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Indpendent Hospital Pricing Authority update
The document outlines updates from the Independent Hospital Pricing Authority regarding safety and quality measures in healthcare, focusing on sentinel events, hospital-acquired complications, and avoidable readmissions. It discusses the significant costs associated with adverse events and emphasizes the need for better measurement and clinical information to improve patient outcomes. Additionally, it presents options for pricing strategies related to hospital-acquired complications and the potential for bundled pricing in maternity care to enhance service delivery and reduce variation.
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- 1. Independent Hospital PricingAuthority UPDATE James Downie Chief Executive Officer
- 2. PRICING FOR SAFETYAND QUALITY • COAG April 2016 first ministers agreed to introduce safety and quality measures into NEP • Three areas of focus: ‒ Sentinel Events ‒ Hospital Acquired Complications ‒ Avoidable readmissions • IHPA to provide options to health ministers for implementation 2 www.ihpa.gov.au
- 3. PRICING FOR SAFETYAND QUALITY • Australian and international costing studies estimate that adverse events explain between 12.0% and 16.5% of total costs • Measurement is foundational to improving patient safety • ICD-10-AM data is a rich source of safety and quality data, currently underutilised • Literature review ‒ Good evidence that the provision of timely clinical information to clinicians & managers leads to improvements in patient outcomes 3
- 4. SENTINEL EVENTS 1. Proceduresinvolving the wrong patient or body part resulting in death or major permanent loss of function 2. Suicide of a patient in an inpatient unit 3. Retained instruments or other material after surgery requiring re-operation or further surgical procedure 4. Intravascular gas embolism resulting in death or neurological damage 5. Haemolytic blood transfusion reaction resulting from ABO incompatibility 6. Medication error leading to the death of a patient reasonably believed to be due to incorrect administration of drugs 7. Maternal death associated with pregnancy, birth and the puerperium 8. Infant discharged to the wrong family 4 www.ihpa.gov.au
- 5. SENTINEL EVENTS • ~100reported per annum • Proposed zero payment • ~$5 million impact • Not directly measurable in ICD-10-AM data 5 www.ihpa.gov.au
- 6. HOSPITAL ACQUIRED COMPLICATIONS • Developedby clinician group • Selection criteria: ‒ Preventability ‒ Patient impact ‒ Cost impact ‒ Clinical priority • Rely on Condition Onset Flag • ~110,000 episodes per annum 6 www.ihpa.gov.au
- 7. Pressure injury Gastrointestinalbleeding Falls resulting in fracture and intracranial injury Medication complications Healthcare associated infection Delirium Surgical complications requiring unplanned return to theatre Persistent incontinence Unplanned Intensive Care Unit admission Malnutrition Respiratory complications Cardiac complications Venous thromboembolism Third and fourth degree perineal laceration during delivery Renal failure Birth trauma 7 www.ihpa.gov.au
- 8. RATES BY HOSPITALTYPE 8 www.ihpa.gov.au
- 9. RATES IN PRINCIPALREFERRAL HOSPITALS 9 www.ihpa.gov.au 0 2 4 6 8 10 12 14 frequency Raw HAC rate per 100 episodes
- 10. RISK ADJUSTED BYAGE 10 www.ihpa.gov.au 0 2 4 6 8 10 12 14 16 18 20 frequency risk adjusted rate (observed/expected)
- 11. RATES BY AGE 11www.ihpa.gov.au
- 12. HOSPITAL ACQUIRED COMPLICATIONS • Threebroad options: ‒ Ignore HACs in DRG assignment ‒ Impacts around 20% of episodes, $180M reduction in funding ‒ Compare hospital HAC rates (risk adjusted) ‒ Funding reduction for worse performing hospitals ‒ Reduce funding for every HAC in every hospital (risk adjusted) ‒ Strong price signal to clinicans 12 www.ihpa.gov.au
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- 14. RISK FACTORS TO CONSIDER 14 www.ihpa.gov.au •Liver Disease • Heart Failure • Myocardial infarction • Stroke with immobility • Cardiovascular disease • Malignancy • Mechanical Ventilation • Parkinson disease • Dementia • Dystocia ACSQHC • MDC • DRG Type • ICU Status • Length of Stay • Presence of another HAC • Indigenous status • SEIFA • Transfer Status • Chronic Disease Count • Highly Specialised Procedures Literature & Jurisdictions • Patient Age Previous
- 15. CODING IS CRITICAL •Increasing awareness of importance of coding with clinicians: ‒ Short video ‒ Coding app • Increased role for coding audit ‒ COF ‒ Public reporting 15 www.ihpa.gov.au
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- 17. BENCHMARKING PORTAL • ABFgenerates masses of data ‒ Cost data collection >1,000,000,000 records • Used properly this data can help improve the efficiency of hospitals by reducing variation • Have to make it accessible at the hospital level!
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- 22. BUNDLED PRICING • Somelimited bundles for chronic disease exist • Exploring bundling maternity care: ‒ Antenatal outpatients ‒ Admission for birth ‒ Post-natal care • Non-admitted utilisation appears reasonably consistent regardless of birth complexity • Aim to reduce variation in service delivery and promote innovative models of care 22 www.ihpa.gov.au
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Editor's Notes
- #15 ACSQHC – Australian Commission on Safety and Quality in Health Care