’s proposed funding methodology regardless of potential system configurations by the year 2000. This should be considered an evolving work which will be updated as the JPPC’s work progresses.

A Methodology for Funding End State Renal Disease Paper reviews existing costing and funding methodologies and recommends funding of the projected incremental growth in end stage renal disease modalities for 1997/98. A full discussion of the working group’s methodology is in Appendix A. A list of working group members is included in Appendix B. Tables referred to in this Report are presented in Appendix C and End Stage Renal Disease definitions are included in Appendix D. A micro-costing template for comparing hospital specific costs for each modality is presented in Appendix E.

An Approach for Funding Small Hospitals Report summarizes recommendations of the Hospital Funding Committee Small Hospitals Sub-Group. As part of its enhancement of the small hospitals funding formula, the sub-committee proposes to refine the small hospital definition, analyse socioeconomic status factors, the availability of community resources, appropriateness of utilization, minimum direct care patient costs, patient to hospital distance factors, governance, remoteness factors and needs-based funding.

Methodology Used to Calculate the 1997/98 MOH Allocation to Ontario Hospitals (no link)

Medical Trainee Data Collection - Final Report (no link)

^ Return to top

1996

An Evaluation of the 1996/97 Hospital Funding Reductions During the fall of 1995, the Adjustment Factors group presented a formula to replace a relatively unfair peer-group system with continuous adjustments. When the finance minister announced major cuts to institutional funding at the end of November, this formula was used as the basis for the JPPC recommendation on how to apply the cut. This evaluation was administered by the JPPC secretariat on behalf of the Hospital Funding Committee. The purpose of the evaluation was to review the objectives, methods, results, and processes leading up to the JPPC recommendation. We begin by considering whether the approach taken was consistent with the Rate-Based Funding Objectives, the Objectives of the JPPC, and the Health Care Reform Agenda. The adverse impact on access, availability, and quality of patient care is mitigated by phasing in the reductions over three years, and by the use of the caps. However, the adjustment factors do not address the possibility of making improvements to access, availability, or quality of patient care. Eliminating peer groups in favour of a continuous adjustment does remove boundary problems, and thus enhances fairness. Similarly, the factors used are expected to restore equity relative to across-the-board cuts. However, until the Adjustment Factors formula is applied to all hospital activity and all hospital types, the MoH funding reductions cannot be considered to be equitable. Although the adjustment factors do promote efficiency, there is no consideration of whether there is a appropriate utilization of the services that are being provided efficiently. There is little consideration for hospitals in high-growth areas. The growth fund that was allocated was small relative to what was taken away, and it was provided on a one-time basis only. Under any system of health care, the estimate of the cost of care provided is a critical element. The work of the JPPC on costs will continue to be very important and could be used to support the introduction of new funding formulae. The approach taken assumed that a stable funding environment would continue and that all hospitals would be funded according to efficiency, i.e., price. It was designed to reallocate within the existing structures and not to address whether service distribution was appropriate.

Searching for a Classification System for Rehabilitation Currently, patient classification and weighting systems only exist for acute inpatient activity (through Case Mix Groups and associated weights) and day surgery activity (through Day Procedure Groups and associated weights). Recently, hospitals were mandated by the Ministry of Health to classify Ministry of Health-designated Chronic Care beds using the Minimum Data Set (MDS). The remaining hospital activity, which includes rehabilitation, emergency care, medical day care and clinics among others, is captured as part of the global funding system and is the focus of ongoing investigation. As Ontario follows the international trend towards a more comprehensive, case-mix sensitive, funding model, the need for patient classification and weighting for those remaining areas becomes more important. The allocation of funds based on the volume and mix of services that an institution provides is considered a more rational basis on which to distribute funds to hospitals than is a global budget. The mandate of the JPPC Chronic Care and Rehabilitation Working Group is to recommend and facilitate the development and implementation of case groups and case weights for the measurement of hospital chronic care and rehabilitation activity. Measurement of this activity is integral to the incorporation of chronic care and rehabilitation activity into a rational funding formula that allocates funds based on the mix and volume of services that an institution provides.

Revised 1994/95 Day Surgery Incentive Model The Revised 1994/95 Day Surgery Incentive Model compares a hospital’s day surgery performance relative to other Ontario hospitals. Hospitals completing more procedures on a day surgery basis relative to the provincial average will receive a financial incentive, which those who complete fewer procedures on a day surgery basis than the provincial average will receive a financial disincentive. This Revised 1994/95 Model applies the revised day surgery definition (i.e. same calendar day or, if over midnight, less than 12 hours) and includes “value-added” reports to assist hospitals in focusing on key areas that have a significant impact on their overall day surgery performance.

Methodology Used to Calculate 1996/97 Transfer Payments to Ontario Hospitals In 1995, the Hospital Funding Committee was asked to develop an approach to meet the fiscal targets outlined by the Minister of Finance, building on existing funding allocation tools. The Hospital Funding Committee recommended that the 5% reduction in hospital transfers be achieved through a combination of funding reallocation using Adjustment Factors for weighted patient care activity (i.e. acute inpatient, newborn, and day surgery) and across-the-board reductions for hospital activity that cannot be accurately measured (i.e., rehabilitation, chronic care, clinics, emergency, and medical surgical day care). This report provides the details behind the calculation of the funding reductions.

^ Return to top

1995

Replacing Peer Groups with Adjustment Factors This discussion paper includes: (a) an overview of the weaknesses of the current Peer Group model; (b) a summary of the Adjustment Factors Sub-Committee’s work over the last year, including the collection of relevant data and analyses of the relationship between various factors and hospital costs per weighted case; (c) the preferred adjustment factors model; (d) commentary on the inclusion of the factors in the preferred funding formula and a summary of the model’s impact on the funding of various hospitals; (e) a consideration of the policy implications of adjustment factors; and (f) the final recommendations of the Adjustment Factors Subcommittee.

Final Recommendations on the Evaluation of CIHI's Psychiatric CMGs The objectives of this study were: (a) to determine the most appropriate classification system to be used for all patients in inpatient and outpatient psychiatric hospital settings for the purpose of activity measurement, planning, and funding; (b) to specifically evaluate the work already undertaken by CIHI on Psychiatric CMGs to determine if they are the appropriate tool for use in hospital activity measurement, planning, and funding; and (c) to understand the comparability of data collected by the ten provincial psychiatric hospitals and those collected by CIHI on psychiatric inpatients and outpatients in the development of the psychiatric CMGs. It was recognized in the recommendations that several approaches to patient classification are needed with respect to psychiatric cases. It was also recognized that although recent improvements have been made to the CIHI psychiatric CMGs, there remains a need for further refinements to this grouping system for psychiatric patients.

Final Recommendation of the JPPC Emergency Specialty Group This Emergency Specialty Group report outlines recommendations to facilitate the development of an Emergency Patient Classification system. Recommendations include: the inclusion of emergency patients within an overall ambulatory patient classification system; the clear definition of emergency, clinic, and medical daycare patients within an overall classification system; the development of a minimum data set for ambulatory care which would be suitable for multiple uses; and the implementation of appropriate security and access controls to safeguard patient confidentiality.

Methodological Improvements in the Calculation of Hospital Referral Population and Utilization Rates Initially, hospital referral populations were calculated using an age-weighted model which adjusted for variations in length of stay and frequency of visits due to patient age. The primary weakness of this methodology was that it failed to account for the acuity of individual hospital visits. The Expected Stay Index model was developed as an improvement to existing methodologies. The ESI methodology adjusts referral population for both patient age and case mix, providing a better predictor of patient day utilization rates across individual hospitals.

^ Return to top

1994

TQM Project # 2: Collection and Use of the Hospital Daily Census Data TQM Project #2 was completed to examine and improve the process of collection and use of hospital daily census data. It is the second in a series of TQM projects, which recognizes the role of quality management within an efficient health care system. Recommendations suggested that the current process involving the Daily Census form be eliminated and a transition be made from this system to an MIS/OHRS system.

TQM Project # 1: Handling Patient Complaints at the MOH As part of the JPPC’s commitment to quality health care service, TQM Project #1 was completed to recommend improvements in the process used by the Institutional Health Group of the Ministry of Health to respond to patient complaints about hospital care. The team recommended the development of a system which isolates all hospital complaints, ensures adequate follow-up, and generates reports which can be used to identify problem areas. Reference is made to a MoH standard of 20 days for a response to complaint letters.

Proposal for a Rate-Based Funding Approach This discussion paper begins with a review of funding approaches across Canada and worldwide as the basis for establishing a set of criteria that a new funding approach should meet. Based on these criteria, the Funding Integration Sub- Committee of the Hospital Funding Committee found that many of the limitations inherent in the current cost-based approach to funding could be addressed using a “closed-ended” revenue-based (i.e., Rate Based) funding approach. A Rate-Based approach allows for cost averaging, resulting in a flexible and responsive funding system. It also shifts the debate away from cost accounting towards effective planning and management of hospital resources.

Literature Review for the Paediatric Specialty Working Group This literature review analyzes the factors that influence paediatric resource consumption and the different types of proposed paediatric classification systems.

Review of Day Procedure Groups and Weights This review was completed in order to: (i) evaluate the proposed modified DPG system as a classification and weighting scheme for Day Procedures; (ii) evaluate the appropriateness of using the Maryland charge database to develop DPG weights; and (iii) recommend the scope of procedures to be incorporated into Ontario Funding Formulae. It was concluded that the DPG grouping methodology is an appropriate grouping system for the development of a weighting system, but that the Maryland charge data requires further review before it is used to develop a weighting system for funding day procedures.

The Restructuring of the Ontario Hospital System This document describes the forces of change in the current economic environment and the barriers to change currently being faced by the hospital system. Principles for an effective restructuring process are outlined and based on these principles, recommendations are made to the JPPC by the Restructuring Sub-Committee of the Hospital Management Committee. 

Moving to Outpatient Surgery: How do you Compare This document consists of a set of data reports, case studies, and a working paper for percentage outpatient surgery, using 1992/93 CIHI data that can be used as a management tool to affect hospital utilization practices.

^ Return to top

1993

Funding Reallocation for Fiscal 1994/95: Final Recommendations  This discussion paper outlines the details of the recommended funding reallocation methodology. It also identifies potential funding reductions for Peer 1 to 6 hospitals based on the identification of hospitals with significantly high average costs per weighted case. Final recommendations are based on the notion that funding reallocation is both practical and necessary as a means to generate funds to address funding pressures experienced by hospitals.

Report on Day Procedures to the Methodology Sub-Committee This report reviews the literature and methodologies associated with the classification and weighting of day procedures. The Day Procedure Group (DPG) classification system is recommended for classifying day procedures. Several options were considered when determining the most appropriate weighting methodology for measuring the relative cost of day procedures. The need to develop a definition of procedures was also reviewed in light of the list of day procedures that could be used to determine or define day procedures for which funding allocations will be made.

^ Return to top

Updated 03/20/2008