19-20 March 2014, Sydney 4th Annual Hospital Patient Costing Conference
Pa#ent	
  Cos#ng,	
  ABF	
  	
  
&	
  Clinical	
  ...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  2	
  
Agenda	
  
Lessons	
  Learnt	
  
SA	
  Health	
...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  3	
  
SA	
  Health	
  
PPM2	
  Implementa#on	
  
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  4	
  
Implementa#on	
  Background	
  
w  Implementa#...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  5	
  
1.  Centralised	
  
One	
  instance	
  of	
  PP...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  6	
  
Key	
  Principles	
  &	
  Responsibili#es	
  
P...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  7	
  
GL	
  Setup	
  –	
  Cost	
  Centres	
  
Pre-­‐I...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  8	
  
SAH	
  standard	
  naming	
  conven0on	
  for	
...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  9	
  
§  Accounts	
  =	
  Oracle	
  GL	
  L7	
  char...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  10	
  
1.  Data	
  Extracts	
  —	
  Started	
  discus...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  11	
  
Quality	
  Checks	
  During	
  Implementa0on	
...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  12	
  
Quality	
  Checks	
  Post	
  Implementa0on	
  ...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  13	
  
Quality	
  Checks	
  Post	
  Implementa0on	
  ...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  14	
  
Service	
  Date/Time	
  &	
  Dura#on	
  Checks...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  15	
  
Other	
  Considera#ons	
  
§  Ensure	
  all	
...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  16	
  
Integra#ng	
  Pa#ent	
  Cos#ng	
  with	
  
Hea...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  17	
  
Casemix	
  Future	
  Direc#ons	
  
Process	
  ...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  18	
  
Casemix	
  Future	
  Direc#ons	
  
Dual	
  rol...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  19	
  
Stage	
  1	
  –	
  Execu#ve	
  
w  Pa0ent	
  ...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  20	
  
Stage	
  2	
  –	
  Finance	
  Workshops	
  
w...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  21	
  
Easier	
  to	
  review	
  &	
  iden*fy	
  low/...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  22	
  
Stage	
  2	
  –	
  Finance	
  Engagement	
  
w...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  23	
  
Stage	
  3	
  –	
  Divisions	
  Workshops	
  
...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  24	
  
Stage	
  3	
  –	
  Divisions	
  Engagement	
  ...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  25	
  
Sample	
  Reports
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  26	
  
Average	
  LOS	
  vs	
  SA	
  Benchmark	
  
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  27	
  
Cost	
  vs	
  ABF	
  Funding	
  
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  28	
  
Cost	
  vs	
  SA	
  Benchmark	
  
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  29	
  
Pathology	
  Cost	
  vs	
  SA	
  Benchmark	
  
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  30	
  
Radiology	
  Cost	
  vs	
  SA	
  Benchmark	
  
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  31	
  
Theatre	
  Time	
  vs	
  SA	
  Benchmark	
  DR...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  32	
  
Theatre	
  Time	
  vs	
  SA	
  Benchmark	
  Pr...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  33	
  
Next	
  Steps	
  
For	
  high/low	
  cost	
  o...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  34	
  
Summary	
  &	
  Conclusion
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  35	
  
Pa#ent	
  Cos#ng	
  Summary	
  
w  Key	
  acc...
Pa#ent	
  Cos#ng,	
  ABF	
  &	
  Clinical	
  Engagement	
   Slide	
  36	
  
Conclusion	
  
For	
  pa0ent	
  cos0ng	
  to	
...
Q&A	
  
Garth	
  Barne*	
  
Senior	
  Cos*ng	
  Consultant	
  
19-20 March 2014, Sydney 4th Annual Hospital Patient Costin...
Upcoming SlideShare
Loading in …5
×

Garth Barnett, PowerHealth Solutions - Patient Costing, ABF & Clinical Engagement

583 views

Published on

Garth Barnett, Senior Costing Consultant, PowerHealth Solutions 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
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
583
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
39
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Garth Barnett, PowerHealth Solutions - Patient Costing, ABF & Clinical Engagement

  1. 1. 19-20 March 2014, Sydney 4th Annual Hospital Patient Costing Conference Pa#ent  Cos#ng,  ABF     &  Clinical  Engagement       Garth  Barne*   Senior  Cos*ng  Consultant  
  2. 2. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  2   Agenda   Lessons  Learnt   SA  Health  PPM  Implementa0on   Integra#ng  Pa#ent  Cos#ng  with   Health  Unit  Management   NALHN  Experience   Sample  Repor#ng   Summary  &  Conclusions   Q&A   H
  3. 3. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  3   SA  Health   PPM2  Implementa#on  
  4. 4. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  4   Implementa#on  Background   w  Implementa#on  scope   §  4  metropolitan  LHNs   §  6  major  country  hospitals   w  Commonwealth  ABF  model   move  away  from  using  State  funding  model   w  Inpa#ent/Outpa#ent/Emergency  encounters   §  Cos0ng  OP  &  ED  encounters  for  the  1st  0me   §  See  the  total  cost  of  the  pa0ent   §  Track  high  users  of  health  system  
  5. 5. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  5   1.  Centralised   One  instance  of  PPM  &  SAH  centralised  processing.   2.  LHN  Setups   Separate  LHN  setups  for  General  Ledger  &  Cos0ng   Dataset,  making  it  easier  to  engage  LHNs.   3.  Data  Extracts   SAH  responsible  for  centralised  data  extracts.   LHNs  responsible  for  site  specific  data  extracts,  &   reviewing  setups  &  results.   4.  Frequent  Processing   Annual  to  monthly  processing  of  result  leads  to  more   useful  &  frequently  reviewed  informa0on,  which  is   likely  to  increase  the  quality  &  comparability.   Configura#on   Pre-­‐Implementa0on  
  6. 6. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  6   Key  Principles  &  Responsibili#es   Pre-­‐Implementa0on   w Training   Provided  training  to  all  key  par0es  so  they   are  familiar  with  how  PPM  works/what  is   required   w Standards   Agreed  on  uniform  standards  with  cos0ng   user  group  to  ensure  comparability  for   repor0ng  &  benchmarking,  as  well  as  same   look/feel  for  all  involved.  
  7. 7. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  7   GL  Setup  –  Cost  Centres   Pre-­‐Implementa0on   SAH  standard  naming  conven0on  allows  for  easier  tracking   of  pa0ent  frac0ons  &  other  GL  movements:   §  Inpa0ents    [Cost  Centre]   §  Emergency    [Cost  Centre]-­‐E   §  Outpa0ents    [Cost  Centre]-­‐O     §  Research    [Cost  Centre]-­‐R   §  Theatre/Surg    [Cost  Centre]-­‐S   §  Teaching  [Cost  Centre]-­‐T   §  Other    [Cost  Centre]-­‐U  
  8. 8. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  8   SAH  standard  naming  conven0on  for  areas,  including   overheads  &  use  of  NHCDC  alloca0on  sta0s0c  names   GL  Setup  –  Areas   Pre-­‐Implementa0on  
  9. 9. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  9   §  Accounts  =  Oracle  GL  L7  chart  of  account   §  Cost  Output  =  Internal  repor0ng  level   §  Cost  Output  Rollup  =  NHCDC  repor0ng  level   GL  Setup  –  Accounts   Pre-­‐Implementa0on  
  10. 10. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  10   1.  Data  Extracts  —  Started  discussions  months  prior.    Can’t   start  earlier  enough!   2.  Reference  Tables  —  Established  standard  SAH  reference   tables   3.  Extract  Sources  —  Sourced  as  many  extracts  from   centralised  SAH  systems  (IP/OP/ED  pa0ent,  encounter,   services,  transfers,  diagnosis  &  procedure)  for  fewer  files   to  load   4.  Health  Unit  Extracts  —  Sourced  &  reviewed  health  unit   extracts  in  advance   5.  Transla#on  —  Formalised  transla0on  of  all  data  extracts  &   elements  into  PPM  format  by  documen0ng  in  templates   6.  DRG  —  Use  DRG  field  for  ED  URGs  &  OP  Tier  2  to  ensure   easy  standard  &  ad  hoc  repor0ng   Data  Load   Pre-­‐Implementa0on  
  11. 11. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  11   Quality  Checks  During  Implementa0on   w  Data  Load  Source  file  amounts  vs  GL  amounts   w  Service  to  Encounter  linking  results  by   encounter  type  where  have  source  details.   w  Unlinked  Services   w  GL  cost  centre  &  account  amount  summaries   vs  previous  year.   w  GL  overhead  alloca0ons   (eg  compare  wards  &  clinics).  
  12. 12. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  12   Quality  Checks  Post  Implementa0on   before  distribu*ng  informa*on  to  internal  users   High  Level  Cos#ng  Reasonableness  Checks   §  Compare  %  encounter  type  expenditure  per  hospital  vs   last  year  ―  IP,  OP,  ED,  teaching  &  research   §  Review  low/high  cost  pa0ents  by  DRG/Tier  2/URG   ―  IP  cost/day,  ED  cost/hour,  OP  cost/encounter   ―  to  iden0fy  any  major  issues            eg  PFRACs  changes  with  OP  costed  for  the  1st  0me.   §  Compare  DRG/Tier  2/URG  average  costs  by  hospital    ―  to  iden0fy  significant  outliers.  
  13. 13. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  13   Quality  Checks  Post  Implementa0on   before  distribu*ng  informa*on  to  internal  users   General  Ledger  &  Feeder  Checks   §  Iden0fy  nega0ve  GL  area/cost  outputs  combina0ons   ―  to  cleanse  GL  of  incorrectly  allocated  recharges/credits   ―  to  avoid  nega0ve  costs.   §  Check  key  GL  cost  outputs  v  source  system  loads   ―  eg  S100/PBS  &  non-­‐PBS/S100  drugs,  pathology,  imaging   §  Check  Service  actual  charges  >  maximum  norm   ―  eg  pathology  tests  >  $3000.  
  14. 14. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  14   Service  Date/Time  &  Dura#on  Checks   §  Match  ED  admihed  encounter  end  date/0me  to   IP  encounter  start  date/0me  ―  as  oien  an  overlap   §  Audit  ED  non-­‐admihed  encounters  >  1  day  where  they   have  no  linked  services  ―  expect  they  would  be   wai0ng  for  pathology  test  results,  etc   §  Compare  Theatre  &  Recovery  >  6  hours  to  ward   transfer  records  ―  as  may  iden0fy  incorrectly  recorded   end  date/0mes.   §  Audit  other  service  file  dura0ons  >  norm  ―  eg  Allied   Health   Quality  Checks  Post  Implementa0on   before  distribu*ng  informa*on  to  internal  users  
  15. 15. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  15   Other  Considera#ons   §  Ensure  all  inpa0ent  encounters  have  a  ward/clinic   transfer  record   §  Audit  high  cost  “dummy”  encounters  by  pa0ent   number,  which  don’t  link  to  legi0mate  encounter      ―  eg  discovered  numerous  $100K+  pa0ents  who   where  pharmacy  was  providing  high  cost  drugs  to   another  hospital’s  pa0ents)   §  Iden0fy  weaknesses  in  the  process  &  look      ―  to  improve  feeder  data,  alloca0on  sta0s0cs,  etc   for  future  studies  (eg  lack  of  prosthesis  feeder).     Quality  Checks  Post  Implementa0on   before  distribu*ng  informa*on  to  internal  users  
  16. 16. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  16   Integra#ng  Pa#ent  Cos#ng  with   Health  Unit  Management   NALHN  Experience H
  17. 17. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  17   Casemix  Future  Direc#ons   Process  of  integra#ng  pa#ent  cos#ng   with  NALHN  opera#onal  management     §  Stage  1  -­‐  Execu0ve   §  Stage  2  -­‐  Finance  Workshops     §  Stage  3  -­‐  Divisional  Workshops     §  Integra0ng  cos0ng  results  with  regular  &  ad  hoc   Casemix  ac0vity  reports   §  Benchmarking  ac0vity  to  iden0fy  savings  strategies  &   opportuni0es  to  improve  performance   §  Use  of  cos0ng  informa0on  in  business  case   development  &  service  planning.   H
  18. 18. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  18   Casemix  Future  Direc#ons   Dual  role  of  this  process   §  Audit  &  improve  the  quality  of  Pa0ent  Cos0ng   §  Beher  educate  the  business  to  u0lise  Pa0ent   Cos0ng  results   H
  19. 19. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  19   Stage  1  –  Execu#ve   w  Pa0ent  Cos0ng  needs  someone  in  Execu0ve  to   champion  the  cause  in  any  organisa0on.   w  Buy-­‐in  from  Execu0ve  is  crucial.    NALHN  CEO,   COO  &  CFO  all  understand  the  value  of  pa0ent   cos0ng  to  aid  decision  making.   w  Ini0al  1  hour  session  with  Execu0ve  (including   clinical  directors)  &  follow-­‐up  session.   w  Provide  basics  of  pa0ent  cos0ng  &  ABF.   w   Live  demonstra0on  of  PPM  with  own  data.   w  Summary  benchmarking  reports  by  ac0vity  of   costs  vs  funding  at  Tier  2  &  URG  level.   w  Aim  to  give  an  apprecia0on  of  the  easy   availability  of  performance  informa0on.   H
  20. 20. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  20   Stage  2  –  Finance  Workshops   w  Half  day  workshops  with  central  and  divisional   finance  staff.   w  Provide  background  on  the  Commonwealth  ABF   reform,  including  how  the  ABF  model  works  and   the  classifica0on  system.   w  Detailed  the  PPM  cos0ng  process  and  standard   SAH  setups,  including  alloca0on  methodology  &   assump0ons.   w  Explained  how  their  role  influenced  the  cos0ng   process  –  par0cularly  2  key  areas:   §  Pa0ent  Frac0ons  (PFRACs)     §   Mapping  of  ac0vi0es  to  the  right  cost  centres   and  areas  (par0cularly  outpa0ent  clinics).   H
  21. 21. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  21   Easier  to  review  &  iden*fy  low/high  outliers  when  summarising  clinic  ac*vi*es  &  costs   Stage  2  –  Finance  Medical  PFRACs   H
  22. 22. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  22   Stage  2  –  Finance  Engagement   w  Engaged  them  as  part  of  audit  process  to  fine  tune   2012/13  cos0ng.   w  Provided  an  awareness  of  the  accuracy  of  pa0ent   level  costs  is  dependant  on  the  availability  of  feeder   informa0on.   w  Aim  to  give  them  an  apprecia0on  of  the  informa0on   to  assist  in  preparing  business  cases:   §  Understanding  of  direct  costs  (to  Divisions)  and   overhead  costs  (to  Health  Unit).   §  Important  for  hospital  planning  where  expanding   specialised  clinical  services  for  pa0ents  within   their  catchment  area.   H
  23. 23. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  23   Stage  3  –  Divisions  Workshops   w  Separate  1  hour  workshops  with  each   Division’s  senior  clinical  management   w  Also  included  key  Execu0ve  and  Finance  staff   w  30  minutes  pa0ent  cos0ng  theory   ―describing  the  methodology  &  assump0ons            behind  the  numbers  &  where  they  can                influence  the  process   ―ie  PFRACs,  ac0vity  mappings  to  GL   w  Iden0fied  where  each  division  could  assist  in   improving  pa0ent  cos0ng  with  feeders    ―  eg  MET  (code  blue)  pa0ents,  specialist   nurses,  security  services  (especially  for  mental   health  pa0ents),  mul0-­‐disciplinary  teams.   H
  24. 24. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  24   Stage  3  –  Divisions  Engagement   w  Provided  a  sample  of  benchmarked  performance  of   their  division  v  other  SAH  to  iden0fy  poten0al  high  &   low  performing  areas:   §  Theatre  0me  per  DRG  &  principal  procedure  to   understand  throughput/prac0ce     §  Pathology/imaging  cost  per  DRG/URG/Tier  2   §  ALOS  per  DRG/URG     w  Inten0on  to  use  benchmarked  informa0on  to  target   efficiency  improvement  strategies  &  assist  in  future   budget  builds.   w  Divisions  asked  to  iden0fy  informa0on  for  future   review  at  performance  mee0ngs.   H
  25. 25. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  25   Sample  Reports
  26. 26. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  26   Average  LOS  vs  SA  Benchmark  
  27. 27. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  27   Cost  vs  ABF  Funding  
  28. 28. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  28   Cost  vs  SA  Benchmark  
  29. 29. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  29   Pathology  Cost  vs  SA  Benchmark  
  30. 30. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  30   Radiology  Cost  vs  SA  Benchmark  
  31. 31. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  31   Theatre  Time  vs  SA  Benchmark  DRG  
  32. 32. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  32   Theatre  Time  vs  SA  Benchmark  Procedure  
  33. 33. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  33   Next  Steps   For  high/low  cost  outliers,  drill-­‐down  to  cost  outputs  &   service  level  informa*on  to  benchmark  clinical  prac*ces    
  34. 34. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  34   Summary  &  Conclusion
  35. 35. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  35   Pa#ent  Cos#ng  Summary   w  Key  accountability  tool   ―  to  monitor  health  service  costs   ―  not  just  for  external  cos0ng  submissions   w  Clinicians   More  useful  if  cos0ng  informa0on  is  used  by   clinicians  to  improve  performance   w  Timely   Informa0on  needs  to  be  0mely   w  Consistent   Consistent  methodologies  promotes  comparability   w  Future  funding   ABF  reforms  will  put  more  emphasis  on  pa0ent   cos0ng  as  basis  for  future  funding.  
  36. 36. Pa#ent  Cos#ng,  ABF  &  Clinical  Engagement   Slide  36   Conclusion   For  pa0ent  cos0ng  to  be     useful  &  comparable  across     Australia  under  an  ABF  framework,     it  is  crucial  that  everyone     is  engaged  through  the  process.  
  37. 37. Q&A   Garth  Barne*   Senior  Cos*ng  Consultant   19-20 March 2014, Sydney 4th Annual Hospital Patient Costing Conference

×