By  Nathan Billing , Robin Beaumont, Brett Cornforth, Zina Ayar, Martin Orr.
<ul><li>Background </li></ul><ul><ul><li>Defining Allied Health Professionals (AHP’s) </li></ul></ul><ul><ul><li>Diagnosis...
 
<ul><li>DRG developed to identify products of hospital </li></ul><ul><ul><li>group together acute inpatients:  </li></ul><...
<ul><li>Health care is labour intensive  </li></ul><ul><li>cost of labour = 60-80% of operating costs 1 </li></ul><ul><li>...
<ul><li>There is a growing demand on health services in New Zealand </li></ul><ul><li>To meet these needs there is a need ...
<ul><li>What is the Concordance/ discrepancy between Allied health activity cost and diagnosis related group based reimbur...
<ul><li>Identify top DRG groups with AHP input </li></ul><ul><li>To determine AHP contact for each episode </li></ul><ul><...
 
Total number of inliers seen by Allied Health Professionals = 1360
Demeere N, Stouthuysen K, Roodhooft F. ,  Health Policy.  2009;92(2):296-304. Activity  Based  Costing Cost centres Physio...
 
<ul><li>Simple model : </li></ul><ul><li>Cost ~ Allied Health cost +Actual length of stay   </li></ul><ul><li>Complex  </l...
P value for AHP cost Outliers p=0.907  Inliers  p= 0.250319 P value for interaction term In & Outliers p=0.00000 P value f...
P value for AHP cost Outliers p=0.00000 Inliers p=0.00014 P value for interaction term In & Outliers p=0.00000 P value for...
<ul><li>Cost centres and charges can be utilised to identify patient groups with high AHP input. </li></ul><ul><li>Allied ...
<ul><li>Secondary data analysis and ? accuracy of data coding </li></ul><ul><li>Timeliness of data (2008-2009).  </li></ul...
<ul><li>Problems of mapping data from separate databases </li></ul><ul><li>Time taken to obtain data limited potential for...
<ul><li>Supervisors </li></ul><ul><ul><li>R0bin Beaumont </li></ul></ul><ul><ul><li>Martin Orr </li></ul></ul><ul><li>Deci...
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Using allied health activity data to compare allied health cost to DRG based funding

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Presentation given at HINZ conference 2011.

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  • Shorten the bullets, e.g.
  • whether or not there is a similar relationship between the allied health cost and the actual incurred health cost simple regression model as this regression model was looking at the simultaneous influence of two variables (allied health cost and Actual cost) on a third (length of stay) it was decided to check for an interaction term to check if the influence of two variables on a third is not additive
  • Using allied health activity data to compare allied health cost to DRG based funding

    1. 1. By Nathan Billing , Robin Beaumont, Brett Cornforth, Zina Ayar, Martin Orr.
    2. 2. <ul><li>Background </li></ul><ul><ul><li>Defining Allied Health Professionals (AHP’s) </li></ul></ul><ul><ul><li>Diagnosis Related Groups (DRG’s) </li></ul></ul><ul><li>Problem </li></ul><ul><ul><li>Research question </li></ul></ul><ul><li>Methodology </li></ul><ul><li>Results </li></ul><ul><li>Conclusion </li></ul><ul><li>Acknowledgement </li></ul>
    3. 4. <ul><li>DRG developed to identify products of hospital </li></ul><ul><ul><li>group together acute inpatients: </li></ul></ul><ul><ul><ul><li>Based on routinely available data on discharge (NMDS) </li></ul></ul></ul><ul><ul><ul><li>Clinically similar conditions (23 MDC) </li></ul></ul></ul><ul><ul><ul><li>Similar pattern of resource use (LOS) </li></ul></ul></ul><ul><li>Widely adopted to control costs & allocate funds </li></ul><ul><ul><li>Historical cost data used & data trimming (L3H3) </li></ul></ul>
    4. 5. <ul><li>Health care is labour intensive </li></ul><ul><li>cost of labour = 60-80% of operating costs 1 </li></ul><ul><li>Allied health staff provide 15-20% of all patient care 2 . </li></ul><ul><li>AHP input not coded alongside clinical information </li></ul><ul><li>Little evidence to show how allied health input contributes to the weighting of DRG’s </li></ul><ul><li>Buchan J, Ball J, O’May F Paper 3. Dept. of Organization of Health Services Delivery. Geneva: World Health Organization . 2000 </li></ul><ul><li>Boyce R. International Journal of Health Planning and Management 1993; 8(3): 201-217. </li></ul>
    5. 6. <ul><li>There is a growing demand on health services in New Zealand </li></ul><ul><li>To meet these needs there is a need for greater efficiency </li></ul><ul><li>Hospital administrative data is available and may be a potential tool to help identify and quantify potential cost savings. </li></ul>(Morgan & Simmons, 2010)
    6. 7. <ul><li>What is the Concordance/ discrepancy between Allied health activity cost and diagnosis related group based reimbursement? </li></ul><ul><li>Does allied health cost increase at same rate as actual cost over length of stay? </li></ul>
    7. 8. <ul><li>Identify top DRG groups with AHP input </li></ul><ul><li>To determine AHP contact for each episode </li></ul><ul><li>Convert AHP time to cost </li></ul><ul><li>To compare the costs and charges </li></ul><ul><li>To test the hypothesis that AHP and Actual cost both vary over length of stay </li></ul>
    8. 10. Total number of inliers seen by Allied Health Professionals = 1360
    9. 11. Demeere N, Stouthuysen K, Roodhooft F. , Health Policy. 2009;92(2):296-304. Activity Based Costing Cost centres Physiotherapy Respiratory Occupational Therapy Speech Therapy Social Work Dietetics New Appointment $3.7 $3.4 $3.5 $3.7 $3.4 $1.4 Follow up $4.0 $3.8 $3.8 $3.6 $3.6 $1.6 Dietetic Education - - - -   $1.4 Rehabilitation Therapy $2.0 - $2.8 $2.3 $3.3 - New Appointment $3.2 $3.0 $3.1 $2.9 $3.0 - Follow up $3.6 $3.3 $3.4 $3.1 $3.2 - Rehabilitation therapy $2.2 - $2.0 $2.0 $2.9 - Total $18.6 $13.6 $18.6 $17.6 $19.3 $4.4 Resp + Physio $32.3         Number of cost centres 10 6 6 6 3 Mean Cost per minute $3.23 $3.09 $2.94 $3.23 $1.48
    10. 13. <ul><li>Simple model : </li></ul><ul><li>Cost ~ Allied Health cost +Actual length of stay </li></ul><ul><li>Complex </li></ul><ul><ul><li>Because looking at simultaneous influence of two variables (allied health cost and Actual cost) on a third (length of stay) </li></ul></ul><ul><ul><li>check for an interaction term to check if the influence of two variables on a third is not additive </li></ul></ul><ul><ul><li>Cost ~ Allied Health cost +Actual cost+ (Allied Health cost:Actual length of stay) </li></ul></ul>
    11. 14. P value for AHP cost Outliers p=0.907 Inliers p= 0.250319 P value for interaction term In & Outliers p=0.00000 P value for AHP cost Outliers =0.00000 Inliers= .00000 P value for interaction term In & Outliers p=0.00000 Z60A E65B Outliers Inliers
    12. 15. P value for AHP cost Outliers p=0.00000 Inliers p=0.00014 P value for interaction term In & Outliers p=0.00000 P value for AHP cost Outliers p=0.00033 Inliers p= 0.00850 P value for interaction term In & Outliers p=0.00000 F62B E62B Outliers Inliers
    13. 16. <ul><li>Cost centres and charges can be utilised to identify patient groups with high AHP input. </li></ul><ul><li>Allied health staff cost does not increase over length of stay as much as actual cost does. </li></ul><ul><li>The interaction term used in our regression model to highlight this had extremely significant results </li></ul>
    14. 17. <ul><li>Secondary data analysis and ? accuracy of data coding </li></ul><ul><li>Timeliness of data (2008-2009). </li></ul><ul><li>Issues of multiple admissions </li></ul><ul><li>DRG funding does not favour prevention </li></ul><ul><li>DRG codes not available on admission </li></ul>
    15. 18. <ul><li>Problems of mapping data from separate databases </li></ul><ul><li>Time taken to obtain data limited potential for more complex analysis </li></ul><ul><li>Further research into potential benefit of this AHP activity data for specific conditions needed </li></ul>
    16. 19. <ul><li>Supervisors </li></ul><ul><ul><li>R0bin Beaumont </li></ul></ul><ul><ul><li>Martin Orr </li></ul></ul><ul><li>Decision Support team </li></ul><ul><ul><li>Zina Ayar </li></ul></ul><ul><ul><li>Brett Cornforth </li></ul></ul><ul><li>Management support </li></ul><ul><ul><li>Phil Barnes </li></ul></ul><ul><ul><li>Kevin Blair </li></ul></ul><ul><ul><li>Stuart Bloomfield </li></ul></ul><ul><ul><li>Tamzin Brott </li></ul></ul>Info about university courses www.fhi.rcsed.ac.uk
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