potential excess acute costs at xyz pct dr rod jones statistical advisor healthcare analysis &...
Post on 26-Mar-2015
220 Views
Preview:
TRANSCRIPT
Potential excess acute costs at XYZ PCT
Dr Rod JonesStatistical Advisor
Healthcare Analysis & Forecasting
Key Issues Capitation formula is linear but true
relationship is sigmoid Low deprivation areas are under funded Gap is mainly NEL (£14M) of which £3M is
excess zero day ‘emergency’ Some EL (mix of counting & intervention) (£9M)
PCT is attempting to recover a general gap against specific HRG
Is this likely to be a ‘successful’ strategy? Need to benchmark against the best
West Berkshire and the RBH
Key Issues (contd) Three acute sites with different counting
& coding issues LA data shows different levels of ‘excess’ OP
& IP A FT highest level of Plastic Surgery ‘DC’ in
the UK AAA LA Wycombe highest level of Gynaecology
admissions BBB LA (M09, M05, N12) High levels of ‘other’ first attendance at B
NHS Trust CCC LA
Suggestions
Segment all output areas (OA) into site catchments for EL, NEL and OP and performance manage by catchment Will make demand management more
pro-active by virtue of ‘focus’ Able to calculate expected/desirable
demand at OA level, hence, specific & measurable targets for each catchment
Efficiency Measures 16% excess bed days within trim points 3% excess NEL bed days > upper trim point 1.4 FCE per Spell for NEL respiratory conditions
(1.1 at RBBH) Highest level of transfers to residential care in
South Central Surgical DC performance is OK
Poor performance only in Ophthalmology 1,440 fewer DC Highest % DC in SCHA in C04 (minor mouth), C22 (nose),
H22 (minor T&O), L98 Chemo Check to see if these are outpatient procedures counted as
DC
Implications Beds occupied hence poor A&E
performance Contract should state ‘will not pay for
excess bed days above national average’ Cost saving of 4,300 excess bed days £130,000 at £300 per excess day Benchmark: RBH 4,700 lower than expected
Residential care & alternatives
Other Cost Pressures
Number to be cleared from the waiting list in Bucks is highest in South Central relative to level of capitation funding Legacy issue with high impact in
07/08 and 08/09 However, this tied funding is released
in 09/10
Outpatient First Attendance Considerable overlap between
Plastic Surgery (£130)[1] & Dermatology (£115); Gynaecology (£135) & Obstetrics (£154); Medical group (£161 to £260); Orthopaedics (£144), Neurosurgery, Plastic Surgery
(£130), Anaesthetics (£187); General Surgery (£151) and Urology (£157).
Specify acceptable proportions in contract
[1] The 06/07 PbR tariff for outpatient first attendance is given in brackets
Excess First Attendance
Local Authority
Population Excess
Excess per 1,000 head
Excess relative to 'best'
AAA 61,945 2,583 42 5,575
BBB 165,741 6,509 39 14,515
CCC 162,105 -4,394 -27 3,436
DDD 89,226 -3,223 -36 1,087
Reading 143,097 -6,912 -48 0
Wokingham 150,211 -7,475 -50
First Attend by Group(excess per 1000 head)
Local Authority All MedicalOrthopaedic
Overlap Plastic & Dermatol
Surgery & Urology
AAA 42 3 5 10 2
BBB 39 11 5 11 7
CCC -27 -4 -5 5 -3
DDD -36 -6 -8 4 -4
Reading -48 -7 -4 -6 -7
Wokingham -50 -8 -4 -7 -7
6 in top 15 LSOA in TVHA(no link with IMD implies GP practice related)
LSOA Ward IMD AllMedica
lOrtho O’lap
Plastic &
Derm
Surg &
Urol
E01017656Coldharbou
r 2 274 34 47 41 26
E01017828 Iver Village 12 156 23 23 12 13
E01017805Burnham
Church 19 151 14 12 18 20
E01017809Burnham
Lent 16 133 7 22 13 11
E01017709 Southcourt 24 131 22 12 22 14
E01017694Marsh
Gibbon 8 128 14 24 15 21
Catchment Area Behaviour
Specialty Type Wex’m Stoke Wyc’be MKGH ORH
All Specialties GP 114% 102% 102% 86% 105%
All Specilaties All 110% 114% 88% 111% 110%
Medical Group GP 92% 135% 105% 96% 109%
Medical Group All 92% 127% 81% 170% 114%
Orthopaedic Group GP 143% 98% 80% 90% 88%
Orthopaedic Group All 114% 108% 86% 118% 107%
Plastic Surgery & Dermatology GP 147% 133% 131% 81% 100%
Plastic Surgery & Dermatology All 142% 156% 117% 85% 115%
Count of max 8 8 1 5 4
Conclusions Counting of ‘other’ is an issue
Specify acceptable ratio of GP to Other Very high first attendance in specific OA
May be function of GP practice Acute site catchment areas show high/low
general patterns Allocate all OA to a site catchment and performance
manage as a group Maximum possible saving of 24,600 first
attend £5M at 07/08 tariff Possible early stage savings of £1.8M in SB and AV
Inpatient
Identify all HRG lines with excess cost > £20,000 p.a.
£14 M NEL and £9M EL
Elective >5,300 excess zero day elective
High likelihood of minor procedures counted as DC
£5.3M less alternative cost as RDA or OP
Some specialist lines are high HRG C35 Major maxillo-facial Proportion of 0 & 1 day too high Coding issue?
Non-elective
£1.8M is zero day NEL £0.9M of which from Wycombe LA Specify in contract that zero day NEL
will be paid up to national average Any HRG ending 99 (Complex
Elderly) May be a coding issue
SEPHO Atlas of conditions
HES data 98/99 to 02/03 Spell per person Relative rate per person Adjusted for age, sex and IMD http://www.uhce.ox.ac.uk/
Epidembase2/Atlases_admissions.html#catalogue
Spell per person
Rheumatoid Arthritis Wyc 1.46, SB 1.38, AV 1.27, Chilt 1.21
Gynaecology SB 1.09; all others 1.02
Relative rates (person based) Knee Arthroplasty
Wyc 120%, AV 110% Mastectomy & Lumpectomy
AV 120%, Chilt 111%, Wyc 107%, SB 103% Squint
AV 114%, Wyc 109%, SB 82%, Chilt 80% Hysterectomy
Wyc 88%, Chilt 82%, AV 79%, SB 67% Cholecystectomy
AV 102%, Chilt 100%, Wyc 97%, SB 86% Peptic Ulcer
AV 136%, Wyc 69%, SB 62%, Chilt 48% CABG
Wyc 113%, SB 102%, Chilt 97%, AV 90%
Programme Budgeting
Links programme expenditure and outcomes over 23 programmes
Uses ICD-10 codes to group http://www.dh.gov.uk/programmebudgeting http://nww.nchod.nhs.uk
High Expenditure
AAA LA(GI, Trauma & Injury, Mental Health, Musculo-skeletal
BBB LA (Trauma & Injury) CCC LA ((Trauma & Injury,
Circulatory)
top related