21 February 2012 The Independent Hospital Pricing Authority PO Box 1414 Woden ACT 2606 Re: The IHPA Draft Pricing Framework This submission is made on behalf of the Australian Diabetes Society, Australian Diabetes Educators Association, the National Association of Diabetes Centres, and Diabetes Australia. The Australian Diabetes Society is the expert organisation in Australia on medical and scientific matters related to diabetes and is devoted to the medical and scientific advancement of diabetes care and research. The Australian Diabetes Educators Association is Australia’s peak professional organisation in diabetes education. The National Association of Diabetes Centres is a collective of specialised multidisciplinary Diabetes Services which collaborate to ensure that services are provided by Centres of Excellence. Diabetes Australia is the national peak body for diabetes in Australia providing a single, powerful, collective voice for people living with diabetes, their families and carers. Our 4 organisations are concerned about the current failure to adequately fund specialised Multidisciplinary Diabetes Services. We seek to ensure that the ABF Model considers the shortfalls in the current system of funding which do not fully recognise the services provided by hospital Diabetes Services. Multidisciplinary Diabetes Services are staffed by teams, which are usually comprised of specialised credentialed diabetes educators, dietitians, podiatrists, and diabetes specialist doctors. Most of these Diabetes Services are currently based in, or affiliated with, Public Hospitals, but some have moved into community settings but remain linked with other specialist hospitals. The mode of service provision includes outpatient clinics, individual diabetes education, group education sessions, outreach services, health professional training, public and health professional education (e.g. schools, nursing homes), telephone and email stabilisation of diabetes as well as provision of emergency advice, and inpatient diabetes education and management. Importantly, apart from general diabetes care and education, Multidisciplinary Diabetes Services provide specialised services such as paediatric and adolescent diabetes care, diabetes in pregnancy care, insulin pump initiation and ongoing support, diabetes stabilisation services, and high risk foot clinics. The primary aims of Diabetes Services include i) the prevention of hospital admissions, ii) fast-tracking hospital discharges, and iii) providing specialised bridging care between the hospital and primary care. Multidisciplinary Diabetes Services are one of the few health service initiatives, which have been proven to be cost-effective and prevent hospital admissions1. Thirty years ago, most hospitals had entire wards dedicated to diabetes patients. Due to the success of Diabetes Services, it is now rare to see patients admitted to hospital primarily for management of diabetes. Ironically, this has reduced the visibility of Diabetes Services in acute care hospitals and much of their activity is not captured by statistics. Consequently the contribution of Diabetes Services to the health system is not fully recognised by health authorities. We seek to ensure the ABF Model adequately addresses the funding model for services such as Multidisciplinary Diabetes Services, which cross the inpatient and outpatient divide, and where the outpatient component mostly no longer operates in the traditional outpatient clinic mode. We see the ABF initiative as an important mechanism to move beyond the cost shifting which has been endemic in our health system for far too long. Thirty two percent of potentially preventable admissions in Australia are related to diabetes2. Savings from preventing hospital admissions need to be measured and their rewards shared appropriately. In the current system additional expenditure is needed to bridge the gap between hospital and primary care and reduce avoidable hospitalisations but has not been forthcoming as federal funding is unwilling to create state savings. We make the following specific comments: Principles of the ABF Pricing Framework We support the principles developed by the IHPA. For Diabetes Services, timely access, the need to support innovation (especially insulin pumps, and continuous glucose monitoring technology), and for activities to be evidence based is particularly pertinent. We suggest an additional principle which is the need to examine budgeting arrangements for bridging hospital and primary care. What public hospital services should be included in new funding arrangements? Criterion 3. We believe that the funding should be based on “outpatient services”, rather than “outpatient clinics” per se. Many of the services provided by Diabetes Services and indeed other ambulatory care units are not in the traditional clinic mode. Mechanisms need to be set in place to capture the patient related services, which are not provided in a clinic, or even in standard face-to-face consultations. These include group education, telephone and email diabetes stabilisation and emergency support. Furthermore it is important to recognise that even for outpatient clinics and individual consultations, much of the activity is time consuming and a range of different “item numbers” will need to be in place. When should public hospitals be funded on an activity basis or a block grant basis? As discussed in the previous question, it may be challenging to fully fund Diabetes Services and some other ambulatory care units by ABF because of the range of services provided: data on some of these activities are not currently captured by the health authorities. Furthermore Diabetes Services have a considerable staff and professional training role, even when based in non-teaching hospitals. Therefore a funding model based purely on activity which is currently captured would underfund Diabetes Services. A few Diabetes Centres which receive some block funding already exist. Consideration needs to be given to a mixture of ABF and block grants for Diabetes Services in general. We would welcome the opportunity to further discuss the funding of Public Hospital Diabetes Services with the IHPA. N Wah Cheung President Australian Diabetes Society Nuala Harkin President Australian Diabetes Educators Association Sophia Zoungas Chairperson National Association of Diabetes Centres Lewis Kaplan CEO Diabetes Australia References 1. Moffitt P, Fowler J, Eather G. Bed occupancy by diabetic patients. Med J Aust 1979; 1: 244-245. 2. A National Health and Hospitals Network for Australia’s Future. Chapter 2. Commonwealth of Australia. Canberra 2010. Contact Details Australian Diabetes Society 145 Macquarie Street Sydney NSW 2000 Telephone: 02 9256 5462 Email: [email protected] Australian Diabetes Educators Association P O Box 163 Woden ACT 2606 Telephone: 02 6287 4822 Email: [email protected] National Association of Diabetes Centres (NADC) P O Box 163 Woden ACT 2606 Telephone: 02 6287 4844 Email: [email protected] Diabetes Australia G P O Box 3156 Canberra ACT 2601 Telephone: 02 6232 3800 Email: [email protected]