The Sound of One Hand Clapping in Healthcare

More than the Sound of
One Hand Clapping
Ross Wilson
Managing Director
Costing and Business Solutions Pty Ltd
ross.wilson@costproplus.com
www.costproplus.com

CostPro Plus - the most accurate real time information at your fingertips
The Sound of One Hand Clapping
The Sound of One Hand Clapping is a 1997
novel by Australian author Richard Flanagan.
The title is adapted from the famous Zen kōan
of Hakuin Ekaku:
“You know the sound of two hands clapping;
tell me, what is the sound of one hand?”.

The Sound of One Hand Clapping
There is no right answer to the koan,
But in extending this imagery to health we could say:
– Hands can represent the two sides of health – one being the
clinical and the other business/funding
– The two hands are part of one body that should function in
unison
– Health organisations need reporting / decision support that is
balanced in both clinical and business

Background
Mainly discuss / cover two areas of costing use
– COAD
– Stroke pathway
In New Zealand
– 20 LHNs with CostPro in 9
– National Cost Data request now in 9th year
– Monthly costing with daily reporting
– Mental Health and Community big areas of focus

New Zealand Context
10 years ago Patient Costing:
– A compliance duty
– A slow turn around of results (often only annual)
– Complicated and not user friendly
– A black box
– No Costing or Counting Standards
– The beginning of national cost data collection

New Zealand Context
Today Patient Costing is about:
– Costing is updated monthly as the GL changes but
patient events are costed every day
– Near real time reporting
– National cost data available to all in Excel data
cubes
– Using patient cost data to identify clinical issues and
business issues

The panacea of decision support
The ultimate in decision support is:
– Active engagement with Clinicians / Managers
using both cost and qualitative measures
– Near real time reporting
– Exception reporting so that the recipient can focus
on the important things
– Reporting that creates a culture of continuous
improvement in clinical / management practice
and is not about blame

DRG E65B COAD
Chronic Obstructive Airways Disease
An example of using costing data
Engage Clinicians to:
– Improve health outcomes
– Standardise practice
– Reduce unnecessary testing

National Data Cube
Accessible through Internet with secure login
Users can link directly to the data cube via Excel
Updated after each annual cost data request
Mainly used for pricing, benchmarking and validation
of costs
A lot of demographic fields available which allows for
slicing /dicing

What does the National Data look Like?
A B C D E F G H I J K L M N O P Q R S T U V
Avg Cost Per WIES 4171 4618 5041 5232 4453 5370 5288 4894 4067 5094 4353 5601 4677 6365 5856 4228 5104 5696 5189 3779 4176 7081
Avg WIES per event 0.83 0.84 0.84 0.83 0.77 0.73 0.80 0.83 0.70 0.76 0.81 0.78 0.79 0.85 0.85 0.83 0.84 0.85 0.76 0.81 0.68 0.79
0.50
0.55
0.60
0.65
0.70
0.75
0.80
0.85
0.90
$3,000
$3,500
$4,000
$4,500
$5,000
$5,500
$6,000
$6,500
$7,000
$7,500
WIES
$
Hospital
Average Cost Per WIES and WIES per Event by Hospital - DRG E65B COAD W/O CC

-$100,000
$0
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
$700,000
$
Hospital
Cost Overhead compared to Benchmark Hospital - DRG E65B COAD W/O CC

4
544
74
431
25
55
222
250
-31
-108
55
-8
140
27
117
14
73
183
18
-51
-74
128
-200
-100
0
100
200
300
400
500
600
BedDaystoSave
Hospital
Bed Day Savings compared to Benchmark Hospital- DRG E65B COAD W/O CC

Now to CostPro…
Reviewed the National Data cube – now to
CostPro
Patient Cost Profile report…

CostPro Patient Cost Profile

Jump to the Doctor Summary Report

Doctor Summary

MRI Utilisation

Feedback from Clinicians
Amazing amount of data and detail
Using cost as a tool to identify anomalies is
different to other tools used
We see there is a lot of unnecessary testing
that we want to eliminate
We want to move to more standardised
practice and this will assist us
Monthly data is good because it is current

Another example -
Stroke Clinical Protocol
An example of using qualitative data from the
costing system to identify differences in clinical
practice
We have identified 6 Flags that we can track in
the system that are important to stroke patients

Stroke Flags
STK Code: The Referral Problem Code "STK"
must be attached to all stroke episodes.
OPRS: All stroke patients must have a stay in
the Older Persons Rehab Service (OPRS) ward
before being discharged.
28 Day: Any patients who are readmitted
within 28 days after discharge from a stroke
episode.

Stroke Flags
Statin: All patients must be administered a
'Statin' medication within the first 2 days of
care.
Physio: All patients must be seen by a physio
within the first 2 days of care.
Imaging: All patients must have a CT or MRI
within the first 2 days of care during a stroke
episode.

Conclusion
Monthly costing with automated load processes is key
– Make the feedback loop more timely
– Automate data loading to reduce time spent on processing
your costing data
– Automate data loading to increase time spent on analysis
It’s a team effort – management and clinical
– Foster the culture
– You need a clinical advocate
– You need CEO, COO, CFO and at least one Senior Doc as
Champion

The Sound of One Hand Clapping in Healthcare

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