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Ross Wilson, Cost Pro Plus - More than the Sound of One Hand Clapping

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Ross Wilson, Managing Director at Cost Pro Plus delivered the presentation at the 2014 Hospital Patient Costing Conference. …

Ross Wilson, Managing Director at Cost Pro Plus 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: http://www.healthcareconferences.com.au/patientcostingconference

Published in: Health & Medicine

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  • 1. 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
  • 2. 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?”.
  • 3. CostPro Plus - the most accurate real time information at your fingertips 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
  • 4. CostPro Plus - the most accurate real time information at your fingertips 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
  • 5. CostPro Plus - the most accurate real time information at your fingertips 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
  • 6. CostPro Plus - the most accurate real time information at your fingertips 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
  • 7. CostPro Plus - the most accurate real time information at your fingertips 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
  • 8. CostPro Plus - the most accurate real time information at your fingertips DRG E65B COAD Chronic Obstructive Airways Disease An example of using costing data Engage Clinicians to: – Improve health outcomes – Standardise practice – Reduce unnecessary testing
  • 9. CostPro Plus - the most accurate real time information at your fingertips 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
  • 10. CostPro Plus - the most accurate real time information at your fingertips 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
  • 11. CostPro Plus - the most accurate real time information at your fingertips -$100,000 $0 $100,000 $200,000 $300,000 $400,000 $500,000 $600,000 $700,000 A B C D E F G H I J K L M N O P Q R S T U V $ Hospital Cost Overhead compared to Benchmark Hospital - DRG E65B COAD W/O CC
  • 12. CostPro Plus - the most accurate real time information at your fingertips 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 A B C D E F G H I J K L M N O P Q R S T U V BedDaystoSave Hospital Bed Day Savings compared to Benchmark Hospital- DRG E65B COAD W/O CC
  • 13. CostPro Plus - the most accurate real time information at your fingertips Now to CostPro… Reviewed the National Data cube – now to CostPro Patient Cost Profile report…
  • 14. CostPro Plus - the most accurate real time information at your fingertips CostPro Patient Cost Profile
  • 15. CostPro Plus - the most accurate real time information at your fingertips Jump to the Doctor Summary Report
  • 16. CostPro Plus - the most accurate real time information at your fingertips Doctor Summary
  • 17. CostPro Plus - the most accurate real time information at your fingertips MRI Utilisation
  • 18. CostPro Plus - the most accurate real time information at your fingertips 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
  • 19. CostPro Plus - the most accurate real time information at your fingertips 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
  • 20. CostPro Plus - the most accurate real time information at your fingertips 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.
  • 21. CostPro Plus - the most accurate real time information at your fingertips 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.
  • 22. CostPro Plus - the most accurate real time information at your fingertips 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
  • 23. 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