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1415 margaret swords

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1415 margaret swords

  1. 1. The Challenge of Public Hospital Funding from the perspective of the COO Margaret Swords Chief Operating Officer RCSI Hospitals Group
  2. 2. CFO's and COO's – How we do business • Roles • Interdependencies • Conflicts • How can we help each other • Lessons from our start up • Peaceful co-existence
  3. 3. Roles • Keeper of the Treasury • Keeper of Operations
  4. 4. Interdependencies – CFO & COO • HIPE – Deposit of rich epidemiology data and basis for funding Basis for all Service planning Performance management of Hospital / Individual Consultants / Teams Research and Education Activity Based Funding Until we get first three right ABF won't be meaningful
  5. 5. Conflicts • Crisis response vs Cost containment • ED overcrowding • HIQA recommendations • Infection Outbreaks • Technological advances • New Treatment modalities • New Drugs • Rationing
  6. 6. How can we help each other? • Communications • Safety Walks • Finance involvement in operational committees • Early alerts in crisis events • Coding • Enhance use of HIPE data for research purposes • Enhance use of HIPE for performance management within directorates/within specialties • Share ownership of coding? • Examples of monetary value of improved coding
  7. 7. Principal Diagnosis K8020 Calculus of gallbladder without cholecystitis, without mention of obstruction Procedures 3044500 [0965] Laparoscopic cholecystectomy 9251499 [1910] General anaesthesia, ASA 99 DRG H08B Casemix Value €5,191 Diagnosis K8020 Calculus of gallbladder without cholecystitis, without mention of obstruction Additional Diagnosis I730 Raynaud's syndrome Procedures 3044500 [0965] Laparoscopic cholecystectomy 9251499 [1910] General anaesthesia, ASA 99 DRG H08A Casemix Value €8,396 46yr old - Elective admission for Laparoscopic Cholecystectomy
  8. 8. 75 yr old - Emergency admission following a heart attack - LOS 16 days Principal Diagnosis I214 Acute subendocardial myocardial infarction Additional Diagnosis I249 Acute ischaemic heart disease, unspecified I48 Atrial fibrillation and flutter I10 Essential (primary) hypertension J22 Unspecified acute lower respiratory infection Principal Procedure 5600100 [1952] Computerised tomography of brain DRG F60B CMU cost €4,025 Principal Diagnosis I214 Acute subendocardial myocardial infarction Additional Diagnosis I249 Acute ischaemic heart disease, unspecified I48 Atrial fibrillation and flutter I10 Essential (primary) hypertension J22 Unspecified acute lower respiratory infection E1172 Type 2 diabetes mellitus with features of insulin resistance Principal Procedure 5600100 [1952] Computerised tomography of brain DRG F60A CMUCOST €9,044
  9. 9. 70yrs old - Elective admission for a hip replacement – LOS 4 days Principal diagnosis M161 other Primary coathrosis additional diagnosis D649 Anaemia E11.72 Type 2 Diabetes mellitus i10 Essential Hypertension Procedure 49318- 00 Total Arthroplasty of hip, unilateral DRG i03b Casemix value €10,931 Principal diagnosis M161 other Primary coathrosis additional diagnosis D649 Anaemia E11.72 Type 2 Diabetes mellitus i10 Essential Hypertension k921 Malena Procedure 49318-00 Total Arthroplasty of hip, unilateral 13706-02 administration of packed cells DRG i03A Casemix value €20,096
  10. 10. 82 yr old admitted following a Stroke - LOS 51 days Principal Diagnosis i639 Cerebral infraction unspecified ( stroke) Additional Diagnosis i48 Atrial Fibrillation and Flutter i10 Essential hypertension DRG B70C Casemix Value €4,883 Principal Diagnosis i639 Cerebral infraction unspecified ( stroke) Additional Diagnosis i48 Atrial Fibrillation and Flutter i10 Essential hypertension G819 Hemiplegia unspecified DRG B70B Casemix Value €9,973 Principal Diagnosis i639 Cerebral infraction unspecified ( stroke) Additional Diagnosis i48 Atrial Fibrillation and Flutter i10 Essential hypertension G819 Hemiplegia unspecified L891 Decubitus ulcer and pressure DRG B70A Casemix Value €23,643
  11. 11. Lessons from our Start-up • Disconnect – eg. cost containment – IP/DC targets • Services must be planned using HIPE data • Services must be funded based on activity • ELS – doesn’t work! • It takes time to achieve efficiencies • Right procedure in right hospital closest to patients • CSSD • Operational back office
  12. 12. Peaceful Co-existence • Communicate about everything • We have adjacent offices with little sound proofing! • The patient is at the centre of everything • Involve yourselves in each others worries • Vocalise your concerns • Both learn how to code
  13. 13. A parting piece of Wisdom - !
  14. 14. • Thank You

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