Transcript QOBNWB - Accident Compensation Corporation

Consultation on a joint ACC and Ministry
of Health Funding Model for Emergency
Ambulance Services
Stakeholder Workshops
November 2010
Welcome
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Introductions
Housekeeping
Format of the meeting
Goals for today
Follow up
ACC and Ministry purchasing
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National Ambulance Sector Office
Looks after contracts for both ACC and the
Ministry for emergency ambulance services
(road, air, communications-111)
Aligns purchasing where possible
Reviews joint service specifications (road,
air, communications-111)
Facilitates new initiatives
Administers the New Zealand Ambulance
Services Strategy
The Starting Point: NZ Ambulance Service
Strategy
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Initiative 2: Develop transparent,
sustainable funding model(s) that link
external drivers to agreed service
expectations
Objective: a consistent agreed basis for
funding Road and Air ambulance providers
The case for change
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Why do we need a new approach to funding
emergency ambulance services?
ACC and the Ministry have different
approaches to funding emergency
ambulance services
Providers have consistently identified that
having 2 funding models is an issue
Critical issues
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Different approaches lead to:
– higher compliance costs for providers
– perverse incentives associated with ACC’s feefor-service
– perverse incentives associated with Ministry
contracts for air transports
– a lack of ability to plan for the future
Challenges with the current funding model
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Question 1: Have we identified the critical
issues with the current funding models? If
not, what are they?
The Emergency Ambulance Service
Emergency ambulance services – key functions
Communications
including initial call
taking and
determining priority
and response needed
Dispatch of vehicle and
crew, including resourcing
decisions around what is
most appropriate to send
(crew, vehicles, proximity)
Triage including
decisions regarding
whether to treat,
transport or not, and
where to transport
Transport:
provision of
appropriate and
timely transport
where required
Scene
management
Treatment
according to
scope set through
standing orders
and delegations
Handover: to
emergency
department or
Accident and
Medical Centre
Reporting and
monitoring of
key performance
information to
funders
Goals for a new funding model
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The goals of the successful funding model are to:
– deliver a single funding model for emergency ambulance
services that meets the needs of both ACC and the
Ministry
– provide value for money for the Government, tax payers
and levy payers
– support decision making consistent with clinical priority
and need
– allow evolution into the future for the whole sector – the
Government and providers (eg, allow for changes in
purchasing of ambulance services across the wider health
sector)
– reduce compliance costs for providers and support longer
term capacity building within the sector.
Goals for a new funding model
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Question 2: Do you support the goals for
the new funding model? Do these goals
address the critical issues?
Assumptions
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the model must work within current funding levels
(taking into account inflationary pressures and any
funding for one-off initiatives)
funding for Emergency Ambulance Communications
Centres will continue on the current basis
the model will have no effect on ownership (ie, the
Crown is not seeking to own the service)
the model will not include DHB funded interhospital transfers at this point in time as the first
step is to align the ACC and the Ministry models.
Range of funding models
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Purely fee-for-service based funding
Blended bulk funded/ fee-for-service model
Status quo
Blended capacity/ fee-for-service model
Bulk funding/block contracts
Pure capacity-based funding
Proposed high level funding model
Total emergency ambulance funding
For example sponsorship,
fundraising, part-charges
ACC and Ministry funding
Bulk-funded/
capacity-funded component
Fee-for-service
component
Blended funding model, combining bulk-funding or
capacity funding with a fee-for-service component
Volume
Provider sourced funding
Proposed high level funding model
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Question 3: Does the proposed high level model
meet the needs of the Government, ACC, Ministry
of Health, emergency ambulance providers, tax
payers, levy payers and patients? Why or why not?
Question 4:
– 4(a) Does the proposed high level model address the
problems with the current funding model?
– 4(b) Why or why not?
– 4(c) What are the benefits and risks, incentives and
disincentives from your viewpoint?
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Question 5: Are there any other funding model
options you would have expected us to investigate?
Please describe the model and how it will address
the issues that have been identified.
Three variations of the blended model
Variation
Features
Bulk funding with a
tolerance zone and
fee-for-service above
and below tolerance
zone
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Capacity-funded fixed
costs and fee-forservice variable costs
Contribution
Capacity-funded fixed
costs and fee-forservice variable costs
with a maximum
funding cap for feefor-service
contribution
total funding per contract period for a specified
level of service is agreed
tolerance zone
services above the tolerance zone attract fee-forservice
funding cap and funding floor
of capacity funding for fixed costs for
an agreed service level
ACC and Ministry would also pay fee-for-service for
each and every service provided, based on variable or
marginal cost of providing service
to capacity funding for fixed costs for an
agreed service level
fee-for-service for each and every service provided
based on variable or marginal cost of providing a
service, up to an agreed service level; above that
service level a lower fee-for-service could be paid
a maximum cap for fee-for-service could also be
specified
Option 1: Bulk funding with a tolerance zone and feefor-service above and below tolerance zone
Total ambulance funding
- sourced funding
Tolerance
No extra FFS payment
Agreed bulk funding level
(eg, fundraising,
sponsorship, part
FFS at agreed rate
zone
Provider
Volume
Funding capped at agreed level
- charges)
No wash up
Wash up payment
Provider returns agreed amount of funding
Funding floor at agreed level
Agreed bulk
funding level
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Question 6: What are the benefits and
risks of this variation of the blended funding
model (Option 1-bulk funding)? What
incentives or disincentives are there in this
model?
Question 7: What would need to be done
to make this work in practice for emergency
ambulance providers?
Option 2: Capacity-funded fixed costs and fee-forservice variable costs
Capacity-funded
fixed costs by the
Crown
Provider-sourced
capacity funding for fixed
costs (eg, fundraising,
sponsorship)
Fee-for-service for all
volumes = agreed variable
cost for each and every
service
Volume of services
Agreed line
for proportion
of capacity
funding
Total caapcity
Total ambulance funding
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Question 8: What are the benefits and
risks of this variation of the blended funding
model (Option 2)? What incentives or
disincentives are there in this model?
Question 9: What should be classified as
fixed costs and variable costs? Have we
classified these correctly? What changes
would you make? (see handout)
Question 10: What would need to be done
to make this work in practice for emergency
ambulance providers (Option 2)?
Option 3: Capacity-funded fixed costs and fee-forservice variable costs with a maximum funding cap for
fee-for-service
Total ambulance funding
Agreed line
for proportion
of capacity
funding
Total caapcity
Lower fee for service
Capacity-funded
fixed costs by the
Crown
Provider-sourced
capacity funding for fixed
costs (eg, fundraising,
sponsorship)
Fee-for-service for all
volumes = agreed variable
cost for each and every
service
Volume of services
Funding cap
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Question 11: What are the benefits and
risks of this variation of the blended funding
model What incentives or disincentives are
there in this model?
Question 12: What would need to be done
to make this work in practice for emergency
ambulance providers?
Comparing the three variations on the high
level blended funding model
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Question 13: What should be the service
components in a blended funding model (eg
transport, call out, attendance, treatment etc)?
Question 14: Do you prefer variation 1 or 2 or 3?
What is your first choice? Second choice? Third
choice? Why?
Question 15: If you prefer Option 1(bulkfunding/fee-for-service) then what should be
included in the bulk funded component? What
service components should be fee-for-service?
Question 16: If you prefer Options 2 or 3
(capacity-funded/fee-for-service) then what should
be included in the capacity funded component?
What service components should be fee-forservice?
Any further questions?
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Question 17: Any other comments?
Next steps
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Key themes from Stakeholder meetings will
be put onto NASO website
(www.naso.govt.nz)
Consultation period closes 5pm 15
December 2010
Send your submission to
[email protected]
Funding model implementation anticipated
through road and air ambulance contracts
December 2012