Download - Steven Lugard
Diagnosing patient care
Getting healthy with benchmarking and business intelligence
Steven Lugard – Dublin, March 2013
Agenda
Central theme: How can Irish hospitals benefit from benchmarking? And what is required to get there? Is it possible today?
Background: Cost per patient in the Dutch DRG System What is benchmarking? Implementation: Technology & management
Some background information:
Cost per patient in the Dutch DRG System
Hospital financing in Netherlands
Until 2005 budget systemLimited impulses for volume/quality/efficiency
Need for cost containment and quality impulse felt strongly by 2002Waiting listsExploding costs (exploding hospitals)
Design of new system: Money Follows the Patient (MFtP)Case based financing introduced in 2005 Starting 2005, prudent growth model
2007: 18% (Hip/Knee/Cataract)2013: 80% of hospital care
First consultation
Diagnostics Theatre
Inpatient stay
Discharge
Check-up
Cost benchmarking in Netherlands
Trusts have own responsibility for financial performance, thus for adequate management information.Need to know own performance vis-à-vis peers
Where are we more expensive or more efficient than our peers?What is causing us to be more/less expensive? Understanding drivers of these costs.Taking action; lowering cost prices or lowering activity levels for treating patients
Forecasting costs; budgeting based on contracted production amounts & benchmarkEarly adapters in the Netherlands are now the most successful trusts
Continuous focus on benchmark, but what is it?
About Benchmarking
Cost breakdown of a DRG
Savings in protocols
What can we reach with influencing the clinician’s behaviour?Own 289 patients
Category Own Peers Best Potential Unit Unit costs Protocol savingsImplant 1 1 1 - units 3,156€ -€ In patient days 8.3 6.9 6.9 405 bed days 321€ 129,877€ Theatre hours 1:47 1:30 1:30 81:53 hours 970€ 79,427€ Laboratory tests 20 32 20 - tests 13€ -€ Radiology exams 2.5 4.2 2.5 - exams 102€ -€ Physiotherapy 6.3 4.7 4.7 462 sessions 48€ 22,019€ Other treatments 4 3 3 289 sessions 18€ 5,058€
236,380€ Cost per patient 8,426€ 7,932€ 7,608€ 818€
Savings % 6% 10%
Protocol
Savings in unit costs
Improving productivity and purchasing conditions adds 10%
289 patientsCategory Best Unit Own Benchmark Best Total savingsImplant 1 units 3,156€ 2,670€ 2,670€ 140,454€ In patient days 6.9 bed days 321€ 289€ 289€ 193,688€ Theatre hours 1:30 hours 970€ 900€ 900€ 109,772€ Laboratory tests 20 tests 13€ 15€ 13€ -€ Radiology exams 2.5 exams 102€ 76€ 76€ 19,074€ Physiotherapy 4.7 sessions 48€ 60€ 48€ 22,019€ Other treatments 3 sessions 18€ 30€ 18€ 5,058€
490,064€ Cost per patient 7,608€ 7,608€ 6,730€
Savings % 10% 10% 20% !!!
Protocol Unit costs
Our new cost breakdown
Getting there:
Technology & implementation
Cost breakdown of a DRG
Hipe
Non-Hipe
…..LantisHIPE Caredos PAS
Dashboard
Benchmark reports
Analysis
C&T C&T C&T C&T C&T C&TConnect and transform
Registration systems
Excel
Cost model TTP Benchmark
database
Technology: current data flow
The data is there. Just connect it.
Performation is currently executing this successfully in Irish hospitals
…..LantisHIPE Caredos PAS
Data ware house
Dashboard
Benchmark reports
Analysis
C&T C&T C&T C&T C&T C&TConnect and transform
Registration systems
Data ware house
Excel
Cost model TTP Benchmark
database
Future data flow in hospital
Structurally assure management information
Management
Don’t wait for everything to be perfectTake (financial) control at local levelBenchmarking is more than technologyImplementation is key
Top management commitmentUse benchmarking as base for budget allocationsDiscussions & workshops with doctorsBuild business cases based on benchmarks
The clinician has to do at least 50%Speak the right language!
Summary
How can Irish hospitals benefit from benchmarking? Get into financial controlPerform better despite budget restraints
And what is required to get there? Costing of the full patient cycleUse all production data sources (Hipe, theatre, pathology, radiology)Technology should be sound: IT and cost model Use the benchmark results in day to day managementTop management should carry the implementation
Is it possible today?Yes, it is possible today in Ireland
Sweelincklaan 1 5 Fitzwilliam Square3712 JA Bilthoven Dublin 2The Netherlands Ireland+31 30 233 3872 +353 1 662 8280
www.performation.com