LSAA Indicator Schedule Refresh2015-2016

Education Session

December 2014

Agenda

1.Context

2.LSAA Organizational Structure

3.Approach to Indicator Validation

4.Changes to Indicators for 2015/16

5.Overall Timelines

6.Questions

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Context

Ontario’s LTCHs provide valuable care to many of the province’s seniors and individuals with complex health needs. The sector has an important role to play in addressing the province’s demographic pressures, fiscal constraints and increasing public expectations related to seniors care.

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There are 634 LTC homes in Ontario, with approximately 78,000 beds.

Ontario’s LTC homes have different governance structures. Some are operated by municipalities, some by hospitals and others by private entities that are either for-profit or not-for-profit.

The various homes are represented by their respective associations: Ontario Long-Term Care Association (OLTCA) Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS) Association of Municipalities of Ontario (AMO) Ontario Hospital Association (OHA)

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Context

Context

The LSAA is the service accountability agreement between a long-term care home licensee and the LHIN that is required by LHSIA.

The role of the LSAA is to clarify that the LTCH will be responsible for delivering not only performance, but also planning and integration towards the development of a health system.

The current LSAA has been signed for the period April 1, 2013 to March 31, 2016.

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Context

LSAA schedules can be refreshed on an annual basis. For 2015/16, the LSAA Performance Schedule (Schedule D) will be updated to reflect new indicators, targets and standards.

These updates were a result of extensive stakeholder consultation and dialogue at key tables comprised of leadership within the LHINs, numerous sector associations and partners, and MOHLTC.

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LSAA Organizational Structure

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The LSAA Advisory Committee provides advice to and supports the development of the LSAA template agreement, as well as schedules and tools to ensure alignment with provincial strategic directions and streamline processes.

The Committee is comprised of representation from LTCHs, OANHSS, OLTCA, MOHLTC, OHA, LHINs, and various municipalities (see Appendix A for membership list).

LSAA Organizational Structure (cont’d)

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The LSAA Indicator Work Group has been established to support the LSAA Advisory Committee.

Based on direction from the LHIN CEOs, the Work Group produces documents and recommendations for discussion by the Advisory Committee, including a list of recommended LSAA indicators, technical specifications, target setting guidelines and education materials.

The Work Group is comprised of representation from the LTC sector, including leadership from various homes, OANHSS, OLTCA, MOHLTC, LHINs, HQO and various municipalities (see Appendix B for membership list).

Approach to Indicator ValidationIndicator Classifications

1) Performance May trigger consequences under the SAA Associated with a target and corridor, or at minimum have a benchmark Are valid, feasible measures of system performance

2) Explanatory Complementary to performance indicators Support planning, negotiation or problem-solving at the provincial or LHIN

level

3) Developmental Require further validation to ensure quality criteria (e.g. validity) are met prior

to moving the indicators to performance/explanatory status Not included in the SAAs

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Approach to Indicator Validation The Indicator Validation Tool lists 10 criteria for an indicator to be validated for

inclusion in a SAA:

1. Strategic Alignment Reflects system perspective and important goals or aspects of the

regional health system Aligns with one or more provincial and/or local system imperative, and

health system outcome objective

2. Reliability Produces consistent results in repeated measurements of the same

condition/event Information is collected in a predictable and consistent manner using

reliable methods

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Approach to Indicator Validation

3. Actionable (Attribution) Within a reasonable ability to influence/control Relevant stakeholders are able to make change to improve the outcome

4. Directional Trending Sufficient historical data to support timely target setting and quality

improvement

5. Timeliness Can be reported in time to allow users to take action to improve

performance

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Approach to Indicator Validation

6. Feasibility Data for the indicator is readily available, and can be collected and

calculated

7. Clarity/Understandability Easily understood by stakeholders and the general public

8. Directional Validity Addresses areas where performance improvement is likely to have

significant impact on the outcomes Clear whether a particular direction (increase or decrease) reflect better

performance

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Approach to Indicator Validation

9. Comparability Can be compared overtime and/or place Data for all comparators in the same units Data should be in relative, rather than absolute, terms

10. Applicability to Accountability Agreement Within the circle of influence of the sector to which the accountability

agreement applies

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Approach to Indicator Validation

To validate and review the indicators in depth, 3 sub-groups were formed, with focuses on: Quality and Resident Safety Indicators Coordination, Access and Primary Care Indicators Organizational Health and Financial Indicators

The sub-groups utilized a modified Delphi approach to review the Indicator Validation Tool assessments, and further discuss and evaluate proposed indicators, which helped build consensus

Sub-groups submitted recommendations to the larger Indicator Work Group for discussion

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Changes to Indicators for 2015/16

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• Below is the list of indicators and their classifications:# Indicator Name Status Quality and Resident Safety1 Percent of Residents who had a Fall in the Last 30 Days Explanatory2 Percent of Residents whose Pressure Ulcer Worsened Explanatory3 Percent of Residents on Antipsychotics without a Diagnosis of Psychosis Explanatory

4 Percent of Residents in Daily Physical Restraints ExplanatoryOrganizational Health and Financial

5 Total Margin Performance6 Debt Service Coverage Ratio Performance (Note: Currently

an explanatory indicator in LSAA)

Coordination, Access and Primary Care 7 Long-Stay Utilization Explanatory (Note: Percent

Resident Days will eventually replace this indicator)

8 Number of Resident Transfers to ER from LTC Homes Resulting in Inpatient Admissions per 1,000 LTC Home Residents*

Developmental

9 Wait Time from CCAC Determination of Eligibility to LTCH Response Explanatory

10 Wait Time from LTCH Acceptance to Placement* Developmental

11 Long-Term Care Home Refusal Rate Explanatory

*Note: Developmental indicators are not included within SAAs.

Notable Changes: Status of 2014/15 Indicators in 2015/16 (1)

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The 2015/16 status of the 4 indicators in the 2014/15 Performance Schedule are as follows: Long-Stay Utilization: Technical aspects regarding the calculation of a

Percent Resident Days indicator—an improved alternative to Long-Stay Utilization—is currently being reviewed by MOHLTC. Until this is implemented, Long-Stay Utilization will remain an explanatory indicator. However, due to the impending arrival of the Percent Resident Days indicator, it is suggested that the establishment of any local targets for Long-Stay Utilization be delayed.

Median Wait Time to Placement in Long-Term Care Home: Not recommended for inclusion in LSAA.

Notable Changes: Status of 2014/15 Indicators in 2015/16 (2)

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Debt Service Coverage Ratio for Non-Municipal Homes/Organizations: Recommended as performance indicator

Compliance Status: was not included as a performance indicator in the current LSAA, nor is it recommended for inclusion in the 2015/16 LSAA.

As a result of further review, the MOHLTC and LHINs are exploring collaborative and complementary approaches in monitoring operational performance of the Long-Term Care Sector. The objective is to develop stronger synergies between the LSAA and Compliance mechanisms.

Notable Changes: Debt Service Coverage Ratio

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DSCR will be reclassified from an explanatory indicator to a performance indicator in 2015/16

It applicable to all LTC homes with long-term debt that are operated by either a non-profit or for profit entity. It is not applicable to Municipally operated homes, nor homes operated by entities that do not hold long-term debt.

Data source is the OHRS Trial Balance Submission

Notable Changes: Debt Service Coverage Ratio

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• Can be calculated at the home level or at the corporate level if appropriate. Should a LTC Home wish to calculate DSCR at the corporate level, the Home must notify the relevant LHIN(s) of their intent.

• A new approach to performance monitoring: if a home has a DSCR less than 1 for two consecutive reporting periods, this would trigger a performance conversation between the home and the LHIN.

Notable Changes: Total Margin

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Total Margin is classified as a performance indicator in 2015/16.

Amount by which an individual LTC home’s (consolidated) revenues exceed or fall short of that LTC home’s total (consolidated) expense, excluding the impact of facility amortization, in a given year.

Data sources include: Ontario Healthcare Financial and Statistical database (OHFS) Income Statement MIS Supplementary Report

Notable Changes: Total Margin (cont’d)

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Identified and calculated at the LTC home level. Performance target is equal to or greater than zero. Final performance

measurement is taken at Q4 (Fiscal Year End) Homes that report a Total Margin of less than zero at Q2 may trigger a

performance discussion with the LHIN. Homes reporting a Total Margin of less than zero at Fiscal Year End will trigger a performance conversation with the LHIN.

Can indicate that a LTC home has a sound financial position even while individual envelopes (with eligible or ineligible expenses) are imbalanced. However, MOHLTC recently introduced additional flexibility that affected a LTC home’s ability to transfer funds between envelopes, which has helped reduce the aforementioned risk substantially.

Overall Timelines

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Deliverable Expected Timeline

Finalize indicators, technical specifications, and target setting guidelines

Sept. 1 – Nov. 30

Conduct provincial stakeholder educational session

Dec. 1-15

LHINs to conduct local education Dec. 15 – Jan. 31

Local consultation to finalize LSAA Indicator Schedule

Dec. 15 – Feb. 29

LHINs in receipt of Board approved final negotiated Schedules

March 31

NB: In January 2015, the LSAA Indicator Work Group will begin to focus attention on data capture and reporting processes.

Questions?

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Sector / Association

Organization Individual, Title

LHIN CE LHIN Deborah Hammons, CEO (Chair)

LHIN WW LHIN Bruce Lauckner, CEO (Vice-Chair)

LHIN HNHB LHIN Donna Cripps, CEO (Vice-Chair)

LHIN CE LHIN James Meloche, Senior Director, System Design and Implementation

MOHLTC MOHLTC Theresa Nowak, Manager, Financial Policies and Procedures Unit, PICB

MOHLTC MOHLTC Jane Sager, Manager, LLB

AMO AMO Monika Turner, Director, Policy

AMO Northumberland County

Elizabeth Savill, CAO

OANHSS OANHSS Jeffrey Graham, Director, Public Policy

OANHSS Regional Municipality of Peel

Carolyn Clubine, Director, LTC

Appendix A: LSAA Advisory CommitteeMembership

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Sector / Association

Organization Individual, Title

City of Toronto City of Toronto Reg Paul, GM, LTCH and Services

OHA OHA Lou Reidel, Director, Health Finance and Reserch

OLTCA OLTCA Candace Chartier, CEO

OLTCA OMNI Health Care Ltd.

Patrick McCarthy, President and CEO

OLTCA Extendicare Christina McKey VP, Eastern Operations

Appendix A: LSAA Advisory CommitteeMembership (cont’d)

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Sector/ Association

Organization Individual and Title

LHIN CE LHIN James Meloche, Senior Director, System Design and Implementation (Chair)

LHIN NSM LHIN Brian Putman Senior Advisor, Financial Health & Accountability

LHIN CE LHIN Emily Van de Klippe Lead, System Finance and Performance Management

LHIN NSM LHIN Neman Khokhar, Senior Manager, Performance, Financial Health & Accountability

LHIN MH LHIN Michelle Collins Senior Lead, Health Systems Performance Management

MOHLTC MOHLTC Theresa Nowak Manager, Financial Policies and Procedures Unit, PICB

MOHLTC MOHLTC Domenic Della Ventura Team Lead, Performance and Accountability, LHIN Liaison Branch

MOHLTC MOHLTC Feng Ding Data Management Specialist, Health Data Branch

MOHLTC MOHLTC Jessie Wong Senior Health Analyst, Health Analytics Branch

Appendix B: LSAA Indicators Work Group Membership

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Sector / Association

Organization Individual and Title

HQO HQO Naushaba Degani Manager, Research Methods

HQO HQO Maaike Devries, Senior Methodologist

AMO Regional Municipality of York

Tony Fernandes Manager, Program Support and Analysis, Long-Term Care and Seniors, Paramedic and Seniors Services

OANHSS OANHSS Dan Buchanan Director, Financial Policy

OANHSS Marianhill Inc. Linda Tracey, CEO

OANHSS City of Toronto Jane Simms Manager, Program & Strategic Support, LTC Homes & Services

OANHSS Bruyere Continuing Care

Amy Porteous VP, Planning and Residential Programs

OLTCA OLTCA David Beirnes Director, Financial Policy & Planning

OLTCA Specialty Care, Inc. Daile Moffat Director, Quality & Management Consulting

OLTCA OMNI Health Care Ltd.

Patrick McCarthy, President and CEO

Appendix B: LSAA Indicators Work Group Membership (cont’d)

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Sector / Association

Organization Individual and Title

MOHLTC MOHLTC Ifeolu Ogunyankinm, Senior Financial Policy Advisor (alternate member)

MOHLTC MOHLTC Sven Schoening, Senior Financial Policy Advisor, X-Ray Safety and Long-Term Care Homes Branch (alternate member)

MOHLTC MOHLTC Stella Chan, Health Analyst, Health Analytics Branch (observer)

Appendix B: LSAA Indicators Work Group Membership (cont’d)