Prepared by Alfa D’Amato

Deputy-Director ABF Taskforce Ministry of Health- NSW

March 2014

NSW Clinical Costing and more

NSW Clinical Costing

Policy environment and considerations

Progressing the implementation of initiatives aimed

at improving the quality of NSW Clinical Costing

Focus on using the data the ABM Portal

Clinical Costing Officers Education Program

Continuous improvement cycle - costing

improvement projects

Policy environment and considerations

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Info

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Enable

Intu

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Data

Clear linkages between dimensions, KPIs, Quality, outcome, patient journey

Facts

Business Modelling, forecasting, system optimisation, clinical and financial information

Purchasing, reusable information, utilisation data

Data in context, easily retrievable data, benchmarking

Organised data, standard platform, consistency, business rules , PPM2

Disorganised Data, no timely retrieval, no reconciliation - financial

Ladder of Business Intelligence (LOBI)

ABF ABM

Start

now

2012

2014

Foundations – clinical costing data

Clinical Engagement

Education

Policy considerations

“Policy decisions do not wait

for excellent information to

become available; decisions

will be taken even where

‘evidence’ is fragmentary and

uncertain”

Brian W. Head (2013) Evidence-Based Policymaking – Speaking Truth

to Power? - Australian Journal of Public Administration, vol. 00, no. 0, pp.

1–7

Policy considerations

‘evidence-informed’ policy-making, on

the basis that decision-making is

typically not derived from objective

science but rather is based on

reasoned argumentation, taking

account of professional

judgements, stakeholder interests

and political contexts.

Brian W. Head (2013) Evidence-Based Policymaking – Speaking Truth

to Power? - Australian Journal of Public Administration, vol. 00, no. 0, pp.

1–7

Policy considerations

‘evidence [..] can be improved if

appropriate standards of

transparency and accountability

are followed in the process of

gathering, analysing, interpreting,

and presenting evidence for policy.

Brian W. Head (2013) Evidence-Based Policymaking – Speaking Truth

to Power? - Australian Journal of Public Administration, vol. 00, no. 0, pp.

1–7

Health Care Spending per Capita by Source of Funding, 2011 Adjusted for Differences in Cost of Living

* 2010.

Dollars ($US)

8,508

Source: OECD Health Data 2013.

THE

COMMONWEALTH

FUND

5,643

4,522 4,495 4,495 4,118

3,925 3,800

3,213 3,405

3,182

Improving the quality of NSW

Clinical Costing One submission multiple use = reconciliation

One

submission

multiple use

Currently

expanding

Improving the quality of NSW

Clinical Costing

01/07/2013 31/12/2013

01/08/2013 01/09/2013 01/10/2013 01/11/2013 01/12/2013

18/10/2013Draft Results

18/10/2013 - 30/11/2013

QA – data analysis

30/11/2013 - 20/12/2013

Buffer

31/07/2013

GL close for FY

05/10/2013

Annual Audited Statement to Parliament

01/07/2013 - 18/09/2013

Data acquisition - preparation

Value Add:

- QA pt lv

- QA aggr

- Clinical

input

PPM2

Standard

QA

queries

CE

sign

off

“To give the same kind of care to

the same kind of patient, some

hospitals cost two or three times

more than others in the same

state.”

“Today, the price paid…includes

costs that can and should be

avoided.”

“Setting the right price is crucial,

but it won’t work on its own.

Hospitals need to know a lot

more about where they stand.

They need detailed information

about where their avoidable

costs are and how they compare

to their peers.”

“Activity-based funding is a good

pricing system, but cost data can

help us improve it.”

The ABM Portal gives you…

A tool to assist in evaluating the efficiency

and efficacy of health service delivery - in

order to review and improve care, leading to

better patient outcomes.

Comparisons of activity, costs and prices for

The ability to benchmark costs and LOS performance

LHDs

Facilities

ABF Workstreams

Patients

Eg. ED, acute, non-admitted

ABM Portal Roll Out

The Portal was first rolled out to LHDs and Pillar in

December 2013, the first being South Eastern Sydney

LHD.

As of March 2014, the Portal has been rolled out to 14

LHDs, with nominated ‘Champion’ users.

The remaining LHDs and Pillars are scheduled in the next

few weeks.

Broader roll out across the health system will occur with

new enhancements .

At a State Level…

Enables a comparison of cost and

LOS across LHDs/Facility/Peer

- To assess LHDs cost

performance against the

state efficient price

- To identify signals that may

suggest unwarranted clinical

variation in cost and LOS

At a State Level…

Allows comparison of

LHDs

Prompts closer scrutiny

of LHD costs:

QUESTION:

Why did this LHD report

cost above the State

Efficient Price?

At a State Level…

QUESTION:

Why did this LHD report

cost above the State

Efficient Price?

ANSWER:

Only this Hospital is

above the average cost

per NWAU

LHD TO INVESTIGATE:

Why does this Hospital

cost more per NWAU?

At a District Level… Enables investigation into

unwarranted clinical variation at

hospitals level within an LHD

when compared to Peers Why is there such a spread in

cost and LOS?

Investigation should focus

on the cost bucket results in

the table such as prostheses

DRG - I03B Hip Replacement

without complication

Is this

partially

explained

by LOS

variation?

At a Clinical Level… Identifies models of care that

need to be addressed

At a Clinical Level…

Identifies opportunity to improve

efficacy of care

Example of a Patient who

attended ED twice a week in 12

months (100 encounters)

ABM Portal

A tool that:

– facilitates transparency and openness

– encourages collaboration between clinical

services around developing and assessing

models of care

– provides the information to empower Local Health

District to manage into the future

Cost of Care available to the public

Clinical Costing Education

Program – HETI

• Currently identifying and developing education

solutions and resources to support clinical costing.

• UNE Partnerships (UNEP) to map work roles and

functions to national standards for education

• Develop education options that are practical, usable,

flexible and incorporate a range of learning methods

such as:

• Scenarios/case studies using a sample dataset

throughout so that learners engage and develop

their skills and knowledge in context.

• Simulation / Blended learning.

Continuous improvement cycle

Internal Audit Program – Auditor General Recommendation

OR costing project – to improve costing allocation

methodologies

Cost of “quality” or lack of..

Radiotherapy costing study

Clinical Costing in NSW

Focusing on using the data to support local

decision making

Support clinical analytics and unwarranted

clinical variation investigations

Education remains a key as well as

continues improvement cycle