Ross Wilson, Cost Pro Plus - More than the Sound of One Hand Clapping

More than the Sound of One Hand Clapping

Ross Wilson Managing DirectorCosting and Business Solutions Pty [email protected]

www.costproplus.com

CostPro Plus - the most accurate real time information at your fingertips

The Sound of One Hand Clapping

The Sound of One Hand Clapping is a 1997

novel by Australian author Richard Flanagan.

The title is adapted from the famous Zen kōan

of Hakuin Ekaku:

“You know the sound of two hands clapping;

tell me, what is the sound of one hand?”.


The Sound of One Hand Clapping

There is no right answer to the koan,

But in extending this imagery to health we could say:

– Hands can represent the two sides of health – one being the

clinical and the other business/funding

– The two hands are part of one body that should function in

unison

– Health organisations need reporting / decision support that is balanced in both clinical and business


Background

Mainly discuss / cover two areas of costing use

– COAD

– Stroke pathway

In New Zealand

– 20 LHNs with CostPro in 9

– National Cost Data request now in 9th year

– Monthly costing with daily reporting

– Mental Health and Community big areas of focus


New Zealand Context

10 years ago Patient Costing:

– A compliance duty

– A slow turn around of results (often only annual)

– Complicated and not user friendly

– A black box

– No Costing or Counting Standards

– The beginning of national cost data collection


New Zealand Context

Today Patient Costing is about:

– Costing is updated monthly as the GL changes but

patient events are costed every day

– Near real time reporting

– National cost data available to all in Excel data

cubes

– Using patient cost data to identify clinical issues and

business issues


The panacea of decision support

The ultimate in decision support is:

– Active engagement with Clinicians / Managers

using both cost and qualitative measures

– Near real time reporting

– Exception reporting so that the recipient can focus

on the important things

– Reporting that creates a culture of continuous

improvement in clinical / management practice

and is not about blame


DRG E65B COAD

Chronic Obstructive Airways Disease

An example of using costing data

Engage Clinicians to:

– Improve health outcomes

– Standardise practice

– Reduce unnecessary testing


National Data Cube

Accessible through Internet with secure login

Users can link directly to the data cube via Excel

Updated after each annual cost data request

Mainly used for pricing, benchmarking and validation

of costs

A lot of demographic fields available which allows for

slicing /dicing


What does the National Data look Like?

A B C D E F G H I J K L M N O P Q R S T U V

Avg Cost Per WIES 4171 4618 5041 5232 4453 5370 5288 4894 4067 5094 4353 5601 4677 6365 5856 4228 5104 5696 5189 3779 4176 7081

Avg WIES per event 0.83 0.84 0.84 0.83 0.77 0.73 0.80 0.83 0.70 0.76 0.81 0.78 0.79 0.85 0.85 0.83 0.84 0.85 0.76 0.81 0.68 0.79

0.50

0.55

0.60

0.65

0.70

0.75

0.80

0.85

0.90

$3,000

$3,500

$4,000

$4,500

$5,000

$5,500

$6,000

$6,500

$7,000

$7,500

WIE

S

$

Hospital

Average Cost Per WIES and WIES per Event by Hospital - DRG E65B COAD W/O CC


-$100,000

$0

$100,000

$200,000

$300,000

$400,000

$500,000

$600,000

$700,000


$

Hospital

Cost Overhead compared to Benchmark Hospital - DRG E65B COAD W/O CC


4

544

74

431

2555

222250

-31

-108

55

-8

140

27

117

14

73

183

18

-51-74

128

-200

-100

0

100

200

300

400

500

600


Bed

Day

s to

Sav

e

Hospital

Bed Day Savings compared to Benchmark Hospital- DRG E65B COAD W/O CC


Now to CostPro…

Reviewed the National Data cube – now to

CostPro

Patient Cost Profile report…


CostPro Patient Cost Profile


Jump to the Doctor Summary Report


Doctor Summary


MRI Utilisation


Feedback from Clinicians

Amazing amount of data and detail

Using cost as a tool to identify anomalies is

different to other tools used

We see there is a lot of unnecessary testing

that we want to eliminate

We want to move to more standardised

practice and this will assist us

Monthly data is good because it is current


Another example -Stroke Clinical Protocol

An example of using qualitative data from the

costing system to identify differences in clinical

practice

We have identified 6 Flags that we can track in

the system that are important to stroke patients


Stroke Flags

STK Code: The Referral Problem Code "STK"

must be attached to all stroke episodes.

OPRS: All stroke patients must have a stay in

the Older Persons Rehab Service (OPRS) ward

before being discharged.

28 Day: Any patients who are readmitted

within 28 days after discharge from a stroke

episode.


Stroke Flags

Statin: All patients must be administered a

'Statin' medication within the first 2 days of

care.

Physio: All patients must be seen by a physio

within the first 2 days of care.

Imaging: All patients must have a CT or MRI

within the first 2 days of care during a stroke

episode.


ConclusionMonthly costing with automated load processes is key

– Make the feedback loop more timely

– Automate data loading to reduce time spent on processing

your costing data

– Automate data loading to increase time spent on analysis

It’s a team effort – management and clinical

– Foster the culture

– You need a clinical advocate

– You need CEO, COO, CFO and at least one Senior Doc as

Champion

More than the Sound of One Hand Clapping

Ross Wilson Managing DirectorCosting and Business Solutions Pty [email protected]

www.costproplus.com

Ross Wilson, Cost Pro Plus - More than the Sound of One Hand Clapping

Health & Medicine

Transcript of Ross Wilson, Cost Pro Plus - More than the Sound of One Hand Clapping