Grouped and Ungrouped Sub and Non-Acute

Activity

Unpacking the differences

Sharon Smith

Manager Sub-Acute and Mental Health Work Streams

NSW ABF Taskforce

Why is this important now?

After 2014/15 Independent Hospital Pricing Authority (IHPA) will not price ungrouped SNAP activity

Out of scope for C’wealth ABF

42 % of expenditure in NSW ABF Facilities

Overview

•  What is Sub and Non Acute Care?

•  What does “grouped” and “ungrouped” mean?

•  Analysis of the differences

•  What next?

Sub and Non Acute care

l  Specialised multidisciplinary care

l  Functioning and quality of life.

l  Care needs and cost not explained by Diagnosis

AN-SNAP=Australian National Sub and Non Acute Patient Classification

AN-SNAP Rehabilitation

Impairment

FIM

Age

Palliative Care

Phase

RUG

Age

GEM

FIM

Age

Maintenance

Maintenance Type

RUG

Psychogeriatric

HoNOS

What does grouped and ungrouped mean?

Speech Pathology

Physio

OT Nursing

Medical

Clinical data Collected

Clinical data NOT Collected

SNAP Class

No SNAP Class

$

$ \

What does grouped and ungrouped mean?

l  SNAP Class = Grouped

l  NO SNAP Class = Ungrouped

How did we get here?

1993

•  1996-1997 SNAP Costing and Classification Development Study

How did we get here?

•  1993 AHMAC casemix development plan

1996 1999

•  NSW- 1999 SNAP in “designated units”

2000 2011/2012

•  NHRA

•  NSW Interim Funding Model

•  NSW- SNAP in

“designated services”

How did we get here?

•  AN-SNAP version 2

•  NSW- SNAP in “designated units”

2007

•  AROC

•  PCOC

•  NSW- SNAP in “designated units”

2013 2014 2015

•  IHPA – “Care type per diems will not continue”

•  All NSW SNAP Activity is grouped

•  Further development of RVU’s

•  Meaningful Clinical data available for all SNAP activity

Where are we now, where do we want to go?

•  NSW- SNAP for all sub and non acute activity

Episodes with and without SNAP Data by LHD: YTD Jan 14

0

2,000

4,000

6,000

8,000

10,000

12,000

Num

ber

of E

piso

des

SNAP Data No SNAP Data

Lowest % Activity without data

Highest % Activity without data

Questions

l  Proportion of ungrouped activity varies by LHD, why?

l  Are the grouped and ungrouped patients similar to each other?

COMPARING THE TWO

NSW 2012/13- Average Cost per Episode  

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000

$10,000

Grouped Ungrouped

$9,814

$6,152

Average Cost per Day

$-

$100

$200

$300

$400

$500

$600

$700

$800

$900

Grouped Ungrouped

$820

$848

Grouped Ungrouped

Comparative LOS  

0

5

10

15

20

25

30

35

40

Ungrouped Grouped

10 12

9

18

Acute Sub-Acute

Top Level View

l  Grouped and Ungrouped SNAP activity similar cost per day

l  Differences in Episode costs driven by LOS differences

Average Cost per Episode by Care Type  

$-

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000

Rehabilitation Palliative Care Maintenance GEM

$16,694

$3,742

$10,728 $10,366

$5,164 $5,879

$7,831 $7,243

Average Cost per Episode by Care Type Grouped Ungrouped

Average Cost per Day by Care Type

$0

$100

$200

$300

$400

$500

$600

$700

$800

$900

$1,000

Rehabilitation Palliative Care Maintenance GEM Geriatric Psychiatry

$827

$887

$576

$709

$951

$906

$954

$771 $750

$889

Grouped Ungrouped

Care Type View

l  Grouped activity Episode Costs higher than ungrouped

Except PC ?

l  Ungrouped activity Per Diem costs higher than grouped

Except Geriatric Psychiatry?

Controlling for Differences

METHODOLOGY  

Maybe its Methodology?

l  Analysis using LHD’s/ Facilities that use common methodology –  Feeders for A/H , pharmacy for example –  Same RVU’s

Comparison of Costing Methodologies

$9,691

$6,378

$14,559

$6,988

818

853

878

851

$700

$720

$740

$760

$780

$800

$820

$840

$860

$880

$900

$-

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

A:Grouped A:Ungrouped F:Grouped F:Ungrouped

Cost per Episode Cost per Day

Controlling for Methodology Differences

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000

Rehabilitation Palliative Care Maintenance GEM

$17,865

$5,014

$9,417 $9,461

$8,041

$7,136 $6,501 $6,205

Grouped Ungrouped

Question?

l  Are the ungrouped patients more similar to acute than sub-acute?

CLINICAL PRESENTATION

What DRG is that?

l  Are grouped and ungrouped episodes coming from the same pool of patients?

l  Analysis of the DRG assigned to the acute episode preceding either the grouped or ungrouped SNAP episode

l  Top 10

Grouped Pool

B70 B B70 C

E62A

B70 A

I03B I08A I03A

I68A L63A Z63B

Ungrouped Pool

B63Z E65B

B64A

B70A

E65A I73A I68A

L63A F62A

E62A

Clinical Presentation

l  Only 4 of top 10 DRG’s in each list the same

l  Acute ALOS = 10 Days for ungrouped

= 12 days for Grouped

l  Subacute LOS= 9 days for ungrouped =18 days for grouped

COST BUCKET COMPARISON

Relative Expenditure by Cost Bucket

0%

5%

10%

15%

20%

25%

30%

35%

Hotel Imaging Pathology Pharmacy Allied Health Ward Nursing Ward Medical

6%

1% 2%

4%

18%

31%

11%

6%

2% 2%

6%

11%

34%

13%

Grouped Ungrouped

Brain Injury Rehab Example: Allied Health

$447

$996

0

10

20

30

40

50

60

$-

$200

$400

$600

$800

$1,000

$1,200

Hospital A (No AH Feeder) Hospital B (AH Feeder)

Average AH cost per Day % Of Expenditure on AH

Palliative Care Example: Pharmacy

$23.00

$25.00

3

4

0  

0.5  

1  

1.5  

2  

2.5  

3  

3.5  

4  

4.5  

$-

$5.00

$10.00

$15.00

$20.00

$25.00

$30.00

Hospital A (No Pharmacy Feeder) Hospital B (Pharmacy Feeder)

Average Pharmacy Cost per Day % of Expenditure

Cost Buckets

l  RVU’s can work for some costs but not others

l  RVU’s need to be current

Site Choice

Feeder Development

Correct Classification?

Understand methodology

RVU Review and

Development

Clinical Review

Meaningful Grouped

Data

The Way Forward

l  Ongoing analysis to inform classification development

l  Use cost data to identify areas of priority

l  Target clinicians and policy makers to ensure data is understood