Transcript Maximising the impact of Activity Based Funding with Engagement April 2012 Cheryl McCullagh Director of Clinical Integration.

Maximising the impact of
Activity Based Funding
with
Engagement
April 2012
Cheryl McCullagh Director of Clinical Integration
SCHN
• New Network
• Revised Executive Team
• Rapidly Evolving State and
National Model
• New network goals
• DCI- new role
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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
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Administration
Medical Records
Clinical staff
ICT
Coding
Analysis
Finance
Business management
• Functions
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EGG
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
ABF Policy and Impact Education Sessions have commenced
following have been held
 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
SPECIALTY/ AREA MEETINGS
Workshops 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
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Review data
Benchmark
Find variance
Discuss
Find detailed solutions
Enact change
Review and refocus
Regular reporting
Network learning
Example Endocrinology
Facility Benchmarking
Row Labels Separations
Average of LOS Sum of Day Case
Crocodile (WA)
467
2.45
Elephant (VIC)
779
1.97
Platypus (NSW)
1089
1.45
Sunbird (SA)
428
2.61
Grand Total
2763
1.95
Average of TotalCost
195 $
5,197.1
503 $
3,352.9
812 $
2,197.4
187 $
4,365.3
1697 $
3,366.0
Average of TotalIndirect
$
2,139.1
$
690.6
$
596.2
$
1,308.4
$
993.9
Average of TotalDirect
$
3,057.9
$
2,662.4
$
1,601.2
$
3,056.9
$
2,372.1
Inpatient Activity comparison between states
LOS low
day cases high
Indirect and direct costs proportionally different
Local level review
Weighted Seps (cwe)
Row Labels
2009/10
A207 - WESTMEAD
509.2
Ambler, Geoffrey
57.2
Cowell, Christopher
43.7
Craig, Maria
31.2
Donaghue, Kim
50.7
Howard, Neville
69.2
Maguire, Ann
10.9
Munns, Craig
171.1
Silink, Martin
39.9
Srinivasan, Shubha
35.2
C238 - RANDWICK
144.8
Woodhead Helen
40.9
Walker Jan
19.0
Verge Charles
45.5
Neville Kristen
31.4
Campbell Thomas
8.0
Hameed Shihab
SCHN
654.0
2010/11
517.7
43.6
48.1
29.4
33.3
83.9
30.0
173.2
46.1
30.2
173.0
41.9
31.0
50.1
47.0
3.0
690.7
Separations
2009/10
1089
127
131
63
74
122
32
409
66
65
177
49
24
54
42
8
1266
2010/11
1057
94
143
54
51
130
62
367
80
76
214
53
33
68
57
3
1271
Sum of Day Cases
2009/10
812
94
116
45
44
74
26
338
35
40
63
24
5
17
17
0
2010/11
802
68
127
37
30
84
44
314
41
57
76
18
13
28
17
875
Proportion of day cases different
Large variation in LOS between clinicians
Large variation in costs
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878
Average of LOS
2009/10
1.45
1.41
1.27
1.25
2.62
1.54
1.28
1.29
1.62
1.55
2.72
2.94
2.63
2.94
1.98
4.13
1.63
2010/11
1.47
1.37
1.18
1.15
2.35
2.09
1.95
1.25
1.60
1.28
2.86
2.43
3.09
2.49
3.39
Average of episode_cost
2009/10
$
2,205
$
2,471
$
1,710
$
2,108
$
4,791
$
2,896
$
1,874
$
1,411
$
3,033
$
2,851
$
7,268
$
8,177
$
7,220
$
7,536
$
5,194
$
10,920
6.00
1.71 $
2,913
Drill down to comparable data
Weighted 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 2010/11
A207
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
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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
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6.33
7.75 $
17,547
K60A
6.4
8.7
3
4
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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 splits
LOS 1.48 vs 2.86
Cost 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
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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
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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
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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
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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.
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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…………………..