Diagnosing patient care

Getting healthy with benchmarking and business intelligence

Steven Lugard – Dublin, March 2013

Agenda

Central theme: How can Irish hospitals benefit from benchmarking? And what is required to get there? Is it possible today?

Background: Cost per patient in the Dutch DRG System What is benchmarking? Implementation: Technology & management

Some background information:

Cost per patient in the Dutch DRG System

Hospital financing in Netherlands

Until 2005 budget systemLimited impulses for volume/quality/efficiency

Need for cost containment and quality impulse felt strongly by 2002Waiting listsExploding costs (exploding hospitals)

Design of new system: Money Follows the Patient (MFtP)Case based financing introduced in 2005 Starting 2005, prudent growth model

2007: 18% (Hip/Knee/Cataract)2013: 80% of hospital care

First consultation

Diagnostics Theatre

Inpatient stay

Discharge

Check-up

Cost benchmarking in Netherlands

Trusts have own responsibility for financial performance, thus for adequate management information.Need to know own performance vis-à-vis peers

Where are we more expensive or more efficient than our peers?What is causing us to be more/less expensive? Understanding drivers of these costs.Taking action; lowering cost prices or lowering activity levels for treating patients

Forecasting costs; budgeting based on contracted production amounts & benchmarkEarly adapters in the Netherlands are now the most successful trusts

Continuous focus on benchmark, but what is it?

About Benchmarking

Cost breakdown of a DRG

Savings in protocols

What can we reach with influencing the clinician’s behaviour?Own 289 patients

Category Own Peers Best Potential Unit Unit costs Protocol savingsImplant 1 1 1 - units 3,156€ -€ In patient days 8.3 6.9 6.9 405 bed days 321€ 129,877€ Theatre hours 1:47 1:30 1:30 81:53 hours 970€ 79,427€ Laboratory tests 20 32 20 - tests 13€ -€ Radiology exams 2.5 4.2 2.5 - exams 102€ -€ Physiotherapy 6.3 4.7 4.7 462 sessions 48€ 22,019€ Other treatments 4 3 3 289 sessions 18€ 5,058€

236,380€ Cost per patient 8,426€ 7,932€ 7,608€ 818€

Savings % 6% 10%

Protocol

Savings in unit costs

Improving productivity and purchasing conditions adds 10%

289 patientsCategory Best Unit Own Benchmark Best Total savingsImplant 1 units 3,156€ 2,670€ 2,670€ 140,454€ In patient days 6.9 bed days 321€ 289€ 289€ 193,688€ Theatre hours 1:30 hours 970€ 900€ 900€ 109,772€ Laboratory tests 20 tests 13€ 15€ 13€ -€ Radiology exams 2.5 exams 102€ 76€ 76€ 19,074€ Physiotherapy 4.7 sessions 48€ 60€ 48€ 22,019€ Other treatments 3 sessions 18€ 30€ 18€ 5,058€

490,064€ Cost per patient 7,608€ 7,608€ 6,730€

Savings % 10% 10% 20% !!!

Protocol Unit costs

Our new cost breakdown

Getting there:

Technology & implementation

Cost breakdown of a DRG

Hipe

Non-Hipe

…..LantisHIPE Caredos PAS

Dashboard

Benchmark reports

Analysis

C&T C&T C&T C&T C&T C&TConnect and transform

Registration systems

Excel

Cost model TTP Benchmark

database

Technology: current data flow

The data is there. Just connect it.

Performation is currently executing this successfully in Irish hospitals

…..LantisHIPE Caredos PAS

Data ware house

Dashboard

Benchmark reports

Analysis

C&T C&T C&T C&T C&T C&TConnect and transform

Registration systems

Data ware house

Excel

Cost model TTP Benchmark

database

Future data flow in hospital

Structurally assure management information

Management

Don’t wait for everything to be perfectTake (financial) control at local levelBenchmarking is more than technologyImplementation is key

Top management commitmentUse benchmarking as base for budget allocationsDiscussions & workshops with doctorsBuild business cases based on benchmarks

The clinician has to do at least 50%Speak the right language!

Summary

How can Irish hospitals benefit from benchmarking? Get into financial controlPerform better despite budget restraints

And what is required to get there? Costing of the full patient cycleUse all production data sources (Hipe, theatre, pathology, radiology)Technology should be sound: IT and cost model Use the benchmark results in day to day managementTop management should carry the implementation

Is it possible today?Yes, it is possible today in Ireland

Sweelincklaan 1 5 Fitzwilliam Square3712 JA Bilthoven Dublin 2The Netherlands Ireland+31 30 233 3872 +353 1 662 8280

www.performation.com