Hospital Funding In Action: Before And After Examples
Knee Replacement Surgery
Current funding model: Surgery is funded through a hospital's global budget or the provincial Wait Time Strategy, often with significant cost variations between hospitals. For example, in one large community hospital a knee replacement surgery costs $6,795, while in another large community hospital it costs $5,529.
Patient-based funding model: Uses one constant rate across Ontario for these procedures. That means all knee replacement surgeries will be funded at a single rate that will encourage efficiency and quality.
Patient-based funding also means better patient care throughout the full patient journey. Currently, there are no targets for how long it takes for a patient to receive rehabilitation care, or where they receive that care.
While evidence shows that 90 per cent of patients should be receiving community rehabilitative care following a knee replacement surgery, only an average of 84 per cent of patients are being discharged into community care now. Under the new model, a target will be set so that 90 per cent of patients receive community care.
Timing targets will also be set for rehabilitative care after a knee replacement surgery in both inpatient and community settings. For inpatients, the decision that they require rehabilitation will be made by the third day of after-acute care, while they are recovering in hospital. Outpatient targets will set the first post-discharge visit to occur within 24 to 48 hours, and visits two through 10 within the first 12 weeks.
Dialysis and Other Treatments for Chronic Kidney Disease (CKD)
Current funding model: Funding is provided based on each service or procedure and not the number of patients being treated. For example, if a hospital receives $1,000 for dialysis, the ministry has no way of knowing how many patients will be treated with those funds.
Patient-based funding model: Annual funding will be provided per patient and will cover a bundle of services that could include both dialysis and follow-up care. For example, approximately $30,000 will be provided to cover the costs for all the services for a patient to receive dialysis at home. This will include the supplies, medications, testing and follow-up care from a nurse and other health professionals like a dietitian.
Patient-based funding also means better patient care throughout the full patient journey. Currently, the type, care and number of treatments a patient receives may vary depending on where they are receiving care.
For example, the number of clinical visits and tests received may vary from one patient to another. Currently, a home dialysis patient in one part of the province may make five visits per year to an outpatient clinic to have their treatment monitored, while a patient in another area makes eight visits.
The new funding model means that a patient's care will be consistent between communities. For example, a patient who is receiving dialysis at home will be covered for six clinic visits regardless of where he or she lives. The patient will be assured that his or her care remains consistent throughout the year and that supports are in place to ensure the supplies, follow-up care and medications needed are provided.