The Analytical Support for Revision

Benchmarking methods of providers production used to in VZP ČR

VZP Open HousePrague, 4th-5th June 2015

Robert Gos, email: robert.gos@vzp.cz

CONTENT

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1) ECONOMICAL AND CLINICAL INDICATORS IN HOSPITALIZATION

2) ECONOMICAL AND CLINICAL INDICATORS IN AMBULATORY SECTOR

3) PROJECT TO EVALUATE QUALITY AND EFFICIENCY OF DENTAL CARE

4) CONCLUSION

THE SUBJECT OF MEASURING

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�The key to the every s uccess measuring and comparison of production by the providers is the right definition of a unit of the production

�The output of this defin ition is items, which groups either clinical and economical features of production to the „dataset of items“ to every patient, on which are services banished

�Every measuring is ce ntered to patients on the basis of his banished main diagnoses

�For ambulatory and la boratory patients we make clusters by statistical functions, for hospitalization patients we use DRG grouper

THE SUBJECT OF MEASURING

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�T his is what we call Economical and clinical indicators (ECI) of providers

�Now „ECI“ are focusedon :

�Hospitalizations

�Outpatients care

�Laboratories

�Radiology and imagin g methods

SOFTWARE PRODUCTS IN VZP ČR

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FOR ANALYTICAL, STATISTICAL PURPOSES AND REPORTING WE USE IN VZP ČR THE COMPREHENSIVE BUSINESS INTELLIGENCE AND ANALYTICS PLATFORM :

Oracle Business Intelligence Enterprise Edition 11g (OBIEE)

�Makes corporate data easier for business users to access

�Provides a common in frastructure for producing and delivering enterprise reports, scorecards, dashboards, ad-hoc analysis, and OLAP analysis

�Includes rich visualiza tion, interactive dashboards, a vast range of animated charting options, OLAP-style interactions and innovative search, and actionable collaboration capabilities to increase user adoption

OBJECTIVE OF ECI IN HOSPITALIZATIONS

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„ECI“ in hospitalizations is an instrument for measuring performance of hospitals and

reporting effectivity of providing services for board and management of Health insurance

company“.

oChance for longtim e measuring (same DRG grouper) and forcomparison of providers on the basis of some statistical methods

oPossible drilling to a „patient level“ to identify improper services

THE LIST OF HOSPITALIZATION INDICATORS

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We divide indicators at the:

�Cost (economic) item s

�Time on operating ro

�Number of days on i

�Medical services pro

om (theatre) - medical services of anesthesia

ntensive care beds and standard care beds vided

during hospitalisation (without anesthesia,laboratories and radiology and imaging methods)

aboratories provided during hospitalisation

adiology and imaging methods provided during stay

drugs and medical material provided during

�Medical services in l

�Medical services of r

�Separately charged hospitalisation

�Extramural care

THE LIST OF HOSPITALIZATION INDICATORS

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And …

�Medical items

�Average age of patie

�Total casemix (a sum

nts

mary of relative weights of cases for a defined unit andperiod), casemix index (per patient)

long-time outliers, % of short-material and long-material

without complications, with complications and with major

er hospitals

�% of short-time and outliers

�% of hospitalisations complications

�% of transfers to oth

�% of deaths

�% of hospitalisations

with an extramural care

METHODS OF COMPARISON IN HOSPITALIZATION ECI

Comparison is done between/among hospitals (and

their DRG basis) on:

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• Basic statistical indicators - hospital averages, same-type hospital

averages and republic averages

• Other statistical indicators – minimum, maximum, median and

standard deviation

• Then, we can very clearly identify improper services in overuse or

underuse of services

OBJECTIVE OF ECI IN OUTPATIENT CARE

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Like „ECI“ in hospitalizations, ECI in outpatient care is an instrument for measuring performance of ambulatory providers and reporting effectivity of providing services for board and management of

Health insurance company“.

APPROACH TO THE MEASURING OF ECI IN AMBULATORY SECTOR (OUTPATIENT CARE, LABORATORY, …)

• Compilation of episodes + assigning primary diagnosis

• Cluster analysis for each separately specialities (2 - 4 clusters)

» clusters clinically similar providers and excludes significantly different provider

» compilation of episodes use International shortlist for hospital morbidity tabulation (ISHMT) instead of International Classification of Diseases (ICD-10)

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METHODS OF COMPARISON ECI IN AMBULATORY SECTOR

• Comparing providers among themselves within a cluster

• Calculation of Economic and clinical indicators

• Cost benchmarking

• Determine relations between/among medical providers

• Scoring system

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INDICATORS FOR OUTPATIENT SPECIALIST

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Number of patient visit

Average costs of own care per patient Average age of patients

The average time of medical services per patient

Separately charged materials value and separately charged medical devices value per patient

Expenditure on prescription drugs per patient Expenditure on medical

devices per patient

Number of comprehensive physical examination per patient Number of

control physical examination per patientValue of requested care in laboratories per patient

Value of requested care in X-ray providers per patient

Number of “Minimal contact” between doctor and patient per patient

Number of “Telephone consultation” between doctor and patient perpatient

INDICATORS FOR LABORATORIES, RADIOLOGY, ….

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Number of patient visit Average age of patients

Average time of medical services per patient

Separately charged materials value and separately charged medical devices value per patient

Average costs of own care per patient

Average distance from inducing doctor to complementary healthcare facilities

• and X-

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Average time gap from the doctor´s visit and visit to laboratories rays

Average number of medical services per patient

Calculation of deviations from the mean (economic, medical and deviation)

SCORING SYSTEM OF LABORATORIES AND X-RAYS

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A PROJECT TO EVALUATE QUALITY AND EFFICIENCY OF DENTAL CARE

A PROJECT TO EVALUATE QUALITY AND

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EFFICIENCY OF DENTAL CARE

• The aim of the project was to find how effective the dental facilities are.

• Certain indicators were chosen, each indicator got a weight. A highest sum of weights was 100.

• Dental facilities with a high score got a bonus, facilities with a low score were subjects to review activities (because of a low quality and efficiency)

• The project was going in years 2012 - 2014

INDICATORS IN THE PROJECT

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-> 6 indicators were chosen. For scoring each indicator got a weight (points) according to a precise calculation. The indicators were:

Indicator In dicator description

Weight (points)

I 1 Percentage of patients with 1 preventive check-up in amount of all treated patients

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I 2 Percentage of patients with 2 preventive check-ups in amount of all treated patients

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I 3 Percentage of tooth decay treatments - fillings - in amount of all treated patients

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I 4 Index of tooth decay retreatment (fillings) in the same tooth location

50

I 5 Fillings and subsequent extractions of milk teeth 6

I 6 Fillings and subsequent extractions of permanent teeth 6

RESULTS OF THE PROJECT

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• As the project started, the indicators were monitored in 6 consequent years 2007 – 2012 (alike next years)

• Percentage of dental facilities with a score lower than 40 fell from 2.4% in 2012 to 0.8% in 2014. This was the consequence of the review activities.

• Percentage of dental facilities with a score higher than 80 rose from 12.2% in 2012 to 19.4% in 2014.

RESULTS OF THE PROJECT

Overal evaluation - scoring by facilities in years 2012 - 2014

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2012 2013 2014

Interval ofscoring Number of

facilities Share in %

Cumulative%

Number of facilities

Share in %Cumulative

%Number of facilities

Share in %Cumulative

(90;100>56 0,9 0,9 102 1,7 1,7 120 2,0 2,0

(80;90>683 11,3 12,2 945 15,7 17,4 1 044 17,4 19,4

(70;80>1 952 32,2 44,3 2 207 36,6 54 2 275 37,9 57,4

(60;70>1 483 24,4 68,8 1 517 25,2 79,2 1 489 24,8 82,2

(50;60>1 202 19,8 88,6 844 14,0 93,2 732 12,2 94,4

(40;50>548 9,0 97,6 329 5,5 98,7 287 4,8 99,2

(30;40>123 2,0 99,6 69 1,1 99,9 41 0,7 99,9

(0;30>22 0, 4 100 9 0,1 100 8 0,1 100

6 069 100 6 022 100 5 996 100

PROGRESS OF 2 MAJOR DENTAL SERVICES

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•Progress of 2 major dental services in years 2012 - 2014:

tooth decay treatments

preventive check-up

3 800 000

3 600 000

3 400 000

3 200 000

3 000 000

2 800 000

2 600 000

2 400 000

2 200 000

2 000 0002012 2013 2014

tooth decay treatments preventive check-up

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THE MAIN CONCLUSIONS

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�All measures must be aimed at the patient and his clinical situation (comorbidities)

�These patients must be clustered to the more general groups

�Only in these cluster s you can measure diversities between providers and make benchmarking on the basis of best practicies

�The pace of adjustme nt differ among providers, the key role has the revisional system

�We have now develop ed the ECI for aprox. 2/3 of our expenditures

�With the SW OBI EE 1 1g we can implement elements of artificial intelligence

THANK YOU FOR YOUR ATTENTION