DoH Consultation on Money Follow the Patient - Policy Paper on Hospital Financing - May 2013

In the IMO’s submission to the DoH on the Money Follows the Patient Policy Paper for hospital financing , the IMO relayed support for a system of Money Follows the Patient (MTFP) which supports efficiency and transparency in the funding of health services, but raised key concerns in relation to:

The accuracy of data including the accuracy of coding in the HIPE system and the costing of DRGs;
The ability of prospective case-based systems to capture the multiplicity and complexity of illnesses related to an ageing population, support future delivery models or cope with rapid changes in new technology and treatments;
The imbalances created by

o The exclusion of Primary Care Services from the MFTP system

o Block funding of Emergency Department Services and other public hospital services

o ‘Per diem’ charges to private patients in public hospitals;

The impact of hospital groupings/Trusts
Governance under the proposed model of Universal Health Insurance (UHI).

IMO principle recommendations for Money Follows the Patient can be summarised as follows:

Accurate coding and exact pricing are key to the success of Money Follows the Patient

· Accuracy of HIPE data is essential. The HSE and the ESRI must provide clear and transparent information in relation to how HIPE data is collated, measured and verified and some clinician input may be required;

· Clarification is needed on how the delayed discharges, due to patients waiting for appropriate rehab, long-term care or supported community living, are to be funded;

· Mental Health services should not be excluded from the MFTP system with a review of the coding practices more accurate coding can be achieved.

· The accurate pricing of DRGs will be key. Some expertise in the pricing of care may be required.

· Pay Costs to be included must be precise. Separation of consultant fees in the public hospital payments system will have to be considered when moving to a Universal Health Insurance System.

· There is a need to reflect the reality of Superannuation arrangements that operate in public hospitals.

· It should be possible to calculate the costs and provide for outlier cases.

Imbalances in the funding of health care services must be addressed

· Money must also follow the patient in Primary Care. A new contract which meets the needs of patients with acute and chronic illness must be a priority;

· Emergency Department services, teaching services and other excluded hospital services must be adequately costed;

· The DOH should consider that Emergency Departments will need to be funded according to activity;

· Private patients in public hospitals should be charged using the public hospital case-based DRG system;

The MFTP systems must be able to capture the multiplicity and complexity of illnesses related to an ageing population, support future delivery models or cope with rapid changes in new technology and treatments;

· Not every patient will be amenable to treatment under an established DRG. The system must be able to identify and appropriately finance such patients;

· Agreed clinical guidelines which underpin the DRG payment system should reflect international best practice, must be regularly updated and flexible to meet individual patient needs and choices;

The impact of Hospital groupings must be known

· Further details are required on Hospital Groups as well as the Framework for Smaller hospitals and the HRB “International Evidence Review on Independent Hospital Trusts”

Governance issues must be addressed before moving to the proposed model of Universal Health Insurance (UHI)

· Issues relating to confidentiality and the secondary use of data will need to be addressed through the long- awaited Health Information Bill.

· The Minister for Health should publish the White paper on Universal Health Insurance;

· Careful consideration must be given to how costs are to be controlled before the Government moves to the proposed model;

· Accurate data, including correct classification, exact pricing of conditions and proper length of stay guidelines, is key to addressing the unintended consequences and perverse incentives.

· The unintended consequences and perverse incentives must be adequately addressed before moving to the proposed model of UHI.