DRG Workshop Belgrade, 18-22.November 2013. DRGs and per case financing Prof Ric Marshall OAM The University of Sydney

DRG Workshop Belgrade, 18-22.November 2013.

DRGs and per case financing

Prof Ric Marshall OAMThe University of Sydney.


HOSPITAL BUDGET HOSPITAL BUDGET MODELLING IN A DRG MODELLING IN A DRG ENVIRONMENTENVIRONMENT


http://www.health.vic.gov.au/pfg/pfg2005/pfg0506.pdf


Non-admitted

T&D including complexit Allaocati &compen

sation

Excluded Fixed cost

(eg Suparann

uation) adjustme

Specified grants

excluding complexi

Bonus fundin

Quality fund incl

materniElectiv surgery

DRG Variable

payments Total

'000s '000s '000s '000s 000s '000s '000s '000s '000s

H1 81,301.51 25,993.81 2,637.36 167,454.49 2,228.97 0.00 8,361.72 297,957.72 585,935.59

H2 45,272.64 11,615.78 1,000.88 76,562.44 1,895.04 1,077.72 3,888.00 220,373.13 361,685.64

H3 86,143.27 26,843.59 1,843.69 192,671.88 3,193.91 538.77 2,666.70 383,295.22 697,197.03

H4 15.59 245.54 0.00 28,573.59 0.00 0.00 0.00 0.00 28,834.54

H5 72,649.31 16,353.38 1,834.34 107,966.85 6,687.10 2,933.15 3,241.23 393,193.11 604,858.67

H6 76,254.00 25,774.49 2,272.43 136,387.50 2,228.97 0.00 3,205.65 340,554.13 586,677.36

H7 36,699.67 6,724.51 143.95 15,762.17 0.00 3,495.02 0.00 159,497.49 222,322.82

H8 37,914.00 8,696.94 1,111.09 83,506.46 2,228.97 1,264.22 684.00 166,836.32 302,242.38

H9 34,588.24 8,674.02 277.82 88,156.04 2,228.97 1,338.30 1,445.21 215,701.91 352,410.69

H10 16,127.65 8,217.04 1,091.66 71,738.47 0.00 0.00 0.00 73,333.68 170,508.49

etc etc etc etc Etc etc etc etc etc etc

Total 890,120.32 233,542.13 20,565.97 1,463,098.34 36,627.05 21,083.65 46,837.05 3,735,355.30 6,447,229.99

MODELLED BUDGETS MODELLED BUDGETS EXAMPLEEXAMPLE


• Inpatient budget/expenditure estimates

• Total hosptial budget for period• Multiplied by IFRAC

• HOSPITAL EXPENDITURES AND IFRACS.xlsx

Inpatient budget estimatesInpatient budget estimates


The modelling processThe modelling process

• Inpatient budgets by hospital• Inpatient volumes by DRG by hospital• Cost weights by DRG• Price from total inpatient budget

– IF COSTWEIGHTS ARE REBASED

• Allocate modelled budget by weighted DRGs

• Adjust for redistributions above 5%• JUL AUG DRG DATA MODEL IT2.xlsx


General HospitalsAdmitted patient payment Feb10*2

JULAUG10 UNWTD Cases

JULAUG08 WTD Cases

Casemix Index (CMI)

PRICE MODELED CSMX PAYMENT

% REDIST / ADJUST

HOSPITAL 0 2 2 0.96 12,897 24,683 #DIV/0!HOSPITAL 1 2,647 2,427 0.92 12,897 31,295,068 #DIV/0!HOSPTIAL 2 22,892,275 1,676 1,694 1.01 12,897 21,841,740 -4.59%HOSPITAL 3 6,736,857 543 523 0.96 12,897 6,738,988 0.03%HOSPITAL 4 13,366,371 1,087 864 0.79 12,897 11,139,141 -16.66%HOSPITAL 5 3,783,590 578 464 0.80 12,897 5,980,649 58.07%HOSPITAL 6 9,667,894 1,211 997 0.82 12,897 12,855,941 32.98%HOSPITAL 7 5,122,843 1,526 1,076 0.70 12,897 13,872,795 170.80%HOSPITAL 8 5,661,691 764 637 0.83 12,897 8,214,503 45.09%HOSPITAL 9 22,819,387 1,381 1,253 0.91 12,897 16,158,023 -29.19%HOSPITAL 10 1,460 1,327 0.91 12,897 17,115,660 #DIV/0!HOSPITAL 11 24,219,319 1,726 1,786 1.03 12,897 23,031,139 -4.91%HOSPITAL 12 15,736,009 1,394 1,040 0.75 12,897 13,415,838 -14.74%HOSPITAL 13 17,485,524 2,000 1,679 0.84 12,897 21,657,054 23.86%HOSPITAL 14 39,213,743 2,065 1,791 0.87 12,897 23,095,039 -41.10%HOSPITAL 15 24,990,846 2,460 2,616 1.06 12,897 33,733,007 34.98% 275,458,763 15,253 17,600 1.15 12,897 226,985,844 -17.60%

487,155,112 37,773 37,773 1.00 12,897 487,155,112 0.00%

Initial modelling framework Initial modelling framework demonstrationdemonstration


Alignment of expenditure data and activity dataCleaning up data by deleting test hospitals dataAggregations of clinics to best approximate a major

teaching hospital for benchmarking purposes.Rechecking estimated IFRACS.Rechecking grouping patterns of hospitals

◦Review grouper logic◦Compare hospital level casemix patterns with peer hospitals ◦Check changes in casemix across time periods.

GENERAL CHECKS/CORRECTIONSGENERAL CHECKS/CORRECTIONS


• Check for missing data Hosp A Hosp B

• Check for missing expenditure data

• Allocate clinics to hospitals?? Or model budgets independently??

• Check hosp X for overcounting of cases or underestimate of current revenue.

– ??Duplicate data

– ??Admitted outpatients

– Ifrac

• Check Hosp Y and Hosp Z For whereabouts of revenue and ??Cases.

Specific corrections


Managing demand for hospital services

• Demand is very elastic.

• What is the right amount?

• Is more better? Prevention investment?

• Targets, incentives to substitution or both?

• Engaging community – self care

• Referral gatekeeper – copayments (equity)

• Budgetary restraint a weak signal.


Target setting

• Based on projection or current baseline– Same as last year’s targets– Same as last year’s actuals

• Adjustment for growth

• Adjustment for efficiency dividend

• Planned service implementation – geographical redistribution

• New services and technology allowance


Innovation, research and development • Cannot be covered by DRG weights based

on previous year’s costings.

• Must be covered by funding supplementation – then becomes absorbed in DRG costs.

• Low volume high cost exceptional services OK for DRG funding if accurately costed– Usually high fixed costs relatively low

variable.


Data sets required for DRG funding of hospital services

• Activity– Data set specification– Coding rules– counting rules– admission rules

• Expenditure previous years’ – quarters’– Standard chart of account - for patient costing– Cost disaggregation standard models.

• Budget and planning estimates

• Price lists



REPORTING FEEDBACK• The key to

– GOOD DATA– EFFICIENCY GAINS– PERFORMANCE IMPROVEMENT

• The basis for rational planning

• A primary mechanism to assess innovation and investment priorities.


Standard reports may include• Productivity• Complexity• Allocative efficiency

• ‘doing the right things’

• Technical efficiency ‘doing things right’

• Coding Completeness• And various quality indicators

– Outcome – Process

• Some examples follow …


Productivity• Performance in total Weighted Episode (WEs) of all

hospitals • Overall performance in total WEs against target by

hospital• WEs by Major Diagnostic Categories (MDC) for Medical

Diagnosis Related Group (DRGs) by hospital• WEs by MDC for Procedural DRGs by hospital• Top 10 increment DRG families by hospital • Top 10 decrement DRG families by hospital


Complexity

– Casemix Index of Medical and Procedural DRGs of all hospitals

– Casemix Index (CMI) by MDC by hospital– Average WEs per patient by MDC in by

hospital– Average number of episodes per patient by

MDC by hospital– Casemix – “1 Year On”


Allocative Efficiency

• Percentage same day episodes by MDC of Medical and Procedural DRGs by hospital

• Change in same day episodes of Ambulatory Medical DRGs

• Percentage of episodes admitted via A&E Department by MDC by hospital


Technical Efficiency

• Average Length of Stay (ALOS) of Medical & Procedural DRGs of all hospitals

• Change in ALOS by MDC by hospital

• Cost per weighted DRG by hospital


Coding Completeness– Percentage of total multi-day episodes for Medical

and Procedural DRGs by severity level in all hospitals– Percentage of total multi-day episodes with Major Co-

morbidities and Complication (MCC) by MDC for Medical DRGs by hospital

– Percentage of total multi-day episodes with MCC by MDC for Procedural DRGs in all hospitals

– Percentage of total multi-day episodes with MCC by MDC by hospital

– WE / CMI by discharged specialty: 4-year trend analysis by hospital


DRGs – QUALITY AND SAFETY

[email protected]


THE FIRST IDEA OF EFFICIENT PRICE

• Data and information for fair and accurate costing and pricing (1)– What is efficient in terms of a reasonable price to

pay? • what is the budget? – realistic quality?

– Accuracy in costing – capital costs – sector differences – lumpy costs (eg redundancies)?

– What about regional cost/salaries/inputs price variations?

– Differences in packaging – eg include workup?– Scale of operation?– Equivalent developing models of care?


THE SECOND IDEA OF EFFICIENT PRICE

• The Payment System – what are you actually paying for?

NHIFMoH

INSURERSPATIENT

HEALTH SYSTEMOPERATORS,

REGIONS,HMOs

EMPLOYED PRACTITIONERSDrug, MD SUPPLIERSSUPPORT SERVICESMANUFACTURERS

HOSPITALS,HEALTH CLINCS,PRACTITIONERS


Coding activity to DRGs

• DRG grouper software online in PAS systems in hospitals– Immediate feedback on DRG effect of coding

• Code finder functions for DRG – optimisation

• Batch or individual record grouping– Patterns of activity by DRG

• DRG pattern reporting and feedback loops


Types of Costing (1/2)

Clinical Costing

Bottom up costing approach

Each patient episode is a product

Requires data of all goods and services consumed in the treatment of individual patients

Allows analysis of resource use by individual patient episode

26


Types of Costing (2/2)

Cost Modelling

Top down approach

Relies on the use of ‘service weights’ and/or other generalised utilisation statistics

27


Patient costing provides detail at the individual patient episode

Easier to apply patient costing to other patient types

Patient costing systems are a good data repository

Why patient costing?

28


Org Code Financial Period PCTAnonymised

Local Patient IDSpell ID Episode ID

Episode start date

Episode end date

Admission date

Discharge date

Episode length of stay

TFC POD Age OPCS 1

RQ3 201213 5PE L1241208 500347135 500347135.3 01/12/2011 01/05/2012 01/12/2011 01/05/2012 152 258 EL PA01A HC02B PA01A HC02D 1RQ3 201213 5M3 L1263467 500348124 500348124.2 14/11/2011 07/05/2012 14/11/2011 07/05/2012 175 711 EL PA52C PA52C PA52C PA52C 16RQ3 201213 5MX C712622 500351125 500351125.3 14/12/2011 20/05/2012 14/12/2011 20/05/2012 158 711 EL PA50Z PA52C PA50Z PA52C 15RQ3 201213 5PG L1266285 500352861 500352861.2 16/03/2012 09/07/2012 16/03/2012 09/07/2012 115 711 EL PA05C PA52C PA05C PA05C 15RQ3 201213 5MK L1268281 500354156 500354156.3 18/06/2012 23/09/2012 18/06/2012 23/09/2012 97 258 NE EA23Z EA23Z EC03C EC03C 1 K174 K174RQ3 201213 5PF L1252138 500355340 500355340.1 23/11/2011 27/07/2012 23/11/2011 27/07/2012 247 711 EL PA53B PA53B PA53B PA53B 16RQ3 201213 5PM C647965 500358421 500358421.1 16/12/2011 20/07/2012 16/12/2011 20/07/2012 217 711 EL PA53B PA53B PA53B PA53B 12RQ3 201213 5QW L1272889 500359817 500359817.4 02/04/2012 23/01/2013 02/04/2012 23/01/2013 296 290 NE PA01A LB11B PA01A LB10B 15 G345 G345RQ3 201213 5QW L1272889 500359817 500359817.5 23/01/2013 28/03/2013 23/01/2013 28/03/2013 64 211 NE LB11B LB11B LB10B LB10B 16 M192 M192RQ3 201213 5M3 C587668 500346374 500346374.1 07/09/2011 06/06/2012 07/09/2011 06/06/2012 273 711 EL PA52C PA52C PA52C PA52C 15RQ3 201213 5PM L1266584 500353394 500353394.1 04/11/2011 31/08/2012 04/11/2011 31/08/2012 301 711 EL PA53B PA53B PA53B PA53B 16RQ3 201213 5PE L1264842 500355057 500355057.1 18/11/2011 14/05/2012 18/11/2011 14/05/2012 178 711 EL PA52C PA52C PA52C PA52C 15RQ3 201213 5PF L1270048 500356405 500356405.7 17/04/2012 18/04/2012 17/04/2012 18/04/2012 1 260 NE PA42Z UZ01Z SA34Z UZ01Z 2 X361 X361RQ3 201213 5PA L1238745 500316978 500316978.1 09/12/2010 18/06/2012 09/12/2010 18/06/2012 557 711 EL PA53B PA53B PA53B PA53B 11RQ3 201213 5PL L1266048 500352076 500352076.1 27/10/2011 06/07/2012 27/10/2011 06/07/2012 253 711 EL PA53B PA53B PA53B PA53B 16RQ3 201213 5QH L1267680 500353279 500353279.1 07/11/2011 30/04/2012 07/11/2011 30/04/2012 175 251 EL PB02Z PB02Z RC16Z RC16Z 0 H221 H221RQ3 201213 5PL C579888 500354432 500354432.1 16/11/2011 28/12/2012 16/11/2011 28/12/2012 408 711 EL PA53B PA53B PA53B PA53B 17RQ3 201213 5PL L1270250 500356715 500356715.4 15/03/2012 13/04/2012 15/03/2012 13/04/2012 29 308 EL PA45Z PA45Z PA45Z SA34Z 2RQ3 201213 5PL C692748 500352614 500352614.2 21/12/2011 09/05/2012 21/12/2011 09/05/2012 140 711 EL PA53B PA53B PA53B PA53B 16

Front Page 1. Instructions 2. Data Input 3. Validation 4. Summary 5. Reconciliation 6. Sign-off Field Definitions Code Tables

PLICS Data Collection Template 2012-13

Please enter your PLICS data in the fields below. Field definitions can be found in the "Field Definitions" worksheet.

For the macros to function correctly, it iscrucial that every entry has an OrgCode recorded against it.

Monitor has been working on costing development for some time

29


Issues with Reference costs

Poor data quality and lack of credibility (e.g. 1 in 8 submissions contained materially incorrect costs, significant unexplained variations in unit costs)

Lack of clinical validity (e.g. cost relativity do not match with clinical input)

Lack of granularity

Poor input data

Issues with Reference costs

Poor data quality and lack of credibility (e.g. 1 in 8 submissions contained materially incorrect costs, significant unexplained variations in unit costs)

Lack of clinical validity (e.g. cost relativity do not match with clinical input)

Lack of granularity

Poor input data

Reference costs are not considered to be fit for purpose in the long run

30


We opened a pilot 2012/13 collection on 12 June 2013 and closed on 27 September

Focused on Admitted Patient Care

66 acute trusts took part in the collection and provided data

Cost data provided are at cost pool level

Trusts also provided coding information

We also collected information to aid our understanding of trusts’ approach to costing

For participating trusts

A trust pack (high level benchmarking)

Further engagement events to help us develop future guidance and assessing the regulatory burden

For Monitor

Assessing the data quality

Data exploration (e.g. PLICS vs. Ref Costs, sampling)

Benchmarking potentials

Evaluating the potential of using PLICS for pricing / currency development

PLICS data – currently collecting to see how it can be used (1)

31


Example of Pilot PLICS CollectionNote: This is a partial snapshot only (it is not a full data sheet)

Anonymised Local Patient ID

Spell ID Episode IDEpisode

start dateEpisode end date

FCE HRG (RC)

Spell HRG (RC)

OPCS 1 OPCS 2 ICD10 1 ICD10 2 Total CostBlood and Blood

ProductsCritical care

Drug Costs (excluding High Cost

Drugs)

Drug Costs (High Cost Drugs)

Imaging Medical Staffing

201200572 67553676755367-6755367 18/01/2012 24/05/2012 FZ69C FZ69C T309 G698 C837 Z511 81466.35592 3907.600235 3705.872062 4804.440494 1563.773183 914.6790091 10420.34636200605286 67653606765360-6765360 23/02/2012 24/05/2012 FZ66D FZ66D M295 Y152 Z436 C56X 48965.48904 870.9660828 0 973.316124 1798.502776 592.9591856 8097.743662201201494 67659516765951-6765951 27/02/2012 27/04/2012 CZ24O CZ24O C021 Z510 21,088 0 0 740 0 196 1,711201200370 67659756765975-6765975 27/02/2012 05/04/2012 HD40E HD40E U071 Y971 C491 Z510 5,790 0 0 268 0 119 1,084201201057 67659946765994-6765994 27/02/2012 15/05/2012 LB60C LB60C T309 T364 C180 R18X 49,380 1,276 1,407 39 0 3,380 9,672200911082 67669986766998-6766998 29/02/2012 13/04/2012 CZ23X CZ23X X708 X867 J069 B259 32,155 1,444 0 854 4,892 647 1,354200111584 67673406767340-6767340 01/03/2012 02/04/2012 RC16Z RC16Z X715 L997 C920 Z511 23,734 2,985 0 1,162 0 65 992201014661 67676496767649-6767649 02/03/2012 06/04/2012 SA35C SA35C X903 W365 D70X Y433 19,338 2,190 0 874 0 571 1,079200701731 67680186768018-6768018 05/03/2012 02/04/2012 KC05K KC05K U051 Y973 E876 C56X 10,011 0 0 270 0 0 812201109554 67695356769535-6769535 09/03/2012 22/05/2012 WA03B WA03B W365 Y532 A419 D70X 28,050 580 0 2,024 133 565 2,137201115251 67696136769613-6769613 11/03/2012 12/04/2012 DZ22G DZ22G X715 X715 J22X B958 12,125 0 0 524 0 0 914201201129 67698146769814-6769814 12/03/2012 13/04/2012 SA31C SA31C X708 A521 C844 Z511 27,868 697 0 976 6,662 644 1,826201202954 67703626770362-6772154 20/03/2012 06/04/2012 SA31D SA31D U052 Y973 C833 B59XD 9,511 0 0 230 0 0 1,876201109911 67706806770680-6770680 14/03/2012 09/04/2012 SA26A SA26A X705 X702 C833 Z511 9,515 1,365 0 355 0 420 805201102818 67706836770683-6771877 20/03/2012 29/04/2012 RC32Z RC32Z X708 J486 J012 K831 54,665 1,916 0 1,588 16,479 3,385 1,163201203450 67713406771340-6771340 16/03/2012 21/04/2012 SA25H SA25H X711 X862 C920 Z511 29,461 2,965 0 1,267 1,240 1,048 1,097201202632 67714196771419-6771419 16/03/2012 21/05/2012 AA24C AA24C X679 Y921 C711 Z510 35,634 290 0 1,718 0 559 1,875201202016 67716416771641-6771641 19/03/2012 27/04/2012 AA24G AA24G U052 Y971 C712 G919 14,616 0 0 399 0 0 1,113201201333 67719756771975-6771975 20/03/2012 07/04/2012 GC12G GC12G U212 Y971 C250 C780 7,674 1,055 0 220 0 355 516201202790 67725086772508-6772508 21/03/2012 05/04/2012 WA14A WA14A U212 Y981 C341 Z530 6,956 0 0 153 0 65 1,818200500860 67725156772515-6772515 21/03/2012 01/04/2012 HD40F HD40F C795 Z510 4,658 0 0 93 0 0 1,702200900815 67725326772532-6772532 21/03/2012 04/04/2012 SA31D SA31D X701 A559 C852 J22X 4,731 0 0 210 0 0 407201200842 67729396772939-6772939 22/03/2012 12/04/2012 FZ92K FZ92K C155 Z510 26,938 0 5,656 278 0 391 8,609201108076 67730646773064-6773064 22/03/2012 03/04/2012 GC12H GC12H C250 C786 3,691 0 0 144 0 0 348201200653 67734156773415-6773415 24/03/2012 03/04/2012 KC05L KC05L E86X C64X 2,975 0 0 122 0 0 290

32


Total Trusts

Implemented 121

Implementing 33

Planning 53

Not Planning 37

TOTAL 244

33

PLICS are now widely implemented across the NHS, especially among acute providers


PLICS data – currently collecting to see how they can be used (2)

Nearly 70% of acute trusts have now implemented PLICS. Previous studies also showed that it could bring the following benefits:

Improved accuracy and consistency

Greater granularity

Greater transparency on cost drivers and what drives cost variations

Greater potential for benchmarking, currency design and pricing development

Nearly 70% of acute trusts have now implemented PLICS. Previous studies also showed that it could bring the following benefits:

Improved accuracy and consistency

Greater granularity

Greater transparency on cost drivers and what drives cost variations

Greater potential for benchmarking, currency design and pricing development

34


Understanding the real cost of NHS services will enable the right prices to be set

Costing services accurately has the potential to deliver higher quality care to patients and better value for tax payers in the long term - through better prices and improved information for decision makers and providers

Having accurate patient level data is key to identifying the drivers of costs - and also the potential opportunities for improved quality of service for patients through innovation

In Summary

35


Tracking expenditure to DRGs


The fundamental of costing


Cost per case – bottom up


DRG based – top down


Australia National hospital cost data collection

DRG Description Cost Standard Number Number ALOS Average Cost per DRG ($) Average Component Cost

per DRG ($)

Weight Error of Seps of Days (Days) Total Direct Ohead Ward Medical Ward Nursing

Non Clinical Salaries

Pathology

DRG

Direct Ohead Direct Ohead Direct Ohead

W01Z Ventiln/Cranio Mult Sig Trauma 22.30 0.08 1,157 35,485 30.68 82,988 68,277 14,711 3,984 784 7,277 1,333 1,572 3,194 468

I69B Bne Dis&Sp Arth A>74/+Cscc 0.90 0.02 5,675 25,445 4.48 3,336 2,421 915 393 59 883 197 203 96 23

C63A Other Disorders Of The Eye +Cc 1.07 0.04 839 3,027 3.61 3,974 2,949 1,025 519 66 957 200 256 99 20

I68A Non-Surg Spinal Disorders +Cc 2.22 0.05 7,466 65,483 8.77 8,280 6,075 2,206 957 126 2,416 479 506 182 41

C01Z Proc For Penetratng Eye Injury 1.90 0.05 609 2,196 3.61 7,084 5,493 1,592 1,181 208 999 247 269 101 12

F21B Oth Circ Sys O.R. Pr -Ccc 1.93 0.02 1,037 5,456 5.26 7,186 5,541 1,645 802 136 1,405 288 383 150 36

E70A Whoopng Cgh &Acte Brnchio+Cc 1.66 0.03 1,722 7,963 4.62 6,186 4,550 1,636 895 109 1,975 315 422 151 34

B60B Estab Para/Quad+/-Or Pr-Ccc 2.14 0.04 4,319 28,993 6.71 7,963 5,979 1,985 892 144 2,258 512 485 155 29

U60Z Mental Health Treat+Samedy-Ect 0.22 0.00 11,571 11,652 1.01 829 623 206 80 8 66 32 23 21 5

J12C L Lmb Pr+Ulcr/Cels-Ccc-Graft 2.54 0.04 668 6,189 9.27 9,451 7,026 2,425 1,184 176 2,498 524 599 216 38

P66D Neo,Admwt 2000-2499G-Sg Op-Prb 1.01 0.04 2,510 13,625 5.43 3,746 2,731 1,015 658 67 1,093 242 176 47 13

X04A Other Pr Inj Lwr Lmb A>59/+Cc 2.66 0.03 497 3,636 7.32 9,890 7,675 2,215 1,084 161 1,958 409 452 218 36

M04A Testes Procedures + Cc 1.54 0.02 405 1,381 3.41 5,720 4,450 1,270 745 122 931 232 218 191 26

G10Z Hernia Procedures A<1 0.86 0.00 1,224 1,660 1.36 3,201 2,489 712 326 36 454 94 123 18 4

G67B Oesphs,Gastr&Mis Dg D A>9-Cscc 0.42 0.00 64,401 122,232 1.9 1,551 1,146 406 163 20 277 64 72 68 15

I19Z Other Elbow, Forearm Procs 1.72 0.01 10,576 27,694 2.62 6,386 5,065 1,321 553 87 705 166 193 41 8

N60B Malignancy Fem Reprod Sys-Cscc 1.02 0.02 1,111 2,964 2.67 3,792 2,866 925 381 51 870 159 277 81 20

F40Z Circ Sys Dx+Ventilator Support 5.70 0.04 749 6,440 8.6 21,204 17,123 4,081 1,252 191 1,334 251 456 1,069 181

I75A Inj Sh,Arm,Elb,Kn,Leg A>64+Cc 2.15 0.05 3,302 33,352 10.1 8,007 5,783 2,224 834 139 2,433 542 493 201 43

A09A Renal Transplant+Pancreas/+Ccc 13.04 0.23 224 3,471 15.52 48,540 40,935 7,604 3,736 696 6,760 1,024 1,496 2,961 398

I13C Humer,Tib,Fib,Ank Pr A<60-Cscc 2.00 0.01 12,090 43,547 3.6 7,448 5,863 1,585 713 116 997 244 253 42 8

B67B Degnrtv Nerv Sys Dis A>59-Cscc 1.16 0.02 2,907 16,200 5.57 4,323 3,194 1,129 566 76 1,203 264 288 95 21

P06B Neo,Admwt >2499G+Sig Or Pr-Mmp 5.18 0.02 425 4,388 10.33 19,264 15,603 3,661 974 70 914 135 402 843 223

G70B Other Digestive System Diag-Cc 0.39 0.01 13,873 22,142 1.6 1,460 1,100 359 199 21 238 58 75 38 8

E70B Whoopng Cgh &Acte Brnchio-Cc 0.79 0.01 11,193 25,954 2.32 2,947 2,170 777 438 42 935 156 207 77 21

F41B Crc Dsrd+Ami+Inva Inve Pr-Cscc 1.56 0.01 3,786 14,809 3.91 5,800 4,652 1,148 516 87 519 91 291 162 20

C15B Glaucoma/Cx Cataract Procs,Sd 0.66 0.02 1,957 1,957 1 2,469 1,882 587 395 33 98 42 48 3 1

B74Z Nontraumatic Stupor & Coma 0.85 0.02 1,183 3,620 3.06 3,157 2,451 706 322 45 690 138 136 138 26

H01B Pancreas, Liver &Shunt Pr-Ccc 3.99 0.03 1,129 9,704 8.59 14,844 11,870 2,974 1,466 187 2,414 467 629 556 90

P61Z Neonate, Admission Wt <750G 40.40 0.65 305 23,781 78 150,380 116,921 33,459 4,748 311 1,779 147 1,049 3,904 686

Z62Z Follow Up -Endoscopy 0.32 0.01 11,647 15,211 1.31 1,201 931 270 177 52 174 51 53 43 7

G05B Mnr Small & Large Bowel Pr -Cc 1.72 0.01 892 4,104 4.6 6,405 4,938 1,467 887 103 1,148 278 318 162 34

H01A Pancreas, Liver & Shunt Pr+Ccc 8.45 0.08 861 16,575 19.25 31,458 25,228 6,231 3,301 561 5,497 1,177 1,166 1,360 231

F09B Oth Cardiothor Pr-Pmp -Ccc 3.89 0.03 413 2,161 5.23 14,477 11,847 2,630 1,187 155 1,584 213 797 418 71

X06A Other Pr Other Injuries + Cscc 3.48 0.03 1,756 16,177 9.21 12,961 10,135 2,826 1,556 253 2,439 549 567 378 69

NATIONAL HOSPITAL COST DATA COLLECTION COST WEIGHTS FOR AR-DRG VERSION 5.1, Round 11 (2006-07)


NHCDC Reporting Standards

http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/EC0666091A19EBB1CA257B9B0083827A/$File/HospitalPatientCostingStandards_v2_Final_June%202011.pdf


In summary - Why do we need clinical costing?

• Accurately value products – eg DRG’s for funding– Costweights for funding and payment – Activity analysis in weighted activity terms

• Benchmark our hospital against others and over time– Properly manage performance – care profiles– Set achievement targets – ‘match the above

average performers over the next two years’


Any questions?

Documents

DRG Workshop Belgrade, 18-22.November 2013. DRGs and per case financing Prof Ric Marshall OAM The University of Sydney