Alfa D'amato, NSW ABF Taskforce - NSW Clinical Costing and more


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Alfa D'amato, NSW ABF Taskforce, Deputy-Director ABF Taskforce, Ministry of Health NSW delivered the presentation at the 2014 Hospital Patient Costing Conference.

The Hospital Patient Costing Conference 2014 examines the development and implementation of patient costing methodologies to reflect Activity Based Funding allocations.

For more information about the event, please visit:

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Alfa D'amato, NSW ABF Taskforce - NSW Clinical Costing and more

  1. 1. Prepared by Alfa D’Amato Deputy-Director ABF Taskforce Ministry of Health- NSW March 2014 NSW Clinical Costing and more
  2. 2. 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
  3. 3. Policy environment and considerations Knowledge Understanding Information EnableIntuition 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 Disorganise d 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
  4. 4. 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
  5. 5. 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
  6. 6. 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
  7. 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 3,2133,405 3,182
  8. 8. Improving the quality of NSW Clinical Costing  One submission multiple use = reconciliation One submission multiple use Currently expanding
  9. 9. 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 18/10/2013 Draft 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
  10. 10. “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.”
  11. 11. “Today, the price paid…includes costs that can and should be avoided.”
  12. 12. “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.”
  13. 13. “Activity-based funding is a good pricing system, but cost data can help us improve it.”
  14. 14. 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
  15. 15. 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 .
  16. 16. 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
  17. 17. 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?
  18. 18. 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?
  19. 19. 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?
  20. 20. At a Clinical Level… Identifies models of care that need to be addressed
  21. 21. 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)
  22. 22. 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
  23. 23. Cost of Care available to the public
  24. 24. 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.
  25. 25. 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
  26. 26. 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