Strategy & Roadmap for Implementation

Simon MooresDirector of Finance

1. Funding Model for Acute Hospitals

2. Strategy for St James’s Hospital

3. Future Opportunities & Challenges

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Funding Model for Acute Hospitals

Strategy for St James’s Hospital

Future Opportunities & Challenges

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BLOCK FUNDING

In-Patient & Day Case =

Activity based funding

Emergency & OPD =

Block funding

2015 2016

Actual costs & revenue per patient key

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• Specified Price paid for each Weighted Unit of

in-patient and day case episode of care up to a limit

of specified Activity

National Average Price set by HPO

Historic Activity Level

Complexity of care by DRG

Funding Model for Acute Hospitals

Strategy for St James’s Hospital

Future Opportunities & Challenges

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Understand and manage costs at patient episode level

To be an international leader in Activity Based Funding

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Appropriate funding & Complexity

Patient level cost visibility

Accountability

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Funding

Stream

Management

Absolute

Cost

Identification

Allocation &

Cost Driver

Identification

Service Line

Management

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Directorate Specialty DRGCode Description Case Units

LOS Peer ALOS

Revenue Cost Est.

HOPE

Oncology E71B: Respiratory Neoplasms W/O Catastrophic CC 1.0 27 7 €6,218 €17,391

G47B: Other Gastroscopy W/O Catastrophic CC 0.6 16 5 €2,743 €9,188

S65A: HIV-Related Diseases W Catastrophic CC 5.4 50 29 €38,280 €68,888

Radiotherapy K62B: Miscellaneous Metabolic Disorders W/O Catastrophic or Severe CC

0.8 30 3 €11,542 €16,934

MEDICINE Cardiology F15A: Interventional Coronary Procs W/O AMI W Stent Implantation W Cat or Sev CC

1.5 21 7 €6,477 €26,592

1.5 23 7 €6,477 €29,125

Dermatology J64B: Cellulitis W/O Catastrophic or Severe CC 0.6 15 4 €2,489 €8,254

Gastro Enterology

H61A: Malignancy of Hepatobiliary System, Pancreas W Catastrophic CC

2.0 44 18 €15,665 €25,186

H61B: Malignancy of Hepatobiliary System, Pancreas W/O Catastrophic CC

1.1 46 8 €15,136 €25,001

General Medicine A06A: Tracheostomy W Ventilation >95 hours W Catastrophic CC 25.0 223 84 €244,409 €451,563

L63B: Kidney and Urinary Tract Infections W/O Catastrophic or Severe CC

0.6 43 6 €13,935 €21,863

Q01Z: Splenectomy 2.5 48 9 €28,860 €83,497

X62A: Poisoning/Toxic Effects of Drugs and Other Substances W Cat or Sev CC

0.8 20 6 €3,308 €11,603

Genito Urina F63A: Venous Thrombosis W Catastrophic or Severe CC 1.1 23 12 €4,602 €10,382

Neurology X05A: Other Procedures for Injuries to Hand W CC 0.8 14 3 €5,859 €9,543

Rheumatolog y E62A: Respiratory Infections/Inflammations W Catastrophic CC 2.1 59 22 €19,700 €32,639

E66B: Major Chest Trauma W Severe or Moderate CC 0.8 17 6 €3,368 €6,401

E75A: Other Respiratory System Diagnosis W Catastrophic CC 1.5 62 17 €18,068 €31,654

F76B: Arrhythmia, Cardiac Arrest and Conduction Disorders W/O Cat or Sev CC

0.4 13 3 €1,734 €6,900

J64A: Cellulitis W Catastrophic or Severe CC 1.4 37 15 €9,505 €16,937

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In Patient,

Day Case,

OPD & ED

Cost Drivers

CONSULTANT

TIME

NUMBER

NCHD’s

ANP /

CLINICAL

NURSE

SPECIALIST

WARD COSTS

ALLIED

HEALTH

OTHER

ANCILLARY

SERVICES

ICT Requirement to capture

data?

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Vision

Aims

Strategic Work

Streams

Strategic Enablers

Funding Stream Management

Absolute Cost Identification

Allocation & Cost Drivers

Service Line Management

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Funding Model for Acute Hospital’s

Strategy for St James’s Hospital

Future Opportunities & Challenges

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• Integrated care pathways

• Insight driven

• Value based healthcare

• Outcome measurement

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