Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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Sharon Smith, Sub and Non Acute Patients and Mental Health Workstreams Manager, NSW ABF Taskforce 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

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Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

  1. 1. Grouped and Ungrouped Sub and Non-Acute Activity Unpacking the differences Sharon Smith Manager Sub-Acute and Mental Health Work Streams NSW ABF Taskforce
  2. 2. Why is this important now? After 2014/15 Independent Hospital Pricing Authority (IHPA) will not price ungrouped SNAP activity Out of scope for C’wealth ABF 42 % of expenditure in NSW ABF Facilities
  3. 3. Overview •  What is Sub and Non Acute Care? •  What does “grouped” and “ungrouped” mean? •  Analysis of the differences •  What next?
  4. 4. Sub and Non Acute care l  Specialised multidisciplinary care l  Functioning and quality of life. l  Care needs and cost not explained by Diagnosis AN-SNAP=Australian National Sub and Non Acute Patient Classification
  5. 5. AN-SNAP Rehabilitation Impairment FIM Age Palliative Care Phase RUG Age GEM FIM Age Maintenance Maintenance Type RUG Psychogeriatric HoNOS
  6. 6. What does grouped and ungrouped mean? Speech Pathology Physio OTNursing Medical Clinical data Collected Clinical data NOT Collected SNAP Class No SNAP Class $ $
  7. 7. What does grouped and ungrouped mean? l  SNAP Class = Grouped l  NO SNAP Class = Ungrouped
  8. 8. How did we get here?
  9. 9. 1993 •  1996-1997 SNAP Costing and Classification Development Study How did we get here? •  1993 AHMAC casemix development plan 1996 1999 •  NSW- 1999 SNAP in “designated units”
  10. 10. 2000 2011/2012 •  NHRA •  NSW Interim Funding Model •  NSW- SNAP in “designated services” How did we get here? •  AN-SNAP version 2 •  NSW- SNAP in “designated units” 2007 •  AROC •  PCOC •  NSW- SNAP in “designated units”
  11. 11. 2013 2014 2015 •  IHPA – “Care type per diems will not continue” •  All NSW SNAP Activity is grouped •  Further development of RVU’s •  Meaningful Clinical data available for all SNAP activity Where are we now, where do we want to go? •  NSW- SNAP for all sub and non acute activity
  12. 12. Episodes with and without SNAP Data by LHD: YTD Jan 14 0 2,000 4,000 6,000 8,000 10,000 12,000 NumberofEpisodes SNAP Data No SNAP Data Lowest % Activity without data Highest % Activity without data
  13. 13. Questions l  Proportion of ungrouped activity varies by LHD, why? l  Are the grouped and ungrouped patients similar to each other?
  14. 14. COMPARING THE TWO
  15. 15. NSW 2012/13- Average Cost per Episode   $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000 $10,000 Grouped Ungrouped $9,814 $6,152
  16. 16. Average Cost per Day $- $100 $200 $300 $400 $500 $600 $700 $800 $900 Grouped Ungrouped $820 $848 Grouped Ungrouped
  17. 17. Comparative LOS   0 5 10 15 20 25 30 35 40 Ungrouped Grouped 10 12 9 18 Acute Sub-Acute
  18. 18. Top Level View l  Grouped and Ungrouped SNAP activity similar cost per day l  Differences in Episode costs driven by LOS differences
  19. 19. Average Cost per Episode by Care Type   $- $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 $16,000 $18,000 Rehabilitation Palliative Care Maintenance GEM $16,694 $3,742 $10,728 $10,366 $5,164 $5,879 $7,831 $7,243 Average Cost per Episode by Care Type Grouped Ungrouped
  20. 20. Average Cost per Day by Care Type $0 $100 $200 $300 $400 $500 $600 $700 $800 $900 $1,000 Rehabilitation Palliative Care Maintenance GEM Geriatric Psychiatry $827 $887 $576 $709 $951 $906 $954 $771 $750 $889 Grouped Ungrouped
  21. 21. Care Type View l  Grouped activity Episode Costs higher than ungrouped Except PC ? l  Ungrouped activity Per Diem costs higher than grouped Except Geriatric Psychiatry?
  22. 22. Controlling for Differences METHODOLOGY  
  23. 23. Maybe its Methodology? l  Analysis using LHD’s/ Facilities that use common methodology –  Feeders for A/H , pharmacy for example –  Same RVU’s
  24. 24. Comparison of Costing Methodologies $9,691 $6,378 $14,559 $6,988 818 853 878 851 $700 $720 $740 $760 $780 $800 $820 $840 $860 $880 $900 $- $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 $16,000 A:Grouped A:Ungrouped F:Grouped F:Ungrouped Cost per Episode Cost per Day
  25. 25. Controlling for Methodology Differences $0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 $16,000 $18,000 Rehabilitation Palliative Care Maintenance GEM $17,865 $5,014 $9,417 $9,461 $8,041 $7,136 $6,501 $6,205 Grouped Ungrouped
  26. 26. Question? l  Are the ungrouped patients more similar to acute than sub-acute?
  27. 27. CLINICAL PRESENTATION
  28. 28. What DRG is that? l  Are grouped and ungrouped episodes coming from the same pool of patients? l  Analysis of the DRG assigned to the acute episode preceding either the grouped or ungrouped SNAP episode l  Top 10
  29. 29. Grouped Pool B70 B B70 C E62A B70 A I03B I08A I03A I68A L63A Z63B
  30. 30. Ungrouped Pool B63Z E65B B64A B70A E65A I73A I68A L63A F62A E62A
  31. 31. Clinical Presentation l  Only 4 of top 10 DRG’s in each list the same l  Acute ALOS = 10 Days for ungrouped = 12 days for Grouped l  Subacute LOS= 9 days for ungrouped =18 days for grouped
  32. 32. COST BUCKET COMPARISON
  33. 33. Relative Expenditure by Cost Bucket 0% 5% 10% 15% 20% 25% 30% 35% Hotel Imaging Pathology Pharmacy Allied Health Ward Nursing Ward Medical 6% 1% 2% 4% 18% 31% 11% 6% 2% 2% 6% 11% 34% 13% Grouped Ungrouped
  34. 34. Brain Injury Rehab Example: Allied Health $447 $996 0 10 20 30 40 50 60 $- $200 $400 $600 $800 $1,000 $1,200 Hospital A (No AH Feeder) Hospital B (AH Feeder) Average AH cost per Day % Of Expenditure on AH
  35. 35. Palliative Care Example: Pharmacy $23.00 $25.00 3 4 0   0.5   1   1.5   2   2.5   3   3.5   4   4.5   $- $5.00 $10.00 $15.00 $20.00 $25.00 $30.00 Hospital A (No Pharmacy Feeder) Hospital B (Pharmacy Feeder) Average Pharmacy Cost per Day % of Expenditure
  36. 36. Cost Buckets l  RVU’s can work for some costs but not others l  RVU’s need to be current
  37. 37. Site Choice Feeder Development Correct Classification ? Understand methodology RVU Review and Development Clinical Review Meaningful Grouped Data
  38. 38. The Way Forward l  Ongoing analysis to inform classification development l  Use cost data to identify areas of priority l  Target clinicians and policy makers to ensure data is understood

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