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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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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