Hospital Benchmarking Prices ModelOverview: Hospital Benchmarking Prices Model Overview


Overview: Overview Pricing Strategy Team Hospital Benchmarking Prices Model (HBPM) Context Major changes Components Operation Summary


Pricing Strategy Team: Pricing Strategy Team Part of Procurement Strategy Unit (Health Services Division) Clinical Strategy Team Quality Strategy Team Surgical Access Service Primarily responsible for: National Hospital Cost Data Collection (NHCDC) Clinical Benchmarking Project Hospital Benchmarking Prices Model (HBPM)


Context: Context ASAP (Aligning Services and Priorities) and CBRC (Cabinet Budget Review Committee) emphasis on identifying areas where performance could be improved and initiating appropriate management action includes Measured Quality Program (MQP) indicators (efficiency and clinical) approved by Health Services Council 2002/03 and 2003/04


Major Changes - scope: Major Changes - scope Hospital Funding Model (HFM) recurrent budget >$2M HBPM MQP indicators >$2M comparative budgets >$6M more realistic limited value to remote/rural hospitals with high proportion of fixed costs


Major Changes - peer groups: Major Changes - peer groups different groupings generated input from Zones changes: Mater Mothers’ (NICU) Gold Coast (Group A) Redland, Gladstone (expansion) Group X (lack of costing structures)


Major Changes - cost benchmarks: Major Changes - cost benchmarks Previous phases based on projected budgets and activity budgets conservative activity targets optimistic result is prices lower than actual cost HBPM used actual costs adjusted for CPI and Enterprise Bargaining increases more realistic


Components: Components Acute Inpatients Sub and Non-Acute Patients (Designated Units) Sub and Non-Acute Patients (General Wards) Designated Psychiatric Units Emergency Ambulatory Renal Dialysis Other Specified Activity


Acute Inpatients: Acute Inpatients V4.2 AR-DRGs Round 5 NHCDC (National Hospital Cost Data Collection) cost weights Base price of $2,500 better reflects actual average cost per case (was $1000) Cost weight of 1 indicates that the DRG cost benchmark is close to the state average


Acute Inpatients: Acute Inpatients HBPM cost benchmark depends on: Peer group different cost weights for each group Public/private status ward medical, prosthetic, pathology and diagnostic imaging excluded from private cost weights Length of stay trim points inlier versus outlier


Trim Points: Trim Points low, high, extra high trim points trimming of data to exclude anomalies not clinically meaningful could use cost per day of stay investigate for next model


Outliers: Outliers


Acute Inpatients: Acute Inpatients “Zero Weight” DRGs specific Error DRGs Rehabilitation DRGs (Z60A, Z60B) SNAP bedday cost benchmark V5.0 AR-DRGs released September 2002 preliminary analysis shows 84% match with V4.2


Sub and Non-Acute Patients (SNAP): Sub and Non-Acute Patients (SNAP) Designated Units bedday cost benchmarks for each AN-SNAP Class Type Zero ADL score = SNAP General Ward benchmark Commonwealth review of SNAP General Wards bedday cost benchmarks based on care types (9, 10, 11, 23, 23, 32, 33)


Designated Psychiatric Units and Emergency Departments: Designated Psychiatric Units and Emergency Departments Designated Psychiatric Units (acute) Bedday cost benchmark for days in a designated unit (based on type of unit) additional DRG payment if days outside unit Emergency Departments cost benchmarks for triage categories NHCDC data quality questionable Emergency NMDS


Ambulatory and Dialysis: Ambulatory and Dialysis Ambulatory cost benchmark for each group groups unique to QH non-admitted data project Dialysis L61Z now has a cost weight (was zero in HFM) included in weighted separation data annualised costs retained for other modalities


Other Specified Activity: Other Specified Activity Costs excluded from benchmarking process Reported to account for total budget examples: Optometrical and Home Medical Aids; specialised statewide services such as Bone Bank


Operation: Operation Comparative and casemix budgets benchmark Surgical Access Service elective surgery funding Veterans’ Health Services Unit contract with Commonwealth to fund Veterans


Quality: Quality Queensland Health coding audit (KPMG) role of Queensland Coding Committee recommendations follow up by Audit and Operational Review Branch


Summary: Summary HBPM incorporates quality measures, not just cost efficiency relationship between Clinical Benchmarking System, NHCDC and HBPM


Contact Details: Contact Details Samantha Daly Principal Policy Officer Pricing Strategy Team (07) 3234 0214