Maximising the impact of Activity Based Funding

with Engagement

April 2012Cheryl McCullagh Director of Clinical Integration

SCHN• New Network• Revised Executive Team• Rapidly Evolving State and

National Model• New network goals• DCI- new role

– ICT– Performance– Efficiency and Revenue– Integration

SCHN

• Children First and foremost– Clinical excellence– Innovation– Maximising opportunities– Leading advocacy– Research and Education

ABF helping our strategy• Measuring and understanding our network

activity• Recognising complexity• Accurate reporting• Better benchmarking• Addressing variance, accounting for difference• Improving clinical outcomes and efficiency• Understanding of current data• Shared education

Governance• Episode funding Governance Group

– Executive leadership• Administration• Medical Records• Clinical staff• ICT• Coding• Analysis• Finance• Business management

EGG• Functions

– Education/communication– Engagement– Target projections– Reporting on performance– Accuracy– Modelling for maximising ABF– Communication across functions– Problem solving process gaps– Addressing variance– Keeping up with changing policy

To Do List• Basic program of education

– Professional and functional groups• Specialty based connections, making ABF relevant to clinical staff in

their everyday work• Engagement goals

– Benchmarking, healthy competition and improvement– Good reporting, accuracy– Recognition of complex work– Maximising funding- last– Actions from the KPMG review

The education program• Basic presentations

– The model– Coding– Costing

• Clinician Coding guidelines developed locally• Other resources sourced from various institutions• Skills refresh for coders and costing staff• Functional group education• Specialty based Education, analysis and improvement• Improving network relationships

COMMUNICATION

Board Medical Staff Councils NUM’s/ NM Clinical Council Clinical Executive CNC’S Allied Health

CNE’s Nurse Practitioners Operational Management

Groups SCH and CHW Staff Forums

ABF Policy and Impact Education Sessions have commenced following have been held

SPECIALTY/ AREA MEETINGSWorkshops with Speciality Groups to discuss ABF/EF Implementation has commenced with a range of workshops scheduled

some specialities addressed so far (not limited to): BMT adolescent Med Endocrinology ENT Gen Med Neurology Cardiology Neonatal Intensive Care Units

Meetings involve;• clinical reps from all sites• coding, records• Analysis• business management• program leaders• executive

Shared learning model• Review data• Benchmark• Find variance• Discuss• Find detailed solutions• Enact change• Review and refocus• Regular reporting• Network learning

Example Endocrinology

Facility BenchmarkingRow Labels Separations Average of LOS Sum of Day Case Average of TotalCost Average of TotalIndirect Average of TotalDirectCrocodile (WA) 467 2.45 195 5,197.1$ 2,139.1$ 3,057.9$ Elephant (VIC) 779 1.97 503 3,352.9$ 690.6$ 2,662.4$ Platypus (NSW) 1089 1.45 812 2,197.4$ 596.2$ 1,601.2$ Sunbird (SA) 428 2.61 187 4,365.3$ 1,308.4$ 3,056.9$ Grand Total 2763 1.95 1697 3,366.0$ 993.9$ 2,372.1$

Inpatient Activity comparison between statesLOS lowday cases highIndirect and direct costs proportionally different

Weighted Seps (cwe) Separations Sum of Day Cases Average of LOS Average of episode_costRow Labels 2009/10 2010/11 2009/10 2010/11 2009/10 2010/11 2009/10 2010/11 2009/10A207 - WESTMEAD 509.2 517.7 1089 1057 812 802 1.45 1.47 2,205$

Ambler, Geoffrey 57.2 43.6 127 94 94 68 1.41 1.37 2,471$ Cowell, Christopher 43.7 48.1 131 143 116 127 1.27 1.18 1,710$ Craig, Maria 31.2 29.4 63 54 45 37 1.25 1.15 2,108$ Donaghue, Kim 50.7 33.3 74 51 44 30 2.62 2.35 4,791$ Howard, Neville 69.2 83.9 122 130 74 84 1.54 2.09 2,896$ Maguire, Ann 10.9 30.0 32 62 26 44 1.28 1.95 1,874$ Munns, Craig 171.1 173.2 409 367 338 314 1.29 1.25 1,411$ Silink, Martin 39.9 46.1 66 80 35 41 1.62 1.60 3,033$ Srinivasan, Shubha 35.2 30.2 65 76 40 57 1.55 1.28 2,851$

C238 - RANDWICK 144.8 173.0 177 214 63 76 2.72 2.86 7,268$ Woodhead Helen 40.9 41.9 49 53 24 18 2.94 2.43 8,177$ Walker Jan 19.0 31.0 24 33 5 13 2.63 3.09 7,220$ Verge Charles 45.5 50.1 54 68 17 28 2.94 2.49 7,536$ Neville Kristen 31.4 47.0 42 57 17 17 1.98 3.39 5,194$ Campbell Thomas 8.0 8 0 4.13 10,920$ Hameed Shihab 3.0 3 0 6.00

SCHN 654.0 690.7 1266 1271 875 878 1.63 1.71 2,913$

Local level review

Proportion of day cases differentLarge variation in LOS between cliniciansLarge variation in costs

Drill down to comparable dataWeighted Seps Separations Sum of Day Cases Average of LOS Average of episode_cost

Row Labels 2009/10 2010/11 2009/10 2010/11 2009/10 2010/11 2009/10 2010/11 2009/10 2010/11A207 446.3 463.3 983 942 741 715 1.42 1.48 2,138$ 1,721$

Diabetes W Catastrophic or Severe CC 2.2 2.2 1 1 0 1 9.00 1.00 17,596$ 944$ K60A 2.2 2.2 1 1 0 1 9.00 1.00 17,596$ 944$

Diabetes W/O Catastrophic or Severe CC 142.4 145.9 215 237 98 125 1.80 1.89 3,417$ 2,451$ K60B 142.4 145.9 215 237 98 125 1.80 1.89 3,417$ 2,451$

C238 137.5 157.9 166 198 58 71 2.80 2.86 7,478$ Diabetes W Catastrophic or Severe CC 6.4 8.7 3 4 0 0 6.33 7.75 17,547$

K60A 6.4 8.7 3 4 0 0 6.33 7.75 17,547$ Diabetes W/O Catastrophic or Severe CC 74.6 96.5 87 110 15 23 3.34 3.31 9,039$

K60B 74.6 96.5 87 110 15 23 3.34 3.31 9,039$ Grand Total 583.7 621.3 1149 1140 799 786 1.62 1.72 2,910$ 1,721$

Proportionally different splitsLOS 1.48 vs 2.86Cost 2138 vs 7478

Endocrinology• Very different proportional CWS and coding• Review of variation increases understanding• Local comparison of Inpatient, OPD and

revenue• Outcomes

– Increased communication– Agreement about what can be compared– Working on shared coding guide

BMT• High cost, high variance noted• Established the clinical model in discussion• Change coding strategy to accurately report clinical

activity• Standardised network coding• Outcomes

– more consistent reporting, shared coding guides– Meeting activity targets– volumes are small but the data suggests a proportional shift at A08B’s to

A’s. – Reported activity increased by $200K ytd

UTI• Care Path established 2 years ago• Splits clinical care into simple UTI vs UTI with CC• Revised care path to work concurrently with the DRG split• Review all non complex admissions• Outcomes

– Recoding 30%– Increased CMI– Improved accuracy, and support for the care path– Clear link between a clinical decision making support process and the coding

efforts– Renewed collaboration between clinical change and coding

Between the Flags• eform for clinical and rapid

response• Available to coders• Increased vigilance for

complications• Increased coding of arrests and

resuscitation events• Regular communication between

the PICU team and coders

Advocacy

• Working with the

• Development of a set of Paediatric CCs and CCLs for Clinical Review• Step 1- Identifying diagnoses with a demonstrated impact on cost and

length of stay.• Step 2 – Assessment of paediatric vs adult impact of CC diagnoses by

ADRG• Step 3 – Refine CC list to exclude CCs with high adult impact• Step 4 - Addition of closely related diagnosis codes to resulting CC list

• F91.8 Other conduct disorders• Q90.9 Down's syndrome, unspecified• F83 Mixed specific developmental disorders• J21.9 Acute bronchiolitis, unspecified• G40.91 Epilepsy, unspecified, with intractable epilepsy• H35.1 Retinopathy of prematurity• K90.4 Malabsorption due to intolerance, NEC• L04.0 Acute lymphadenitis of face, head and neck• N13.7 Vesicoureteral-reflux-associated uropathy• R62.8 Other lack of expected normal physiological development• Q02 Microcephaly• Z93.1 Gastrostomy status• G47.30 Sleep apnoea, unspecified• G47.32 Obstructive sleep apnoea syndrome

Out of Home Care Build• Stage 2 of this trial will be

to investigate how we can implement a similar field across the two campuses. Potentially we may be able to use the data from this field to trigger an Out of Home Care Admin Alert in Patient Management as there is a similar field in SCHN –R system.

Biggest Gains• Accuracy• Understanding our business• One size will never fit all in terms of education• Finding the relevant variance for each group and peaking the interest, the

lessons are then transferred to all areas of documentation• Collaboration between all the content experts • Translation of changing clinical models, to improved documentation to

improved coding• Network sharing and the realisation of common goals• Contribution to advocacy• Potential for research

• This is a long term plan…………………..