Transcript Dr Alasdair MacDonald

The Independent Hospital Pricing Authority’s
Clinical Advisory Committee
Dr Alasdair MacDonald
Deputy Chair, Clinical
Advisory Committee
Wednesday 15 May 2013
The Innocent Clinicians Perspective
o At the beginning of this process in those states not
already familiar with ABF
“You mean the more operations I do the more money
the hospital gets?”
o Was a familiar catch cry
Clinical Advisory Committee
• The IHPA Clinical Advisory Committee (CAC) is a
key component of the National Health Reform
Agreement and the National Health Reform Act
2011 which recognises the critical role of clinicians
in the development of activity based funding
• CAC was established to ensure that clinicians
have a voice in the development of a national
activity based funding system through the
provision of timely and quality clinical advice to
inform Pricing Authority decision making
Clinical Advisory Committee
• Members are appointed by the Commonwealth
Minister for Health and are drawn from a range of
clinical specialties and backgrounds to ensure CAC
represents a wide range of clinical expertise
• The 27 CAC members provide high level technical
and clinical advice to the Pricing Authority on a range
of issues such as activity based funding classification
development and revision to guide policy
development at IHPA and to inform the national
efficient price and national efficient cost.
National Health Reform Act 2011
The Clinical Advisory Committee (CAC) is a statutory committee that
was established under Part 4.10 of the National Health Reform Act
2011.
The functions of the CAC as described in s. 177:
a) to advise the Pricing Authority in relation to developing and
specifying classification systems for health care and other
services provided by public hospitals;
b) to advise the Pricing Authority in relation to matters that:
i) relate to the functions of the Pricing Authority; and
ii) are referred to the Clinical Advisory Committee by the
Pricing Authority;
c) to do anything incidental to or conducive to the performance
of the above functions.
What has been achieved?
•
CAC has played a key role in the
development and revision of clinically
relevant classifications which support the
implementation of a nationally consistent
ABF framework
•
Informed IHPA’s work in classification
development to ensure hospital data is
grouped appropriately which in turn
contributes to the determination of a national
efficient price
•
Provided critical input into the development
of the Pricing Framework for Australian
Public Hospital Services for 2012-13 and
2013-14
•
Informed the development of the national
efficient price 2012-13 and 2013-14 and the
national efficient cost 2013-14 through the
provision of clinically relevant and timely
advice
What other roles do we play?
• The strategic thinking clinician in the street role.
(i.e. the ability to hypothetically apply the pricing process.)
– Hence recognise possible inequalities
– But also opportunities for gaming
Price and Quality (Carrot and/or Stick)
• This remains a vexed issue with a joint working party
with ACSQHC reviewing this issue but with little appetite
to use a stick in this process.
• But how best to reward quality without widening the gap
between the so called “good and bad”.
• How do we invest in improvement?
Teaching, Training and Research
o How to Price?
o Currently Block Funded.
o A working Group has been established with CAC
members and other experts in the area to price these
aspects of healthcare.
o But do they share more that an historically similar
funding model?
Teaching
o A dynamic environment with evolving models of
education, a shift to in training assessment and
increased scrutiny on accountability.
o All adding strain to a model that has been dependant on
pro-bono contribution and hence likely cost.
o Are we future proofing our funding model or leaving the
system vulnerable to unsustainable future costs.
Training
o Regulatory and Award requirements
o Compulsory CPD
o Looming Revalidation
Research
o The Pricing of the infrastructure that a Hospital
requires to support and administer research
agendas.
o This is instrumental in recruitment and retention.
o It is not a luxury as it maintains a hospital profile.
o This not about funding research but about
making a hospital research capable
What next?
• Continue to inform future key policy development
at IHPA including the provision of key clinical input
into the Pricing Framework for Australian Public
Hospital Services 2014-15 and future national
efficient prices and national efficient costs
• Work on activity based funding classification
development for admitted acute care, nonadmitted care, sub-acute care and emergency
department care
• Advise on the plan to develop AR-DRG v 8 and
ICD-10-am 9TH edition for acute admitted care
• Assess the proposed approach to sub acute and
non-acute services classification revision and
development (AN-SNAP) and the revision of
emergency department classifications
• Contribute to the development of mental health
and teaching training and research classification
systems during 2013-14
• Undertake an evaluation of the implementation of
activity based funding in Australia
• Play a key role in future policy development and
pricing determinations through its assessment of
the impact of new technology on hospital services
delivery
Back to the Innocent Clinician
I suggest we all lack training in Pricing and in no
other aspect of our lives would we proceed
without such training.
Personal Perspective
o The Health System, ABF and IHPA will only survive in
an environment of a realistic public expectation of
their health system.
o So it is the responsibility of everyone in the health
profession to improve not only our own financial
literacy but the publics health literacy and its
understanding of the value equation.