Performance monitoring is a process that ensures the best possible outcomes are being achieved for clients. The framework outlines ACC’s approach towards monitoring the performance of providers and the outcomes achieved for contracted and regulated services.
ACC Health Service Provider Performance Monitoring Framework process diagram
Legislative background
Under the Crown Entities Act 2004 sections 16 to 18 (external link) ACC is authorised to act for the purpose of carrying out its functions. Section 262 of the Accident Compensation Act 2001 (AC Act) sets out the functions of ACC, which include duties set out under section 165 of the AC Act. Section 165(1)(b) provides that ACC has a duty to provide entitlements..
Schedule 1, Part 1 of the AC Act deals with entitlements and clauses 1 to 6 set out ACC’s obligation to pay for treatment.
To ensure that the health services ACC purchases meet these legislative requirements, the Corporation monitors the delivery of health services against the AC Act, AC Regulations, and health service contracts.
Objectives
The objectives of performance monitoring are:
Improved provider compliance:
- Ensuring provider’s compliance with service specifications – either in contract or regulations and associated guidelines.
- Measuring the extent of variation between provider performance and service specifications.
Improved risk management:
- Ensuring risks are identified and minimised.
- Measuring the extent of risk associated with various services.
Improved service/provider performance:
- Using benchmarks to encourage best practice.
- Measuring the extent of variation between provider performance and best practice.
Guiding principles
The guiding principles for performance monitoring are:
Partnership:
ACC works in partnership with providers to ensure services are delivered appropriately. As part of this, Rehabilitation Service Development will openly develop performance-monitoring systems so industry groups have the opportunity to contribute and have a clear understanding of ACC’s expectations.
Open communication:
ACC will manage communications with providers to ensure that two-way open dialogue is maintained.
Good practice:
Performance monitoring provisions and management practices will comply with the Office of the Controller and Auditor General’s: Procurement – a Statement of Good Practice, June 2008 (external link).
Clarity:
ACC will use plain English when defining service specification reporting requirements, performance monitoring processing and relationship management processes.
Versatility:
Service monitoring plans will be tailored to the needs of individual services.
Monitoring against expectations
Monitoring is an essential component of quality assurance. At ACC we use a range of performance indicators to profile and compare treatment providers with their peers.
The basis for performance monitoring will be the expectations defined by either Service Specifications or by Regulation. These expectations will be formally conveyed to you prior to implementing performance monitoring.
Provider performance management takes place through:
- establishing expectations with providers through either the Treatment Provider Handbook, for specified treatment providers, or through provider contracts
- sharing information with providers through ACC News, ACC Reviews, ACC Bulletins, best practice and evidence-based guidelines, other regular reports, and direct mail
- sharing data with professional and/or representative provider organisations, eg IPAs, PHOs, NZ Society of Physiotherapists, NZ Private Hospitals Association, etc
- using sophisticated data mining and trend analysis tools to detect inconsistent behaviour patterns and monitor providers’ performance
- profiling and ranking providers with their peers at diagnosis and injury site levels. For example, we compare the average number of days GPs authorise time off work for clients with low back soft tissue injuries with peer benchmark and best practice guidelines
- obtaining and responding to feedback on health service delivery, experiences and performance from staff within ACC, other providers, clients and their support people.
We use both random and targeted assessments of provider performance through:
- assessing clinical records
- undertaking client telephone surveys
- on-site visits
- asking for more information on claims, or to see client’s clinical records.
Acting on our information
Actions we have taken as a result of our provider performance management work include:
- asking for client verification forms, or copies of client’s clinical records to be submitted with claims
- providing peer mentoring support to treatment providers
- referring concerns about clinical competency to the relevant professional body
- temporarily suspending bulk billing and asking for additional supporting documentation to be sent with the claim
- implementing a prior approval process, for example to limit treatment to a number and frequency in line with accepted professional practice, or to restrict a vocational rehabilitation service to stage-by-stage approvals against objectives
- rejecting assessments, reports, etc (including payment for same) where it is evident that ACC’s requirements have not been met
- in extreme cases, and where there is a proven pattern of failure to meet ACC’s requirements, ACC will explore the termination of a provider contract or registration privileges
- referring matters to our ACC Investigation Unit.
Last updated: 20 February 2009