Non-Cardiac Vascular Quality-Based Procedure Expansion Initiative

Prior to February 2021, the Non-Cardiac Vascular (NCV) Quality-Based Procedure (QBP) excluded same day (outpatient) and urgent/emergent Aortic Aneurysm (AA) and Lower Extremity Occlusive Disease (LEOD) procedures and advanced AA procedures. CorHealth advised the ministry that this created vascular funding fragmentation and misalignment between funding and the evolution towards minimally invasive technology. Expansion would set the foundation towards a population-based approach of service provision for patients with vascular disease in Ontario.

The NCV QBP Expansion Initiative aims to enhance the NCV QBP in a phased approach:

  • Phase 1 (complete): Addressed the evolution of care through expansion of the NCV QBP Clinical Handbooks (both AA and LEOD) to include same day (outpatient) procedures, and provided hospitals with the flexibility to use inpatient QBP funding for outpatient procedures starting in fiscal year (FY) 2020-21

    The goal of phase 1 was to advance the uptake of minimally invasive and same day procedures in Ontario to help relieve pressures on hospital inpatient resources that have become even more constrained during the COVID-19 pandemic and contribute to the efforts to end hallway medicine in Ontario.

  • Phase 2 (complete): Addressed urgency through new NCV QBP subgroups for non-elective AA and LEOD procedures as well as advanced AA procedures starting in FY 2022-23

    The goal of phase 2 was to include non-elective AA and LEOD procedures in the QBP program as well as advanced AA procedures. In this phase, a formal carve-out and price will be established for outpatient and non-elective AA and LEOD procedures as well as advanced AA procedures. In addition, formal NCV QBP Definitions will be updated. Formal updates to the NCV QBP funding model and NCV QBP Definitions will be shared by the Ministry of Health when available. This allows for greater visibility into the management of AA and LEOD procedures across the province. In addition, this expansion sets the foundation towards a population-based approach of service provision for patients with vascular disease in Ontario.

The NCV QBP Expansion Initiative will include the following Phase 1 and Phase 2 activities:

Activity Phase 1 (FYs 2020-21 and 2021-22) Phase 2 (FY 2022-23 and beyond)
QBP Clinical Handbooks
  • Update NCV QBP Clinical Handbooks (AA & LEOD) to include outpatient procedures
    		•
  • Update NCV QBP Clinical Handbooks (AA & LEOD) to include urgent/ emergent and advanced (AA) procedures
    		•
    QBP Funding
  • Provide hospitals with flexibility to use inpatient QBP funding for outpatient procedures
  • No recovery of funds for inpatient QBP volumes not completed during first two years of implementation (i.e., FYs 2020-21 and 2021-22)
  • No changes to pricing or carve-out in this initial phase
    		•
  • Establish carve-out and price for:
    • Outpatient AA and LEOD procedures
    • Urgent/emergent AA and LEOD procedures
    • Advanced AA procedures
  • Update QBP Definitions for Ontario Health (OH) Region-Managed QBPs (i.e., definitions used for funding)
    		•
    Data Collection / Reporting Requirements
  • Vascular Interventional Radiology (IR) Current State Survey
  • Mandatory reporting of same day IR suite procedures into the National Ambulatory Care Reporting System (NACRS) starting in FY 2020-21
    		•
  • Continued reporting of same day vascular volumes in NACRS to support QBP volume management
    		•

    The potential benefits/outcomes of the NCV QBP Expansion Initiative include the following:

    Area of Impact Benefits/outcomes
    Financial flexibility
  • Provide immediate flexibility to hospitals to use inpatient QBP funding for outpatient activity
    		•
    Population health
  • Promote the provision of appropriate care for vascular patients and increased flexibility in care settings
  • Reduce fragmentation and ensure consistent management of LEOD revascularization and AA repair procedures
  • Set the foundation towards a population-based approach of service provision for patients with vascular disease in Ontario
    		•
    Evidence of care
  • Align with the evolving evidence that includes individualized treatment approaches based on patient and disease characteristics and patient preference
  • Eliminate unnecessary hospital inpatient admissions (in order to quality for QBP funding)
    		•
    Per capita cost
  • Align with the evolving evidence to shift vascular care towards same day and minimally invasive modalities, creating opportunities to optimize value for money
    		•
    COVID-19 Response
  • Support hospitals in responding to COVID-19 by allowing hospitals to treat more patients on an outpatient basis, thus freeing up valuable resources to address the surgical backlog due to COVID-19
    		•

    Clinical Handbooks

    The NCV QBP Clinical Handbooks were most recently updated in March 2022 and can be accessed by clicking the links below:

    Supporting Documents

    Supporting documents can be accessed by clicking the links below:

    Historical Documents

    Historical documents can be accessed by clicking the links below:

    For General Enquiries

    For clinical questions, please contact the CorHealth Ontario Service Desk at oh-corh_service@ontariohealth.ca.

    For questions related to QBP funding, please contact the Ministry of Health at HSF@ontario.ca.

    Questions related to NACRS data submission and coding can be submitted via CIHI’s eQuery tool under My Services and by selecting Inpatient/ambulatory abstracting and education (DAD & NACRS) as the question topic.