Bill Stomfay, Dept. of Health QLD - Use of Queensland Patient Costing Data to Inform the IHPA Pricing Model


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Bill Stomfay, Manager - ABF Models, Healthcare Purchasing, Funding and Performance Management Branch, Department of Health, Queensland 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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Bill Stomfay, Dept. of Health QLD - Use of Queensland Patient Costing Data to Inform the IHPA Pricing Model

  1. 1. Use of Qld Patient Costing Data to Inform the IHPA Pricing Model Presenter: Bill Stomfay Manager, HHS Funding Models Acknowledgement to Colin McCrow
  2. 2. Overview •  QH NHCDC processing & QA •  IHPA NHCDC processing •  IHPA funding model development •  IHPA funding model calculations •  IHPA model release and implementation •  Impact modelling •  Localisations
  3. 3. QH NHCDC Processing •  Transition II (SDSM Core) –  AS400/DB2 platform –  End of life, but still functional and robust •  holds extensive clinical data – not just costing engine –  Business Case for replacement system in progress •  Each HHS responsible for their own database •  Compliant with Australian Hospital Patient Costing Standards
  4. 4. QH NHCDC Processing •  Local sites control costing •  Corporate office extracts, processes and submits data – Pre-extract QA – Consistency and quality assurance – Submission requirements a moving target – Local report production and feedback to sites – Signoff by CEO/CFO – Move to quarterly processing
  5. 5. Pre-Extract Audit •  The quality of the underlying costing data is assessed using a number of ODBC Crystal reports which identify common data quality issues that can affect costing outcomes •  This is documented in a scorecard, where a confidence level of 80 % must be reached prior to data extraction from the AS400 •  The scorecard and reports are reviewed by the costing teams and agreement is reached that the data is of sufficient quality for the next step of the NHCDC data transformation process
  6. 6. QH NHCDC Processing •  Initial data extraction from AS400 – For each patient encounter •  Department •  Cost Type/Category •  Product/feeder key and RVU •  Date of service and quantity •  Actual and Budget cost – Approx 1 billion rows of data for 12/13, taking up over 2TB of disk space
  7. 7. Source Data Extraction •  pAWS ( the QLD revenue system) – contains patient level admitted information which is used for cost model facilities and aggregate data for Emergency services and outpatients – also used for cost model and virtual patient model data. In addition grouping information is obtained for patient level records and summary activity information •  DSS – GL data for the state is obtained for the reference year and is used for reconciliation purposes for all sites and for cost model data
  8. 8. QH NHCDC Processing •  SQL Server Processing –  Quality Assurance •  Activity matching –  silos with multiple sources of truth •  GL reconciliation –  HHS based, not facility level –  HHS overhead allocation –  Corporate costs •  Site specific adjustments –  inconsistent practices –  Mapping to NHCDC cost centres and line items –  Construction of IHPA tables for submission
  9. 9. NHCDC RD17 Data Transformation Process Pre-extract Audit Costing System Data Extraction Stored Procedure Audit Data Element MappingFacility Code UpdateUnlinked Clinic Update Mismatched Records Management Negative Cost Encounters Site Specific Data Management Final Stored Procedure Audit IHPA File Formatting Cost Validation Audit Excluded Services Data Quality Element UpdatesData Quality ExclusionsCost Weight Reports Activity Reconciliation Submission File Audit Submission File Exclusions End to End Reconciliation Data Transformation DocumentationFinal Results and Reports
  10. 10. Data Mapping and Review •  Iterative process that is undertaken based on either known changes in data element values for QLD Health data or changes in IHPA data elements, or in the management of new data elements such as departments or cost centres. •  The stored procedures written for the basic data transformation of the data from QLD costing system data elements into data elements that will meet the IHPA input requirements.
  11. 11. Initial Audit & Validation Reports •  These are a series of reports run off stored procedures that identify key data quality issues in the source data as extracted from the costing databases that will require correction or exclusion from the final dataset submitted to IHPA. •  These reports are run twice – an initial report and a final report after update scripts have been run to correct or exclude these issues.
  12. 12. Initial Audit & Validation Reports The data issues identified by these reports include: •  Incorrect facility codes •  Unlinked encounters •  Cost variance between the encounter and charge detail tables •  Data elements that need to be mapped •  Patient demographic records without cost records and cost records without patient demographic data
  13. 13. Costing/Data Issues- all sites There remain a number of low level costing issues many of which are only identified during the in depth data element audit and validation these include the following. • Missing DRG’s – or XXXX/ZZZZ (deriver) • Date of birth prior to 1 Jan 1900 (machine date)
  14. 14. Costing/Data Issues- all sites •  Unqualified Neonatal records with no mother’s episode number •  ED presentations where discharge disposition indicated patient was admitted but no admitted record to match. •  Total negative cost patients •  Very high cost patients for encounter types that would not normally have a high cost.
  15. 15. Costing/Data Issues- Cost Modelled sites •  Overhead Costs high for all work-streams •  No separate ED and outpatients cost centres requires costing split but basing split on calculated revenue for aggregate count data sees ED costs too low and Outpatient costs too high •  For detailed review of costing process and update of mapping tables with local staff
  16. 16. Facility Specific Data Transformation •  From time to time there are some specific data transformation steps that are required for individual facilities to ensure correct reporting of facility level activity and costs. An example of this is where a facility has a combined cost centre or department for emergency services and outpatients – activity/cost mismatch
  17. 17. Facility Specific Data Transformation •  For cost modelled sites, where actual patient level data is based on records stored in HSU (from the HQI) or virtual patient level data can be created based on aggregate counts, facility specific data transformation steps will be used to report this data at patient level •  These facility specific steps will be subject to change over time and are source data dependent
  18. 18. NHCDC  Corporate  Overhead  Alloca3on  Process   HSIA  Clear  Cost   DSS  GL  Transac3ons   pAWS  IP  Ac3vity   pAWS  ED  Ac3vity   pAWS  OP  Ac3vity   Corporate    Cost   Detail   Facility  Volumes   Corporate    Cost   Summary   Corporate   Product  Cost   Summary   Corporate   Facility  Load  File   Site  TII  Database   Cost  Model  Site   GL  &  Ac3vity   Data   Site    SQL   Database  –Total   Cost  for  each   Pa3ent   Stored  Procedure   Source   Line   Items   Corp  OH   Line   Items   Final  Line  Items  Cost  Outcomes  
  19. 19. Activity Reconciliation •  For round 17 reconciliation process were undertaken between the cost data set and the activity datasets as submitted to IHPA •  There were significantly more valid cost records than there were activity records. Most of this was for the smaller facilities where only aggregate count data was reported but there were also variances for ABF sites in ED data and Inpatients data.
  20. 20. Cost Audit and Validation •  Database tables are built using a number of SQL queries that transform the data elements into a format that will meet the IHPA submission requirements. •  The source QLD data tables are thus retained and ensure a full reconciliation of all data transformation processes undertaken by the corporate ABF team.
  21. 21. Cost Audit and Validation •  Further data transformation may be required at this step; for example where the ED data indicates that a patient was subsequent admitted but for whom no admission record is found matching by episode number and date time stamps •  As this data cannot be submitted the records need to be removed to ensure that data is able to be submitted
  22. 22. End to End Reconciliation •  Reconciliation at facility level is required to be included with the cost data as part of the overall NHCDC state submission –  Queensland operates at HHS level, not facility •  Cost data is reconciled back to the audited return, between the GL load file and DSS and then other data transformation processes are also accounted for •  Activity data is reconciled back to the activity DSS files submitted to IHPA for each quarter.
  23. 23. NHCDC  GL  Reconcilia3on  -­‐TII  Sites   HHS  Audited  Return   GL  Transac3ons   HHS  Summary   GL   Transac3ons   Facility  Level   Ac3vity  Summary   Cos3ng  Database   GL  Load  File   Facility  Level   TII  Cos3ng   Process   Overhead   alloca3ons  /   Excluded   Services   Facility   Pa3ent  Cost   Records   Ini3al  Extracted   Data   NHCDC   Mapping   WIP  Current/Excluded   Costs/Data  Quality   Final  Mapped   Data   Record  Audit    &   Valida3on   Excluded  Records   (Data  Quality)   SubmiQed  Record   Summary   Variance   Analysis   Final  Facility   Reconcilia3on   Ac3vity  Data  /   Reconcilia3on   Process   1   2   3   4   5  
  24. 24. NHCDC  GL  Reconcilia3on  -­‐Cost  Model  Sites   HHS  Audited  Return   GL  Transac3ons   HHS  Summary   GL   Transac3ons   Facility  Level   Cost  Model   Process   GL  Load  File   Facility  Level   Cost    Centre   Mapping   Overhead   alloca3ons  /   Excluded   Services   Facility   Pa3ent  Cost   Records   Ini3al  Extracted   Data   NHCDC   Mapping   WIP  Current/Excluded   Costs/Data  Quality   Final  Mapped   Data   Record  Audit    &   Valida3on   Excluded  Records   (Data  Quality)   SubmiQed  Record   Summary   Variance   Analysis   Final  Facility   Reconcilia3on   Ac3vity  Data  /   Reconcilia3on   Process   1   2   3   4   5  
  25. 25. Cost Outcome Reports •  Prior to the final submission of the HHS level data, a review of the cost reports is undertaken to ensure that there are no significant costing issues that may require re-extraction and data processing •  These cost reports will mirror the final cost reports that IHPA produces as they are based on the same data and are provided back to the HHS as part of the overall round data transformation process.
  26. 26. Final Report •  A final round report is provided once IHPA have supplied the jurisdiction with the national results •  All HHS data transformed by this process along with the supporting documentation is provided back to the HHS along with analysis of the potential impacts of cost data outcomes for that round
  27. 27. QH NHCDC Processing •  Data submission – Enterprise Data Warehouse •  Data validation checks •  Date/time fields – Dropbox •  Stability and login issues
  28. 28. IHPA NHCDC Processing •  Previously outsourced, now in-house •  Data quality checks – Queries back to jurisdiction/sites •  Load into SAS •  Analysis – Exclusion of out of scope data •  Errs on the side of excluding valid data – Outliers – Trimming
  29. 29. IHPA NHCDC Processing •  Cost Report – National average – Jurisdictional comparisons •  Differences to PHE, ROGS •  Alignment project under way – Year to year changes – DRG cost weights by cost bucket •  Benchmarking •  Source data for funding model –  National data circulated to all jurisdictions
  30. 30. IHPA Funding Model Development •  Major groups –  Jurisdictional Advisory Committee (JAC) –  Technical Advisory Committee (TAC) –  Clinical Advisory Committee (CAC) •  Working Groups –  Non-admitted –  Subacute –  Mental Health –  Emergency Care –  Small Hospitals –  Teaching & Training
  31. 31. IHPA Funding Model Development •  Monthly meetings, normally 2 hour videoconference –  Membership is reps from each State/Territory, Commonwealth, chaired by IHPA •  Jurisdictional nominations –  Agenda, minutes & papers in PDF –  Only real opportunity to influence model •  evidence, not opinion •  need major players onside •  window for change April – August/September –  Minutes and action items need close attention to detail
  32. 32. IHPA Funding Model Development •  Face to face workshops – Usually one per working group per year •  Consultancies – Usually around classification development and costing (which includes data items not captured in NHCDC) – Jurisdictional impact on workload and IT systems
  33. 33. IHPA Funding Model Calculations •  Undertaken in SAS •  Outlier trimming •  Multiple Regression, often stepwise – Multicollinearity – Goodness of fit - R squared, Mean Absolute Percentage of Error (MAPE) and SMAPE
  34. 34. IHPA Technical Specifications
  35. 35. IHPA Model Release •  Draft NEP/NEC released at end of November –  embargoed, limited circulation –  45 days for response (includes Christmas/New Year) –  PDF document plus technical specifications, series of Excel and SAS calculators •  Final NEP released end February –  published on IHPA website, with Excel calculators –  Usually no structural changes but parameters updated
  36. 36. Impact Modelling •  Undertaken on Draft NEP •  New model built in corporate IT systems –  structural and logic changes from prior models –  parameter tables updated –  NWAUs reconciled to SAS/Excel calculators •  Comparisons between new and old model –  Limited circulation –  Overall changes –  Winners/losers –  Anomalies •  Clarification from IHPA •  Comments to IHPA •  Formal 45 day response
  37. 37. Impact Modelling •  HHS Purchasing SLAs – Conversion from old to new model – ABF pool and base price calculations – First Round offers based on Draft NEP •  Updated for Final NEP – Visibility in corporate reporting systems
  38. 38. Impact Modelling •  Site Specific Grants –  Based on 12/13 actual activity and costs –  Categories are Classification Failure, Out of Scope Clinical Service Costs, and Statewide Clinical Advisory Services •  Costs exceeding revenue for particular units is necessary but not sufficient •  Classification failure demonstrated for cardiac ablations, stents, neurocoils, hyperbaric •  Must be applicable to other hospitals •  May become future localisations and/or proposed changes to national model
  39. 39. Localisations •  Incentives/penalties to encourage/ discourage inappropriate clinical practices – Private patients paid at public price – OP new/review/telephone – Pre-op days – ‘never events’ – HITH – Out of scope (laser refraction, vasectomies)
  40. 40. Summary •  QH NHCDC processing & QA •  IHPA NHCDC processing •  IHPA funding model development •  IHPA funding model calculations •  IHPA model release and implementation •  Impact modelling •  Localisations
  41. 41. Questions?