QLD Rural Costing ProjectAn overview of issues associated with accurate
costing
Presenter: Colin McCrow RN,RM,PICC, B HlthSc(Nsg),
Grad Dip Hlth Admin & Info Sys, M Hlth Admin & Info Sys.Manager ABF Costing
ObjectivesIn this session we will:• Briefly outline key costing principles• Review the costing processes undertaken
in the last three years (patient costing sites and cost model sites)
• Identify the costing issues (patient costing sites and cost model sites)
• Outline the plans to improve rural and remote activity & costing data
COSTING PRINCIPLES
QLD Rural Costing ProjectAn overview of issues associated with accurate costing
4 Key Costing Principles
• Collect Everything (or as much information as you can). The better we can describe the full patient journey the better our costing will be.
• Cost Everything -even those items you later may exclude. This ensures full consumption cost is identified.
4 Key Costing Principles
• Align Activity And Costs – Activity cost mismatch is the greatest cause of low level cost inaccuracy.
• Review All cost outputs with the area producing the services.
• (note there are more principles see the author for more details the previous are the most critical)
COSTING PROCESS- PATIENT COSTING SITES
QLD Rural Costing ProjectAn overview of issues associated with accurate costing
Cost Modelled LHN (4)
Qld Facility ProfileABF Activity Funded Facilities (34) – All patient CostedABF Block Funded Facilities (89) – Many patient costedNon ABF Funded Facilities (81) –Excluding Community Mental Health, Dental, General Community and offender Services facilities ~ Some patient costed
Round 17 Qld Facility Profile
Patient Level costing
• Full intermediate product consumption costing undertaken by hospital teams on a monthly basis.
• Formal end of year rollover process undertaken each year with focus on costing outcomes and review of relative value units in association with clinical service providers.
Patient Level costing
• No fractioning is required as virtual products are used where no patient level data is available or a new system is yet to be interfaced.
• Overhead allocation uses simultaneous equations.
• Audit and reporting are integral activities regular reporting to Hospital Boards of costed activity throughout the year .
Day 1 MR Weekly
Day 8 MR Weekly
Monthly Processing Cycle
Day 7 Financial Extracts
Day 9 FL structures
Day 15 DL Extract
Day 17 DL Structures
Day 18 PL Extract
Coding
Day 10-14 Clinical Systems
Initial Summation
Reporting
Encounter MatchingDay 16 MR Weekly
Day 19 Full MR
Final Summation
DoH Corporate Process
• Multi-year data is extracted directly from the site costing databases.
• Qld data elements are mapped to corresponding national code sets.
• Corporate Overheads added• WIP Current removed• Extensive Final Audit and validation
processes prior to final submission.
NHCDC RD17 Data Transformation Process
Pre-extract Audit Costing System Data Extraction Stored Procedure Audit
Data Element MappingFacility Code UpdateUnlinked Clinic Update
Mismatched Records Management
Negative Cost Encounters
Site Specific Data Management
Final Stored Procedure Audit
IHPA File Formatting Cost Validation Audit
Excluded Services
Data Quality Element UpdatesData Quality ExclusionsCost Weight Reports
Activity Reconciliation
Submission File Audit Submission File Exclusions End to End Reconciliation
Data Transformation DocumentationFinal Results and Reports
NHCDC Corporate Overhead Allocation Process
HSIA Clear Cost
DSS GL Transactions
pAWS IP Activity
pAWS ED Activity
pAWS OP Activity
Corporate Cost
Detail
Facility Volumes
Corporate Cost
Summary
Corporate
Product Cost
Summary
Corporate
Facility Load File
Site TII Database
Cost Model Site
GL & Activity
Data
Site SQL
Database –Total
Cost for each
Patient
Stored Procedure
Source
Line
Items
Corp OH
Line
Items
Final Line ItemsCost Outcomes
NHCDC GL Reconciliation -TII Sites
HHS Audited Return GL Transactions
HHS Summary
GL Transactions
Facility Level
Activity Summary
Costing Database
GL Load File
Facility Level
TII Costing
Process
Overhead
allocations /
Excluded
Services
Facility
Patient Cost
Records
Initial Extracted
Data
NHCDC
Mapping
WIP Current/Excluded
Costs/Data Quality
Final Mapped
Data
Record Audit &
Validation
Excluded Records
(Data Quality)
Submitted Record
Summary
Variance
Analysis
Final Facility
Reconciliation
Activity Data /
Reconciliation
Process
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COST MODEL PROCESS-METHODOLGY- ACTIVITY
QLD Rural Costing ProjectAn overview of issues associated with accurate costing
Data Sources
• Inpatient activity data is extracted from pAWS (which builds the Funding Model) from data it extracts from the HQI
• Outpatient and ED aggregate count data are also extracted from pAWS which is based on the MacOnline data submitted by the HHS.
• Revenue amounts by patient (admitted) or URG / Clinic mapping (outpatients and ED) are extracted from pAWS.
Aggegate Count Data
• As part of the Funding Model Build pAWS collates the ED and oupatient data reported and groups it by the final products for the NHCDC.
• Different record lines are built based on fields associated with funding type (eg DVA) or discharge disposition etc.
• Data is summarised to identify total revenue amount and a revenue “cost” per episode is calculated.
Source Data
ED Aggregate Count Data – (sample not complete table)
COMPANY
CODE
FACILITY
CODE FORM TYPE
TRIAGE_
CODE
SEPN_
MODE URG JUDG PRESENTATIONS NWAUS NREVENUE ED_LEVEL
IHPA
FUNDING
TYPE
SWQ 00121 MACONES 5 2NE3 10 3 0.1464 682.224 1BLOCK
SWQ 00121 MACONES 5 2NE3 10 76 3.7088 17283.008 1BLOCK
SWQ 00119 EDIS 5 2N71 10 1 0.0488 227.408 2BLOCK
SWQ 00119 EDIS 5 2N72 10 1 0.0488 227.408 2BLOCK
SWQ 00119 EDIS 5 2N78 17 34 1.3634 6353.444 2BLOCK
SWQ 00119 EDIS 5 1A37 5 1 0.1241 578.306 2BLOCK
Presentations are summed for each facility by product and divided into sum of total revenue to get a revenue “cost” per episode this in turn is used to
divide total costs allocated and thus get a relative patient level cost
Create Virtual Patients
EstabID NhcdcID EpiNo EpiRev pAWS_REV Epipercent Checkbal
310000121 4SUR 4SUR03NE35012VPM.12 227.408 180051.682 0.001263015 227.408
310000121 4SUR 4SUR04NE32012VPM.2 822.024 180051.682 0.004565489 822.024
310000121 4SUR 4SUR01NE34012VPM.7 360.218 180051.682 0.002000637 360.218
310000121 4SUR 4SUR04NE35012VPM.2 227.408 180051.682 0.001263015 227.408
310000121 4SUR 4SUR02NE34012VPM.18 360.218 180051.682 0.002000637 360.218
Virtual Patients are created based on aggregate count volumes and product type for each reporting facility. The epi % then is used as a multiplier for
actual costs at line item
COST MODEL PROCESS-METHODOLGY- GL COSTS
QLD Rural Costing ProjectAn overview of issues associated with accurate costing
GL Cost Data
• GL data is extracted from based on the LHN.• GL accounts are mapped to Cost Types and Cost
Categories using the same mapping as the QLD Clinical Costing System
GL Account Mapping
Account Mapping Examples
COST_
CENTRE
_ID COST_CENTRE_DS
FACILITY
_CODE DEPT DEPT_NAME NhcdcCC NhcdcItem Account ACCOUNT_DS
880367 Roma- Clinical Services 00119 NUGM01 General Med Ward GenWard Blood 566003 SUPPLIES-BLOOD RELATED
880367 Roma- Clinical Services 00119 NUGM01 General Med Ward GenWard DeprecE 590020 DEPEXP-MEDICAL EQUIPMENT <200K
880367 Roma- Clinical Services 00119 NUGM01 General Med Ward GenWard GS 566007 SUPPLIES-TELECOM RELATED
880367 Roma- Clinical Services 00119 NUGM01 General Med Ward GenWard Hotel 565005 OTHSUP-BEDDING AND LINEN
880367 Roma- Clinical Services 00119 NUGM01 General Med Ward GenWard MS 560100 CLNSUP-DISPOSABLE-GENERAL
880367 Roma- Clinical Services 00119 NUGM01 General Med Ward GenWard Oncosts 511210 WORKCOVER EXPENSE
880367 Roma- Clinical Services 00119 NUGM01 General Med Ward GenWard Path 566002 SUPPLIES-PATHOLOGY&LAB RELATED
880367 Roma- Clinical Services 00119 NUGM01 General Med Ward GenWard PharmNPBS 555031 DRUGS-RESPIRATORY SYSTEM
880367 Roma- Clinical Services 00119 NUGM01 General Med Ward GenWard SWNurs 500030 SALWAG-NURSING
Cost Centre Mapping
• Cost Centres are mapped to “departments” these are same as used in Transition II and map to NHCDC Cost Centres
• Cost Centres not found in GL file flagged as inactive
• New Cost Centres are added • Cost Centres are flagged as Overhead or
Final• Creates a maping table
Cost Centre MappingCOST_CENTRE_ID COST_CENTRE_DS Facility_Code FACILITY_DS TII_DEPT NhcdcCC CDNHC_CC_TYPE UPDATE_RD Status
681101
Augathella Repairs
And Maintence 00111
AUGATHELLA
HOSPITAL IBEM20 MaintEngReprs O 15 A
681111 Auga Health Service 00111
AUGATHELLA
HOSPITAL NUGM20 GenWard F 15 A
681170
Augathella Medical
Superintendent 00111
AUGATHELLA
HOSPITAL IMED20 MedAdmin O 15 A
689003
Char-Tst-Donations-
Augathella 00111
AUGATHELLA
HOSPITAL IOTT20 Excld F 15 A
680008
Contract Labour
Charges 00112
CHARLEVILLE
HOSPITAL IFIN01 FinAdmin O 17 A
680108
District Payman
Transfers Inter
District 00112
CHARLEVILLE
HOSPITAL ICOR10 CorpMan O 15 A
681301
Charleville Repairs &
Maintenance 00112
CHARLEVILLE
HOSPITAL IBEM10 MaintEngReprs O 15 A
681304
Char-All-
Physiotherapy-
Charleville 00112
CHARLEVILLE
HOSPITAL ALPH10 Physiotherapy F 15 A
681306
Char-All-Speech
Therapy-Charleville 00112
CHARLEVILLE
HOSPITAL ALSP10 Speech F 15 A
681305
Char-All-Outreach
Physio-Charleville 00112
Charleville
Hospital ALPH10 Physiotherapy F 15 I
681308
Char-All-Social
Worker-Charleville 00112
Charleville
Hospital ALSW10 SocialWork F 15 I
681310
Char-Eme-
Outpatients-
Charleville 00112
Charleville
Hospital OPES10 Outpat F 15 I
Split Cost Centres• Where activity data and revenue data indicate that
inpatients, ED and outpatient services have been delivered at specified facilities, but the cost centre structure does not have a unique cost centre for each workstream, costs need to be split. The amount of revenue for each workstream is used to split the cost centre.
• New departments are created that carry these costs based on the split
Split Cost Centres
FACILITY_NAME %ED %OP %IP 3waydept to split Eddept OPDept IPDEPT
AUGATHELLA HOSPITAL 0.158699 0.296465 0.544836 NUGM20 EDES20 OPGM20 NUGM20
CHARLEVILLE HOSPITAL 0.33156 0.66844 EDES10 OPES10
CUNNAMULLA HOSPITAL 0.325672 0.674328 EDES25 OPES25
DIRRANBANDI HOSPITAL 0.513973 0.486027 EDES30 OPGM30
INJUNE HOSPITAL 0.111033 0.309763 0.579204 NUGM35 EDES35 OPGM35 NUGM35
MITCHELL HOSPITAL 0.67183 0.32817 EDES40 OPGM40
MUNGINDI HOSPITAL 0.727586 0.272414 EDES45 OPGM45
QUILPIE HOSPITAL 0.107614 0.484095 0.408292 NUGM50 EDES50 OPGM50 NUGM50
ST GEORGE HOSPITAL 0.573172 0.426828 EDES55 OPGM55
SURAT HOSPITAL 0.122749 0.102365 0.774886 NUGM60 EDES60 OPGM60 NUGM60
THARGOMINDAH HOSPITAL 0.655262 0.344738 EDES65 OPGM65
Overhead Dept Mapping & allocation• Indentify “ Parent” and “Child” Departments• Update Mapping table• This is used in for a simple step down one pass
approach to pass LHN wide Costs to patient level based on total cost of each department.
• Costs are moved to child departments based on an allocation statistic which is total cost of the department as a percentage of all child departments * by total cost of the overhead department
Apply Overhead Allocation statistics
COMPANY
CODE
PARENT
DEPT
CHILD
DEPT CHILD_DEPT_NAME
CHILD_DEPT
COST
PARENT_ALLOC
COST
ALLOCATION
STAT
PARENT_DEPT
COST
ALLOCATION
AMT
Sample IAAC01 ALAU01 Audiology $ 1,763.61 $ 33,896,524.70 0.0000520292 $ 4,503,023.35 $ 234.29
Sample IAAC01 ALDI01 Dietetics $ 133,296.90 $ 33,896,524.70 0.0039324651 $ 4,503,023.35 $ 17,707.98
Sample IAAC01 ALOT01 Occupational Therapy $ 125,939.87 $ 33,896,524.70 0.0037154213 $ 4,503,023.35 $ 16,730.63
Sample IAAC01 ALPH01 Physiotherapy $ 257,932.46 $ 33,896,524.70 0.0076094072 $ 4,503,023.35 $ 34,265.34
Sample IAAC01 ALPO01 Podiatry $ 97,070.54 $ 33,896,524.70 0.0028637313 $ 4,503,023.35 $ 12,895.45
Sample IAAC01 ALSP01 Speech Pathology $ 91,409.04 $ 33,896,524.70 0.0026967083 $ 4,503,023.35 $ 12,143.34
Sample IAAC01 EDES01 Emergency Services $ 74,283.24 $ 33,896,524.70 0.0021914707 $ 4,503,023.35 $ 9,868.24
COMPANY
CODE
PARENT
DEPT
CHILD
DEPT CHILD_DEPT_NAME
CHILD_DEPT
COST
PARENT_ALLOC
COST
ALLOCATION
STAT
PARENT_DEPT
COST
ALLOCATION
AMT
Sample IAAC01 ALAU01 Audiology $ 1,763.61 $ 33,896,524.70 0.0000520292 $ 4,503,023.35 $ 234.29
Sample IADM01 ALAU01 Audiology $ 1,763.61 $ 33,896,524.70 0.0000520292 $ 3,805,043.53 $ 197.97
Sample IALH01 ALAU01 Audiology $ 1,763.61 $ 707,412.42 0.0024930436 $ 190,909.73 $ 475.95
Sample IBEM01 ALAU01 Audiology $ 1,763.61 $ 33,896,524.70 0.0000520292 $ 3,586.31 $ 0.19
Sample ICOR01 ALAU01 Audiology $ 1,763.61 $ 33,896,524.70 0.0000520292 $ 3,945,671.32 $ 205.29
Sample IFIN01 ALAU01 Audiology $ 1,763.61 $ 33,896,524.70 0.0000520292 $ 1,381.19 $ 0.07
Final Line Items
• After all parent department overheads have been allocated to child departments, overhead costs are passed to the NHCDC line items based on the episode percent of each patient as a multiplier against the total cost for example $ 1000 of Medical Supplies (MS) costs is the total department amount to be distirbuted to all outpatients and the epsiode percent for one outpatient is 0.0035678 the amount this patient will recive will be 0.0035678 * 1000 a patient with a epi% value of 0.0071356 will recive twice as much of this final department cost. The Epi% is based on the revenue for each distinct class of patient.
Episode % CalculationFacility_Code NhcdcID EpiNo ProdType ProgramGroup EpiRev pAWS_REV Epipercent Checkbal
00XXX 4XXX XX5091-4 AC A 18529.02 2332344.954 0.007944373 18529.0174
00XXX 4XXX XX6231-8 AC A 18529.02 2332344.954 0.007944373 18529.0174
00XXX 4XXX XX3035-12 MA S 28545.87 2332344.954 0.01223913 28545.8738
00XXX 4XXX XX0577-7 MA S 14705.45 1927094.913 0.00763089 14705.4502
00XXX 4XXX XX2465-3 AC A 18529.02 2332344.954 0.007944373 18529.0174
00XXX 4XXX XX0141-9 AC A 9578.444 1927094.913 0.004970406 9578.4436
00XXX 4XXX XX4404-3 AC A 19126.73 1927094.913 0.009925161 19126.7277
00XXX 4XXX XX9363-2 MA S 2595.079 2107252.867 0.001231499 2595.07944
00XXX 4XXX XX3466-3 AC A 3912.694 1927094.913 0.002030359 3912.69444
00XXX 4XXX XX2422-5 AC A 3978.245 2107252.867 0.001887882 3978.24489
The revenue for each admitted episode is divided into total revenue for that facility The epi precent is checked as a multiplier to ensure the relative costliness can be maintained
Final Line Items
• All direct costs that have been summed to the department from the ledge are split also use the epi% methdology. Direct costs appear in the CostDir column while overhead costs appear in CostOH
Inpatient ExampleEstabID EpiNo ProdType ORP NhcdcCC NhcdcItem CostDir CostOH
310000XXX XX0012-7 AC Inpat GenWard SWOther 0.546874 375.6148
310000XXX XX0012-7 AC Inpat GenWard Blood 2.735145 0.170008
310000XXX XX0012-7 AC Inpat GenWard OnCosts 123.7731 111.6544
310000XXX XX0012-7 AC Inpat GenWard SWNurs 1391.143 35.90793
310000XXX XX0012-7 AC Inpat GenWard DeprecB 278.3481 131.2977
310000XXX XX0012-7 AC Inpat GenWard Imag 0.046368 0
310000XXX XX0012-7 AC Inpat GenWard SWMed 2056.831 0.807316
310000XXX XX0012-7 AC Inpat GenWard Corp 0 15.23005
310000XXX XX0012-7 AC Inpat GenWard GS 359.8248 964.6786
310000XXX XX0012-7 AC Inpat GenWard Path 78.95274 -6.180261
310000XXX XX0012-7 AC Inpat GenWard MS 62.67844 -16.41398
310000XXX XX0012-7 AC Inpat GenWard Pros 0.175356 0
310000XXX XX0012-7 AC Inpat GenWard PharmNPBS 22.54774 0.001389
310000XXX XX0012-7 AC Inpat GenWard DeprecE 36.81207 4.783283
310000XXX XX0012-7 AC Inpat GenWard Hotel 2.374267 2.885877
Negative OH costs will occur where large credits have occurred in overhead departments – may be a GL management practice issue
Outpatient ExampleEstabID EpiNo ProdType ORP NhcdcCC NhcdcItem CostDir CostOH
310000xxx 4XXX012005C1201VPM.4 OP NonAdmit Outpat DeprecE 8.308912 0.434149
310000xxx 4XXX012005C1201VPM.4 OP NonAdmit Outpat GS 68.54653 110.4407
310000xxx 4XXX012005C1201VPM.4 OP NonAdmit Outpat SWNurs 231.321 6.650824
310000xxx 4XXX012005C1201VPM.4 OP NonAdmit Outpat SWOther 13.03787 36.02461
310000xxx 4XXX012005C1201VPM.4 OP NonAdmit Outpat SWVMO 0 0.01608
310000xxx 4XXX012005C1201VPM.4 OP NonAdmit Outpat Corp 0 59.57884
310000xxx 4XXX012005C1201VPM.4 OP NonAdmit Outpat Hotel 2.042373 0.313157
310000xxx 4XXX012005C1201VPM.4 OP NonAdmit Outpat Imag 0.244611 0
310000xxx 4XXX012005C1201VPM.4 OP NonAdmit Outpat OnCosts 20.70877 14.1941
310000xxx 4XXX012005C1201VPM.4 OP NonAdmit Outpat PharmNPBS 3.140694 0.000124
310000xxx 4XXX012005C1201VPM.4 OP NonAdmit Outpat SWMed 15.34401 102.1741
ED exampleEstabID EpiNo ProdType ORP NhcdcCC NhcdcItem CostDir CostOH
310000XXX 4XXX01NE35011VPM.3 NE ED EmergMed MS 9.29587 34.1299
310000XXX 4XXX01NE35011VPM.3 NE ED EmergMed Blood 0.405651 0.025259
310000XXX 4XXX01NE35011VPM.3 NE ED EmergMed DeprecE 5.459616 0.720468
310000XXX 4XXX01NE35011VPM.3 NE ED EmergMed SWVMO 0 0.026684
310000XXX 4XXX01NE35011VPM.3 NE ED EmergMed PharmNPBS 3.344067 0.000206
310000XXX 4XXX01NE35011VPM.3 NE ED EmergMed SWOther 0.081107 59.78261
310000XXX 4XXX01NE35011VPM.3 NE ED EmergMed SWNurs 206.3212 11.037
310000XXX 4XXX01NE35011VPM.3 NE ED EmergMed Corp 0 49.86353
310000XXX 4XXX01NE35011VPM.3 NE ED EmergMed Hotel 0.352129 0.519682
310000XXX 4XXX01NE35011VPM.3 NE ED EmergMed Path 11.70952 -0.918234
310000XXX 4XXX01NE35011VPM.3 NE ED EmergMed SWMed 305.0496 169.5572
310000XXX 4XXX01NE35011VPM.3 NE ED EmergMed GS 53.36579 183.2757
310000XXX 4XXX01NE35011VPM.3 NE ED EmergMed DeprecB 41.28194 19.50759
310000XXX 4XXX01NE35011VPM.3 NE ED EmergMed Imag 0.006877 0
310000XXX 4XXX01NE35011VPM.3 NE ED EmergMed OnCosts 18.35685 23.55501
310000XXX 4XXX01NE35011VPM.3 NE ED EmergMed Pros 0.026007 0.013673
NHCDC RD17 Data Transformation Process –Cost Modelled Sites
GL Extract Cost Centre /Dept Mapping Update OH Allocation Stats
Apply AllocationFinal GL Line Items FacilitypAWS Activity Extracts
Build EpiPercent values from Aggregate data
Create Final Pat Line items
Create Virtual patient records
GL Reconciliation & Scaling
IHPA File Formatting Cost Validation Audit
Excluded Services
Data Quality Element UpdatesData Quality ExclusionsCost Weight Reports
Activity Reconciliation
Submission File Audit Submission File Exclusions End to End Reconciliation
Data Transformation DocumentationFinal Results and Reports
NHCDC GL Reconciliation -Cost Model Sites
HHS Audited Return GL Transactions
HHS Summary
GL Transactions
Facility Level
Cost Model
Process
GL Load File
Facility Level
Cost Centre
Mapping
Overhead
allocations /
Excluded
Services
Facility
Patient Cost
Records
Initial Extracted
Data
NHCDC
Mapping
WIP Current/Excluded
Costs/Data Quality
Final Mapped
Data
Record Audit &
Validation
Excluded Records
(Data Quality)
Submitted Record
Summary
Variance
Analysis
Final Facility
Reconciliation
Activity Data /
Reconciliation
Process
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COST ISSUES
QLD Rural Costing ProjectAn overview of issues associated with accurate costing
Service Delivery Models
• Typically clinical services to rural and remote facilities are delivered on a hub and spoke model.
• GL structures do not usually follow the same model leading to activity cost mismatch BUT only when looking at individual facilities. At LHN level this is not the case. National reporting however is by facility
Hub & Spoke Impact
0
500
1000
1500
2000
2500
3000
3500
4000
4500
4PC1 4PC1 4PC1 4PC1 4PC2 4PC2 4PC2 4PC3 4PC3 4PC3 4PM1 4PM2
4BIL 4EME 4MMR 4YEP 4BLA 4SPR 4THH 4BAR 4MOH 4WOO 4GLA 4ROC
LHN Ave TotalCst
ABF Activity Facilities
ABF Block Funded Hub
HubSpoke
Travel Costs
• Where a hub and spoke model is used while there can be some additional costs for higher acuity patients cared for within the hub where there is significant travel time and cost for the same service it is reasonable to expect that the cost in the spoke site should be higher
Impact on accounting for travel
0
50
100
150
200
250
300
350
400
450
spoke spoke Hub spoke spoke spoke spoke Hub spoke
LHN1 LHN1 LHN1 LHN1 LHN1 LHN1 LHN2 LHN2 LHN2
Obstetrics Ave Cost
Travel Costs in Hub Site
Travel Costs in Ledger (except one
site)
Activity Reporting Issues
• Is all ED and OP activity being reported • MPHS patients – are these reported
separately ?• Private practice data• Not able to link ED admitted data to
Inpatient from aggregate count data as no patient information
Activity mapping issues
• Have correct cost centres been mapped to departments providing direct hands on care ?
• Are there any overhead departments that also provide some direct care ?
• Are any services provided from a single cost centre at multiple facilities or types of services?
Cost Outcome Issues OPProduct Name Code
TotalCst TotalDir TotalOhd
WardMedDir
WardMedOhd
WardNursDir
WardNursOhd
AlliedDir
AlliedOhd
Minor Surgical 10.03 1120.138 605.191 514.947 0.000 157.194 382.001 10.231 0.000 0.000Anaesthetics 20.02 155.050 66.852 88.198 10.134 13.287 20.415 0.872 0.000 0.002General Medicine 20.05 638.941 326.112 312.829 12.704 88.221 189.011 5.742 0.000 0.000General Surgery 20.07 111.343 39.214 72.129 0.085 10.644 5.272 0.702 0.000 0.003Occupational Therapy 40.06 306.655 148.960 157.695 69.368 38.549 46.918 2.509 0.000 0.000Midwifery 40.28 366.012 181.360 184.652 55.195 43.326 74.325 2.820 0.000 0.000
Medical clinic –little or no medical direct costs
Allied Health Clinic – with medical costs and nursing costs but no allied health costs
Nursing Clinic –with medical costs
RURAL COSTING PROJECT
QLD Rural Costing ProjectAn overview of issues associated with accurate costing
Patient Costing Sites
• Work with local teams on the introduction of a “staff travel” intermediate product to better assign costs to the non patient facing part of clinical services delivered in a hub and spoke model (affects ambulatory services).
• This product will be bundled with the clinic appointment in the final cost. Separate costing improves facility benchmarking.
Cost Modelled LHN’s
• Site Visit to correctly identify all cost centres where staff who provide direct care are paid.
• Map activity to cost centres and service locations.
• Split cost centres further where required by professional stream.
• Understand Service delivery model
Cost Modelled LHN’s
• Utilise activity mapping information and cost centre mapping information to build a patient level cost database in TII.
• Turn on interfaces from corporate clinical systems to produce patient consumption data for costing.
• Interface other local systems as necessary• Work with local staff to improve low level
product costing.
All Sites• Hospital Costing teams are to Actively
Encourage the formal signoff of cost outcomes by department heads for services produced in each department as being a realistic cost for each service delivered.
• Work with local costing teams and CFO’s to identify areas of activity cost mismatch through the production of quarterly YTD cost weight reports.
Why ?• The more efficient use of all resources
across the state will allow for more quality care to be provided for less.
• To make an informed analysis you must have data on activity and cost for all facilities regardless of funding source.
• This data is also useful for service planning and quality outcome analysis.
Healthcare purchasing 3 years on – what’s changing?
Focus broadening from NEAT/NEST to wider (harder) s ystem challenges • Outpatients• Chronic disease management/integrated care
Focus on maximising revenue • End of More Beds for Hospitals • Federal budget changes to efficient growth funding• Private patient pricing
Focus is not only on ABF facilities/activity • National Efficient Cost • Primary and Community Review
Focus of the purchaser is less on the ‘how’ and mor e on the ‘what’• Incentivising outcomes not prescribing models of care • PMF and KPI review
Questions ?
Acknowledgements• Healthcare Purchasing, Funding &
Performance Management Branch –Healthcare Purchasing 3 years on slide
Questions & Contact Information
Please direct any questions to:Colin McCrowManager ABF CostingABF Model TeamSystem Policy & Performance Division Queensland HealthEmail : [email protected]
