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Maximising the impact of Activity Based Funding
with Engagement
April 2012Cheryl McCullagh Director of Clinical Integration
SCHN• New Network• Revised Executive Team• Rapidly Evolving State and
National Model• New network goals• DCI- new role
– ICT– Performance– Efficiency and Revenue– Integration
SCHN
• Children First and foremost– Clinical excellence– Innovation– Maximising opportunities– Leading advocacy– Research and Education
ABF helping our strategy• Measuring and understanding our network
activity• Recognising complexity• Accurate reporting• Better benchmarking• Addressing variance, accounting for difference• Improving clinical outcomes and efficiency• Understanding of current data• Shared education
Governance• Episode funding Governance Group
– Executive leadership• Administration• Medical Records• Clinical staff• ICT• Coding• Analysis• Finance• Business management
EGG• Functions
– Education/communication– Engagement– Target projections– Reporting on performance– Accuracy– Modelling for maximising ABF– Communication across functions– Problem solving process gaps– Addressing variance– Keeping up with changing policy
To Do List• Basic program of education
– Professional and functional groups• Specialty based connections, making ABF relevant to clinical staff in
their everyday work• Engagement goals
– Benchmarking, healthy competition and improvement– Good reporting, accuracy– Recognition of complex work– Maximising funding- last– Actions from the KPMG review
The education program• Basic presentations
– The model– Coding– Costing
• Clinician Coding guidelines developed locally• Other resources sourced from various institutions• Skills refresh for coders and costing staff• Functional group education• Specialty based Education, analysis and improvement• Improving network relationships
COMMUNICATION
Board Medical Staff Councils NUM’s/ NM Clinical Council Clinical Executive CNC’S Allied Health
CNE’s Nurse Practitioners Operational Management
Groups SCH and CHW Staff Forums
ABF Policy and Impact Education Sessions have commenced following have been held
SPECIALTY/ AREA MEETINGSWorkshops with Speciality Groups to discuss ABF/EF Implementation has commenced with a range of workshops scheduled
some specialities addressed so far (not limited to): BMT adolescent Med Endocrinology ENT Gen Med Neurology Cardiology Neonatal Intensive Care Units
Meetings involve;• clinical reps from all sites• coding, records• Analysis• business management• program leaders• executive
Shared learning model• Review data• Benchmark• Find variance• Discuss• Find detailed solutions• Enact change• Review and refocus• Regular reporting• Network learning
Example Endocrinology
Facility BenchmarkingRow Labels Separations Average of LOS Sum of Day Case Average of TotalCost Average of TotalIndirect Average of TotalDirectCrocodile (WA) 467 2.45 195 5,197.1$ 2,139.1$ 3,057.9$ Elephant (VIC) 779 1.97 503 3,352.9$ 690.6$ 2,662.4$ Platypus (NSW) 1089 1.45 812 2,197.4$ 596.2$ 1,601.2$ Sunbird (SA) 428 2.61 187 4,365.3$ 1,308.4$ 3,056.9$ Grand Total 2763 1.95 1697 3,366.0$ 993.9$ 2,372.1$
Inpatient Activity comparison between statesLOS lowday cases highIndirect and direct costs proportionally different
Weighted Seps (cwe) Separations Sum of Day Cases Average of LOS Average of episode_costRow Labels 2009/10 2010/11 2009/10 2010/11 2009/10 2010/11 2009/10 2010/11 2009/10A207 - WESTMEAD 509.2 517.7 1089 1057 812 802 1.45 1.47 2,205$
Ambler, Geoffrey 57.2 43.6 127 94 94 68 1.41 1.37 2,471$ Cowell, Christopher 43.7 48.1 131 143 116 127 1.27 1.18 1,710$ Craig, Maria 31.2 29.4 63 54 45 37 1.25 1.15 2,108$ Donaghue, Kim 50.7 33.3 74 51 44 30 2.62 2.35 4,791$ Howard, Neville 69.2 83.9 122 130 74 84 1.54 2.09 2,896$ Maguire, Ann 10.9 30.0 32 62 26 44 1.28 1.95 1,874$ Munns, Craig 171.1 173.2 409 367 338 314 1.29 1.25 1,411$ Silink, Martin 39.9 46.1 66 80 35 41 1.62 1.60 3,033$ Srinivasan, Shubha 35.2 30.2 65 76 40 57 1.55 1.28 2,851$
C238 - RANDWICK 144.8 173.0 177 214 63 76 2.72 2.86 7,268$ Woodhead Helen 40.9 41.9 49 53 24 18 2.94 2.43 8,177$ Walker Jan 19.0 31.0 24 33 5 13 2.63 3.09 7,220$ Verge Charles 45.5 50.1 54 68 17 28 2.94 2.49 7,536$ Neville Kristen 31.4 47.0 42 57 17 17 1.98 3.39 5,194$ Campbell Thomas 8.0 8 0 4.13 10,920$ Hameed Shihab 3.0 3 0 6.00
SCHN 654.0 690.7 1266 1271 875 878 1.63 1.71 2,913$
Local level review
Proportion of day cases differentLarge variation in LOS between cliniciansLarge variation in costs
Drill down to comparable dataWeighted Seps Separations Sum of Day Cases Average of LOS Average of episode_cost
Row Labels 2009/10 2010/11 2009/10 2010/11 2009/10 2010/11 2009/10 2010/11 2009/10 2010/11A207 446.3 463.3 983 942 741 715 1.42 1.48 2,138$ 1,721$
Diabetes W Catastrophic or Severe CC 2.2 2.2 1 1 0 1 9.00 1.00 17,596$ 944$ K60A 2.2 2.2 1 1 0 1 9.00 1.00 17,596$ 944$
Diabetes W/O Catastrophic or Severe CC 142.4 145.9 215 237 98 125 1.80 1.89 3,417$ 2,451$ K60B 142.4 145.9 215 237 98 125 1.80 1.89 3,417$ 2,451$
C238 137.5 157.9 166 198 58 71 2.80 2.86 7,478$ Diabetes W Catastrophic or Severe CC 6.4 8.7 3 4 0 0 6.33 7.75 17,547$
K60A 6.4 8.7 3 4 0 0 6.33 7.75 17,547$ Diabetes W/O Catastrophic or Severe CC 74.6 96.5 87 110 15 23 3.34 3.31 9,039$
K60B 74.6 96.5 87 110 15 23 3.34 3.31 9,039$ Grand Total 583.7 621.3 1149 1140 799 786 1.62 1.72 2,910$ 1,721$
Proportionally different splitsLOS 1.48 vs 2.86Cost 2138 vs 7478
Endocrinology• Very different proportional CWS and coding• Review of variation increases understanding• Local comparison of Inpatient, OPD and
revenue• Outcomes
– Increased communication– Agreement about what can be compared– Working on shared coding guide
BMT• High cost, high variance noted• Established the clinical model in discussion• Change coding strategy to accurately report clinical
activity• Standardised network coding• Outcomes
– more consistent reporting, shared coding guides– Meeting activity targets– volumes are small but the data suggests a proportional shift at A08B’s to
A’s. – Reported activity increased by $200K ytd
UTI• Care Path established 2 years ago• Splits clinical care into simple UTI vs UTI with CC• Revised care path to work concurrently with the DRG split• Review all non complex admissions• Outcomes
– Recoding 30%– Increased CMI– Improved accuracy, and support for the care path– Clear link between a clinical decision making support process and the coding
efforts– Renewed collaboration between clinical change and coding
Between the Flags• eform for clinical and rapid
response• Available to coders• Increased vigilance for
complications• Increased coding of arrests and
resuscitation events• Regular communication between
the PICU team and coders
Advocacy
• Working with the
• Development of a set of Paediatric CCs and CCLs for Clinical Review• Step 1- Identifying diagnoses with a demonstrated impact on cost and
length of stay.• Step 2 – Assessment of paediatric vs adult impact of CC diagnoses by
ADRG• Step 3 – Refine CC list to exclude CCs with high adult impact• Step 4 - Addition of closely related diagnosis codes to resulting CC list
• F91.8 Other conduct disorders• Q90.9 Down's syndrome, unspecified• F83 Mixed specific developmental disorders• J21.9 Acute bronchiolitis, unspecified• G40.91 Epilepsy, unspecified, with intractable epilepsy• H35.1 Retinopathy of prematurity• K90.4 Malabsorption due to intolerance, NEC• L04.0 Acute lymphadenitis of face, head and neck• N13.7 Vesicoureteral-reflux-associated uropathy• R62.8 Other lack of expected normal physiological development• Q02 Microcephaly• Z93.1 Gastrostomy status• G47.30 Sleep apnoea, unspecified• G47.32 Obstructive sleep apnoea syndrome
Out of Home Care Build• Stage 2 of this trial will be
to investigate how we can implement a similar field across the two campuses. Potentially we may be able to use the data from this field to trigger an Out of Home Care Admin Alert in Patient Management as there is a similar field in SCHN –R system.
Biggest Gains• Accuracy• Understanding our business• One size will never fit all in terms of education• Finding the relevant variance for each group and peaking the interest, the
lessons are then transferred to all areas of documentation• Collaboration between all the content experts • Translation of changing clinical models, to improved documentation to
improved coding• Network sharing and the realisation of common goals• Contribution to advocacy• Potential for research
• This is a long term plan…………………..
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