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HoNCAB
support crea+on of pilot network of hospitals related to payment of care for cross border pa+ents
Do). Ranieri Poli
Azienda Ospedaliera Universitaria Integrata Verona, Italy
Bruxelles 26th February 2013
The Project
HoNCAB
Background
• Pa+ent mobility across borders has been steadily rising over the years (the current scale of cross-‐border mobility amounts to 1% of overall EU-‐27 states public health spending); • Difficul+es on comparability of hospital services in different countries or between different hospitals; • Poli+cal, administra+ve and legal differences between Member States concerning the healthcare and reimbursement procedures; • European Direc+ve 2011/24/EU of March 9th 2011 the applica+on of pa+ents rights in cross-‐border health care.
The DirecFve 2011/24/EU
The ObjecFve * Considering the overarching values of universality, access to good
quality care, equity, and solidarity :
• Determine the pa+ents' rights in terms of access to cross-‐border health assistance and en+tlement to reimbursement of such treatment,
• Ensure access and provision of safe, high-‐quality, efficient and quan+ta+vely adequate healthcare outside their Member State affilia+on
• Support collabora+on between Member States regarding health-‐care
* As per EU Direc+ve and subsequent synthesis documents
HoNCAB
Background
Project submission May 2011
Project approval October 2011
Start of the Project 1° September 2012
HoNCAB
HoNCAB Project
HoNCAB
General ObjecFve To obtain a be[er understanding of the financial and organiza+onal requirements that may arise as a result of a pa+ent receiving healthcare outside the Member State of affilia+on
‘Member State of affiliation’ means* the Member State where the person is insured or has the rights to sickness benefits (also included the Member State that is competent to grant to the insured person a prior authorisation to receive appropriate treatment outside the Member State of residence or in another Member State) ‘Member State of treatment’ means the Member State on whose territory healthcare is actually provided to the patient (in the case of telemedicine, healthcare is considered to be provided in the Member State where the healthcare provider is established)
* As per EU Directive and subsequent synthesis documents
HoNCAB Project
HoNCAB
ObjecFve DescripFon
To set up a pilot network of hospitals Se^ng up of mechanisms that allow for an efficient network func+oning so that it can be sustained a_er project comple+on and progressively extend its membership to other hospitals across MS
To exchange informa+on related to all aspects of costs and services
Crea+on of a web-‐based informa+on system that can be u+lised by the hospital network to collect the relevant required informa+on
To obtain feedback from pa+ents Elabora+on of a ques+onnaire that will be u+lised to evaluate the pa+ents experiences
Compare tariffs Analysis of grouping algorithms for a selected list of principally elec+ve treatments
Inves+gate exis+ng experiences of cross-‐border care
“Direct” cross-‐border healthcare and “Health Tourism”
Provide recommenda+ons on Direc+ve 2011/24/EU by October 2013
The recommenda+ons will be drawn up in two formats to reflect the different target audience
Specific ObjecFve
HoNCAB Project
HoNCAB
Project Target 1. Pa+ents seeking and receiving care outside their Member State
of affilia+on 2. Healthcare providers (e.g. Hospitals) that provide cross-‐border
healthcare 3. Na+onal and Regional Ministries that need to apply the Direc+ve
2011/24 EU (procedures, costs, etc.) 4. Policy makers at EU level who need to be able to monitor the
impact of new European legisla+on on the applica+on of pa+ents’ right in cross-‐border healthcare
Member States parFcipaFng in the project
HoNCAB
Austria
Belgium
France
Germany
Greece
Italy
Hungary
Slovenia
Package DescripFon
WP1 – Coordina+on Ac+ons undertaken to manage the project and to make sure that it is implemented as planned
WP2 – Dissemina+on Ac+ons undertaken to ensure that the results and deliverables of the project will be made available to the target groups
WP3 – Evalua+on Ac+ons undertaken to verify if the project is being implemented as planned and reaches the objec+ves
WP4 – System for exchange of informa+on
Se^ng up of a of web-‐based database that will be designed to collect and exchange informa+on on administra+ve issues related to payment of care
WP5 – System to receive feedback from pa+ents
Design of a survey that will collect feedback from pa+ents on their experience of cross-‐border care with a focus on reimbursement issues
Work Packages
HoNCAB
Work Packages
HoNCAB
Package DescripFon
WP6 – Hospital Network Se^ng up of a hospital pilot network which will test and implement the knowledge management systems created in WP4 and WP5
WP7 – Comparison of DRG-‐based tariffs
Comparison of DRG-‐based tariffs for a list of common types of elec+ve surgery and will draw conclusions on general cost levels and discrepancies
WP8 – Inves+ga+on on key thema+c issues: tourism, cross-‐border health
Inves+gate exis+ng experiences of cross-‐border care in the areas of “direct” cross-‐border healthcare and “Health Tourism”
WP9 – Recommenda+ons Make recommenda+ons on the organisa+onal requirements for cross-‐border management of payment issues in view of the enforcement of Direc+ve 2011/24/EU by October 2013
WP1 -‐ Project CoordinaFon AOUI-‐Verona
Management structure
HoNCAB
Advisory Board Regional Reference Hospitals
Hospital Network Members
Associated Partners
Collaborating Partners
CHUN (Nice) AOUI-VR 1 AP regional representative
Hospital
All interested Provece-Alpe-Cote D’Azur Hospitals All interested Veneto Hospitals All interested Hospitals in the
Region
PILOT NETWORK of Hospital related to payment of care for cross border patients
Public Bodies (ministries, local authorities, …)
Operational Partners (all WPs leaders)
Steering Commi)ee
HoNCAB Management Team
ScienFfic
Pier Paolo Benetollo Valeria Perilli Stefano Tardivo Luciano Sterzi
Management/CoordinaFon Ranieri Poli Daniela Marcer Massimo Mirandola
AdministraFve and Financial Alessandra Napoletano Stefano Benvenu>
HoNCAB
Work Package n° 4 System for exchange of informaFon
AOUI -‐ Verona
WP4 -‐ System for exchange of informaFon
Objec+ve: set up a web-‐based applica+on for data collec+on/entry of cross-‐border pa+ents informa+on, according to predefined variables.
HoNCAB
Methodology
• Cons+tu+on of a working group (technical exper+se from Associated Partner)
• Collec+on and analysis of the proposal set of variables (analysis of data collected from hospital)
• Construc+on of a Web Based Applica+on (working group supported by an external resource for the technical part)
• Set up of the training (working group supported by the external resource)
• Test of the tool (internal pilot study plus internal pilot study in selected hospitals)
• Dissemina+on of the App (via web)
SIALON II HoNCAB
Work Package n° 5 System to receive feedback from PaFents
Na>onal Ins>tute for Public Health Ljubljana, Slovenia
WP5 -‐ System to receive feedback from PaFents
Objec+ve: create a system to receive feedback from pa+ents receiving cross-‐border care, with 3 foci: -‐ -‐ reimbursement process -‐ -‐ pa+ent mo+va+on for mobility -‐ -‐ perceived quality
HoNCAB
Methodology
The survey will be designed and piloted in the first year of the project (2012/2013) and carried out in the second (2013/2014).
Pa+ents tracked into the Web-‐based Applica+on (WP4) will be
asked to take part to the mailed survey (voluntary recruitment) They will be fully informed of the project and its objec+ves and
aims. They will be asked to sign a wri[en consent and be provided with the outcomes of project from own country as well as from the en+re project
SIALON II HoNCAB
Work Package n° 6 Hospital Network
Hospices Civils de Lyon Lyon, France
WP6 – Hospital Network
ObjecFve • To set up an efficient pilot network of hospitals
-‐ that receive a significant number of pa+ents from other Member States -‐ will test and implement the knowledge management systems created in WP4 and WP5 -‐ and will progressively extend its membership to other hospitals
HoNCAB
Methodology 1: Structures: A protocol establishing the network (11 hospitals involved) :
=> the roles and responsibilities of each member
=> mechanisms for communication among members
=> management structure and a management board, which will meet formally at least once a year.
2: Capacity Building: Implementation of internal regulations and quality procedures will be fostered by a specific training programme. This training programme will present how hospitals do with foreign patients, experiences, good practices and recommendations on it
3: Implementa+on: Within each hospital, a project unit (like Verona’s team), made up of staff from the hospital administrative management, will be set up, with at
least 1 person being appointed to act as the liaison officer for the hospital. 4: Launch and Expansion: Once a hospital has completed all the above-mentioned steps, it will be rewarded with a certificate confirming its status as a network member.
SIALON II HoNCAB
Work Package n° 7 Comparison of DRG-‐based tariffs
Technische Universität Berlin (TUB) Berlin, Germany
WP7 – Comparison of DRG-‐based tariffs
ObjecFves: • to analyse the pa+ent classifica+on methodologies used in Austria, Italy, France, Greece, Hungary, Malta and Slovenia in order to facilitate a common language among project partners • to figure out which episodes of care (EoCs) are (or poten+ally can be) done on a cross-‐border basis among the HoNCAB countries • to compare how pa+ent classifica+on systems deal with selected EoCs and how classifica+ons are linked to payments in respec+ve countries
HoNCAB
Methodology A) DRG system comparison (Austria, England, Estonia, Finland, France, Germany,Ireland, the Netherlands, Poland, Portugal, Spain and Sweden) B) Detailed analyses of DRG grouping algorithms for selected EoCs C) The ability of DRGs to explain resource consump+on and varia+on in costs
SIALON II HoNCAB
HoNCAB
Thank you for your a[en+on
DIAPO DI RISERVA
WP2 -‐ DisseminaFon HOPE –Brussels, Belgium
WP2 -‐ DisseminaFon
Objec+ves: • Promote the visibility of the project • Ensure its sustainability
HoNCAB
Methodology
SIALON II HoNCAB
Plan
Create, Distribute, Organise & Participate
Evaluate
Role of other WPs and APs
Role of CPs
Dissemination: identify target audience & channels
Sustainability issues
Create dissemination channels and materials (website, leaflet etc.)
Distribute materials and project results
Organise/Participate to events
Evaluate
Work Package n° 3 “EvaluaFon of the project” Ministry of Health – Italy (MoH-‐IT)
ObjecFves • To set up pilot network of hospitals • To exchange related to payments • To obtain feed-‐back from pa+ents • To compare Tariffs across Member States • To inves+gate exis+ng Cross-‐Border experiences • To provide recommenda+ons on organisa+onal requirements
HoNCAB
WP3 -‐ EvaluaFon of the project
Methodology
-‐ Periodical monitoring of the partners * process and output indicators * management web-‐tool, Annual Work plans and Yearly Prog.Rep. -‐ External evaluator
SIALON II HoNCAB
Work Package n° 8 InvesFgaFon on key themaFc issues:
tourism, cross-‐border health 2° Regional Health Care Administra>on of Piraeus
and Aegean Islands Piraeus, Grecia
WP8 – InvesFgaFon on key themaFc issues: tourism, cross-‐border health
Objec+ves: Inves+ga+on on key thema+c issues: -‐ tourism -‐ cross-‐border health
HoNCAB
Methodology -‐ Report with compila+on of case studies
SIALON II HoNCAB
Work Package n° 9 RecommendaFons
NÖ Gesundheits-‐ und Sozialfonds (NÖGUS), St. Pölten (A)
WP9 -‐ RecommendaFon
Objec+ves • Provide recommenda+ons on the organisa+onal requirements for cross-‐border management of payment
HoNCAB
Methodology
• Research based on literature (cross-‐border payment, ini+a+ves, projects, etc.) • Analyse and combina+on of WP’s results and analyses • (Legal) exper+se
SIALON II HoNCAB
PresentaFon of the InsFtuFon
HoNCAB Management Team
HoNCAB
VENETO REGION
AOUI-‐VR
HoNCAB Management Team
Mr Benetollo Mr Poli Mrs Marcer Mr Tardivo Mrs Perilli Mr Sterzi Mrs Napoletano
Mr Mirandola Mr BenvenuF
CReMPE
The Veneto Region
Background
HoNCAB
The Veneto Region Local Health Authorities and Hospital Trusts
Management and Delivery of Services
Background
HoNCAB
Short presentaFon of the InsFtuFon
Mission • To provide high quality and highly specialised healthcare for the popula+on of Verona, the Veneto Region and other regions in Italy. • To carry out both clinical research and research in the management and organisa+on of healthcare services; • To share cultural and scien+fic knowledge on diagnosis and care as well as on rehabilita+on and preven+on.
HoNCAB
BEDS: 1.384 BEDS IN DAY HOSPITAL: 138 EMPLOYEES: 6.081 WARD: 84 U.O.C. including 78 certificate ISO 9001:2008 16 Complex Services including 14 certificati ISO 9001:2008 DAILY ACTIVITIES: 1.150 patients; 100 operations; 280 patients in Day Hospital; 400 patients in Emergency Room; 3.000 patients in Outpatient’s clinic; 10 delivery Transplantation in 2010: 194 (heart, kidney, liver, bone marrow)
Short presentaFon of the InsFtuFon
Main acFviFes: • Healthcare: 60,000 hospital admissions per year • Surgery: Centre of excellence for Heart, Liver, Kidney, Bone-‐Marrow Transplant • General Medicine: Centre of excellence for Stroke Unit, rheumatology, coagulopathy, management of liver transplant pa+ents, neo-‐natal and pediatric intensive care.
• Laboratory and other services: Centre of excellence for neuroradiology, radio and chemotherapy, +ssue analysis, psychiatry.
• Training: Degree courses, Specialisa+on courses, Doctoral and post-‐Doctoral research, Professional training courses.
• Research: Centre for Clinical Research, Centre for Cys+c Fibrosis, Centre for Bone marrow transplant, Cell Factory (for stem cell therapy), Experimental Robo+c Surgery.
• InternaFonal AcFvity: Member of Interna+onal Cancer Genome Consor+um, Leader and Partner in projects funding by European Commission (DG Sanco), Twinning with other European Teaching Hospitals.
HoNCAB
HoNCAB
NO URGENCY
URGENTY TOTAL
AUSTRIA -‐ 4 4 23 193 BELGIUM -‐ 2 2 20 153 BULGARIA 3 4 7 22 205 CYPRUS -‐ -‐ -‐ -‐ -‐ DENMARK 4 6 10 13 111 ESTONIA -‐ -‐ -‐ 2 19 FINLAND -‐ 1 1 7 84 FRANCE -‐ 14 14 95 796 GERMANY 6 33 39 150 1.139 GREECE -‐ 1 1 9 80 IRELAND 2 2 15 120 LATVIA -‐ -‐ -‐ -‐ -‐ LITHUANIA -‐ 3 3 9 94 LUXEMBOURG -‐ -‐ -‐ 2 19 MALTA -‐ -‐ -‐ 1 17 NETHERLANDS -‐ 7 7 32 230 POLAND 1 7 8 34 248 PORTUGAL -‐ -‐ -‐ 9 61 UNITED KINGDOM 1 17 18 66 429 CZECH REPUBLIC 5 1 6 11 51 SLOVAKIA -‐ 2 2 3 36 ROMANIA 21 154 175 609 5.013 SLOVENIA -‐ 3 3 1 13 SPAIN 2 7 9 76 464 SWEDEN 2 3 5 11 102 HUNGARY 1 6 7 10 105 TOTAL 48 275 323 1.230 9.782
UE citizens activities -‐ 2011 yearAdmissions
A&E Outpatients (from A&E and outpatients)
COUNTRY
Current situaFon (data from 2011)
