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Grouped and Ungrouped Sub and Non-Acute Activity Unpacking the differences Sharon Smith Manager Sub-Acute and Mental Health Work Streams NSW ABF Taskforce

Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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Sharon Smith, Sub and Non Acute Patients and Mental Health Workstreams Manager, NSW ABF Taskforce delivered the presentation at the 2014 Hospital Patient Costing Conference. The Hospital Patient Costing Conference 2014 examines the development and implementation of patient costing methodologies to reflect Activity Based Funding allocations. For more information about the event, please visit: http://www.healthcareconferences.com.au/patientcostingconference

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Page 1: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

Grouped and Ungrouped Sub and Non-Acute

Activity

Unpacking the differences

Sharon Smith

Manager Sub-Acute and Mental Health Work Streams

NSW ABF Taskforce

Page 2: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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

Page 3: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

Overview

•  What is Sub and Non Acute Care?

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

•  Analysis of the differences

•  What next?

Page 4: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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

Page 5: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

AN-SNAP Rehabilitation

Impairment

FIM

Age

Palliative Care

Phase

RUG

Age

GEM

FIM

Age

Maintenance

Maintenance Type

RUG

Psychogeriatric

HoNOS

Page 6: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

What does grouped and ungrouped mean?

Speech Pathology

Physio

OT Nursing

Medical

Clinical data Collected

Clinical data NOT Collected

SNAP Class

No SNAP Class

$

$ \

Page 7: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

What does grouped and ungrouped mean?

l  SNAP Class = Grouped

l  NO SNAP Class = Ungrouped

Page 8: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

How did we get here?

Page 9: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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”

Page 10: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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”

Page 11: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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

Page 12: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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

Page 13: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

Questions

l  Proportion of ungrouped activity varies by LHD, why?

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

Page 14: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

COMPARING THE TWO

Page 15: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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

Page 16: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

Average Cost per Day

$-

$100

$200

$300

$400

$500

$600

$700

$800

$900

Grouped Ungrouped

$820

$848

Grouped Ungrouped

Page 17: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

Comparative LOS  

0

5

10

15

20

25

30

35

40

Ungrouped Grouped

10 12

9

18

Acute Sub-Acute

Page 18: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

Top Level View

l  Grouped and Ungrouped SNAP activity similar cost per day

l  Differences in Episode costs driven by LOS differences

Page 19: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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

Page 20: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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

Page 21: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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?

Page 22: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

Controlling for Differences

METHODOLOGY  

Page 23: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

Maybe its Methodology?

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

Page 24: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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

Page 25: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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

Page 26: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

Question?

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

Page 27: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

CLINICAL PRESENTATION

Page 28: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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

Page 29: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

Grouped Pool

B70 B B70 C

E62A

B70 A

I03B I08A I03A

I68A L63A Z63B

Page 30: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

Ungrouped Pool

B63Z E65B

B64A

B70A

E65A I73A I68A

L63A F62A

E62A

Page 31: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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

Page 32: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

COST BUCKET COMPARISON

Page 33: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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

Page 34: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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

Page 35: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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

Page 36: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

Cost Buckets

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

l  RVU’s need to be current

Page 37: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

Site Choice

Feeder Development

Correct Classification?

Understand methodology

RVU Review and

Development

Clinical Review

Meaningful Grouped

Data

Page 38: Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing

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