Simon Moores , Director of Finance at St. James's Hospital

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This document outlines the strategy and roadmap for implementation at an acute hospital. It discusses (1) moving to an activity-based funding model for inpatient and day cases, (2) developing a strategy for St. James's Hospital focused on understanding costs at the patient episode level and becoming a leader in activity-based funding, and (3) future opportunities and challenges such as appropriate funding, cost visibility, accountability, and integrated care pathways.

Healthcare

Strategy & Roadmap for Implementation
Simon Moores
Director of Finance

1. Funding Model for Acute Hospitals
2. Strategy for St James’s Hospital
3. Future Opportunities & Challenges
2

 Funding Model for Acute Hospitals
 Strategy for St James’s Hospital
 Future Opportunities & Challenges
3

4
BLOCK
FUNDING
In-Patient & Day
Case =
Activity based
funding
Emergency &
OPD =
Block funding
2015 2016
Actual costs &
revenue per
patient key

6
• Specified Price paid for each Weighted Unit of
in-patient and day case episode of care up to a limit
of specified Activity
National
Average Price
set by HPO
Historic
Activity Level
Complexity of care by
DRG

 Funding Model for Acute Hospitals
 Strategy for St James’s Hospital
 Future Opportunities & Challenges
7

Understand and manage costs at
patient episode level
To be an international leader in Activity
Based Funding
8

9
Appropriate funding & Complexity
Patient level cost visibility
Accountability

10
Funding
Stream
Management
Absolute
Cost
Identification
Allocation &
Cost Driver
Identification
Service Line
Management

11
Directorate Specialty DRGCode Description Case
Units
LOS Peer
ALOS
Revenue Cost
Est.
HOPE Oncology E71B: Respiratory Neoplasms W/O Catastrophic CC 1.0 27 7 €6,218 €17,391
G47B: Other Gastroscopy W/O Catastrophic CC 0.6 16 5 €2,743 €9,188
S65A: HIV-Related Diseases W Catastrophic CC 5.4 50 29 €38,280 €68,888
Radiotherapy K62B: Miscellaneous Metabolic Disorders W/O Catastrophic or Severe
CC
0.8 30 3 €11,542 €16,934
MEDICINE Cardiology F15A: Interventional Coronary Procs W/O AMI W Stent Implantation W
Cat or Sev CC
1.5 21 7 €6,477 €26,592
1.5 23 7 €6,477 €29,125
Dermatology J64B: Cellulitis W/O Catastrophic or Severe CC 0.6 15 4 €2,489 €8,254
Gastro
Enterology
H61A: Malignancy of Hepatobiliary System, Pancreas W Catastrophic
CC
2.0 44 18 €15,665 €25,186
H61B: Malignancy of Hepatobiliary System, Pancreas W/O
Catastrophic CC
1.1 46 8 €15,136 €25,001
General Medicine A06A: Tracheostomy W Ventilation >95 hours W Catastrophic CC 25.0 223 84 €244,409 €451,563
L63B: Kidney and Urinary Tract Infections W/O Catastrophic or Severe
CC
0.6 43 6 €13,935 €21,863
Q01Z: Splenectomy 2.5 48 9 €28,860 €83,497
X62A: Poisoning/Toxic Effects of Drugs and Other Substances W Cat
or Sev CC
0.8 20 6 €3,308 €11,603
Genito Urina F63A: Venous Thrombosis W Catastrophic or Severe CC 1.1 23 12 €4,602 €10,382
Neurology X05A: Other Procedures for Injuries to Hand W CC 0.8 14 3 €5,859 €9,543
Rheumatolog y E62A: Respiratory Infections/Inflammations W Catastrophic CC 2.1 59 22 €19,700 €32,639
E66B: Major Chest Trauma W Severe or Moderate CC 0.8 17 6 €3,368 €6,401
E75A: Other Respiratory System Diagnosis W Catastrophic CC 1.5 62 17 €18,068 €31,654
F76B: Arrhythmia, Cardiac Arrest and Conduction Disorders W/O Cat
or Sev CC
0.4 13 3 €1,734 €6,900
J64A: Cellulitis W Catastrophic or Severe CC 1.4 37 15 €9,505 €16,937

13
In Patient,
Day Case,
OPD & ED
Cost Drivers
CONSULTANT
TIME
NUMBER
NCHD’s
ANP /
CLINICAL
NURSE
SPECIALIST
WARD COSTS
ALLIED
HEALTH
OTHER
ANCILLARY
SERVICES
ICT
Requirement
to capture
data?

Vision
Aims
Strategic
Work
Streams
Strategic
Enablers
Funding Stream
Management
Absolute Cost
Identification
Allocation &
Cost Drivers
Service Line
Management
16

 Funding Model for Acute Hospital’s
 Strategy for St James’s Hospital
 Future Opportunities & Challenges
17

18
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