Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing
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Transcript of Sharon Smith, NSW ABF Taskforce - Australian National Sub and Non Acute Patients (AN-SNAP) Costing
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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
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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
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Overview
• What is Sub and Non Acute Care?
• What does “grouped” and “ungrouped” mean?
• Analysis of the differences
• What next?
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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
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AN-SNAP Rehabilitation
Impairment
FIM
Age
Palliative Care
Phase
RUG
Age
GEM
FIM
Age
Maintenance
Maintenance Type
RUG
Psychogeriatric
HoNOS
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What does grouped and ungrouped mean?
Speech Pathology
Physio
OT Nursing
Medical
Clinical data Collected
Clinical data NOT Collected
SNAP Class
No SNAP Class
$
$ \
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What does grouped and ungrouped mean?
l SNAP Class = Grouped
l NO SNAP Class = Ungrouped
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How did we get here?
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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”
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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”
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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
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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
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Questions
l Proportion of ungrouped activity varies by LHD, why?
l Are the grouped and ungrouped patients similar to each other?
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COMPARING THE TWO
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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
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Average Cost per Day
$-
$100
$200
$300
$400
$500
$600
$700
$800
$900
Grouped Ungrouped
$820
$848
Grouped Ungrouped
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Comparative LOS
0
5
10
15
20
25
30
35
40
Ungrouped Grouped
10 12
9
18
Acute Sub-Acute
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Top Level View
l Grouped and Ungrouped SNAP activity similar cost per day
l Differences in Episode costs driven by LOS differences
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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
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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
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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?
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Controlling for Differences
METHODOLOGY
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Maybe its Methodology?
l Analysis using LHD’s/ Facilities that use common methodology – Feeders for A/H , pharmacy for example – Same RVU’s
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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
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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
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Question?
l Are the ungrouped patients more similar to acute than sub-acute?
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CLINICAL PRESENTATION
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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
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Grouped Pool
B70 B B70 C
E62A
B70 A
I03B I08A I03A
I68A L63A Z63B
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Ungrouped Pool
B63Z E65B
B64A
B70A
E65A I73A I68A
L63A F62A
E62A
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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
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COST BUCKET COMPARISON
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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
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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
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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
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Cost Buckets
l RVU’s can work for some costs but not others
l RVU’s need to be current
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Site Choice
Feeder Development
Correct Classification?
Understand methodology
RVU Review and
Development
Clinical Review
Meaningful Grouped
Data
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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