Bill Stomfay, Queensland Health

Report
Implementing the National 13/14 ABF Model
in Queensland
Bill Stomfay
Manager, ABF Models, Queensland Health
Overview
Disclaimer
Status
Structural Differences (localisations)
Implementation and Results
Unintended Incentives
Other Issues
Disclaimer
QH model only finalised last week
Analysis is draft and subject to change
Does not cover Quality Improvement Payments
Status – 2013/14
Queensland
National
Phase 16 finalised
NEP Determination publicly released
28th February.
IHPA Web Site
Will be used in conjunction
with Purchasing Initiatives for
HHS funding (Service Level
Agreements)
Will determine Commonwealth
share of funding direct to HHSs
Process and Costing
Queensland
National
QH ABF Models Team,
Purchasing Team and DSS
(statewide reporting)
Jurisdictional & Technical
Advisory Groups, several
working groups
As per national model
10/11 (Round 15) NHCDC data
Price Setting
Queensland
Q16 Base Price $4,660
Adjusted for QH localisations
NEP1314 QH $4,660
Set equal to Q16 base price for
simplified comparison with Q16
National
NEP $4,993 = 10/11 costs indexed at
4.7% per annum
Structural Differences
Acute Inpatients
Critical Care
Mental Health
Sub/non-acute Inpatients
Emergency Department
Outpatients
Clinical Education
Acute Inpatients
Queensland
National
Classification
As per national model AR-DRG 6.0X
Trim Points
As per national model Low and High mostly based
on L3H3, MDCs 19 and 20
1.5/1.5
LOS unit
As per national model Whole Bed Days
Acute Inpatients
Queensland
HITH (Hospital Episode payment
in the Home) discounted for 3
specific DRGs and
long stay outlier at
85% for other DRGs
National
No distinction
Acute Inpatients
Queensland
National
Peer Groups
As per national model
Nil
Loadings
As per national model
Paediatric (DRG specific)
ATSI (4.0%)
Outer Regional (8%), Remote (15%),
Very Remote (24%)
Psychiatric age (4% to 30%)
Acute Inpatients
Queensland
National
Sameday DRGs As per national model DRGs with a high trim point
of one day have no long stay
payments
Sameday
Prices
As per national model Several overnight DRGs have
sameday price which
replaces short stay payment
(for sameday patients)
Acute Inpatients
Queensland
National
‘Up Front’
prices
As per national model Surgical (and some other)
DRGs have theatre and
prosthetic base payment
Zero Cost
DRGs
As per national model Error DRGs
plus ‘never’ events,
vasectomies, and
laser refraction
Acute Inpatients
Queensland
National
Private Patients No pricing distinction Discounted price (approx
70% public price)
Compensable No pricing distinction Some out of scope (DVA,
Patients
W/comp, Dept of Defense)
Critical Care
Queensland
As per national model
National
CCU, NICU, SCN bundled in DRG
price.
Level 3 ICUs/PICUs receive copayment for each hour unless
specifically identified as bundled
Mental Health
Queensland
National
Retention of earlier QH
model – per diem payments
based on designated ward
types, no psych age loading
for DRG component
DRG based. Age loading based on
being in designated psych ward or
MDC 19 or 20.
Acute inpatients only (no adjustment
for non-acute inpatients)
Sub/Non-Acute Inpatients
Queensland
As per national model
National
Per Diem payments based on SNAP
V3 class (if available) or care type (if
no SNAP class)
Inlier and outlier per diem payments
Emergency Departments
Queensland
Classification
National
As per national model Urgency Related Groups
except for Did Not Wait (URGs) for ED
(no payment)
Departments, Urgency
Disposition Groups (UDGs)
for Emergency Services
Outpatients
Queensland
National
Classification
NHCDC Tier 2 – Clinical NHCDC Tier 2 – Clinical
Measurement in scope Measurement out of scope
New/Repeat
Differential pricing
except for Allied
Health. Phase 15
relativities preserved.
No
Peer Groups
No differential
No
Block Funding
Queensland
National
Hospitals in
Scope
As per national model
Hospitals with less than
3,500 acute inpatient
NWAUs
NWAU
calculation
All hospitals receive
NWAUs but only ABF
hospitals receive
NWAU funding
Funding based on
National Efficient Cost
determination, depending
on remoteness and
patient volume
Block Funding
Queensland
Private
Hospitals
National
Outsourced activity to Private patients out of
be allocated to funding scope, contracted services
HHS
in scope
Clinical Education
Queensland
National
Based on agreed proportion of
clinical salaries and wages (by
occupational stream and level).
Includes allowance for
undergraduate weeks.
Out of Scope for 13/14 – indirect
teaching and research included in
DRG price.
Implementation and Results
Funding Context
Change of Government
Review of State financial viability
Reduction of public service staffing
Productivity dividend
Business as usual is not an option
Implementation
SQL Server (pAWS)
•
ED and OP summary source data does not include
indigenous status
•
•
•
summary OP data (unit record data not statewide)
OP clinic reclassification
SNAP V1 vs V3 – use of ICD10 data for SNAP Grouper
Validation of Draft NEP by Ernst Young
DSS Panorama (statewide reporting)
•
need to support current and previous State and national
models with different structures
Results - Methodology
All ABF funded hospitals, all components
State funding model comparison
Patient costed ABF hospitals only
Actual costs vs funding
QH Phase 15 (12/13) ABF Model
QH Phase 16 (13/14)
Actual 11/12 costs
All costs and prices in 13/14 dollars
Q15 to Q16 Summary of Results
Component
Variance
Correlation
MAPE
Acute Inpatients
-2.27%
99.87%
10.03%
SNAP
-13.61%
99.88%
13.92%
Non SNAP subacute
+4.77%
99.87%
15.22%
Emergency Departments
-4.63%
99.28%
5.35%
Outpatients
-0.76%
99.53%
12.65%
All Components
-2.47%
99.94%
6.07%
Please Note:
This comparison only showed differences
between the current 12/13 QH funding model
and the 13/14 model. It does not mean that
one is any better than the other and simply
illustrates the magnitude of the change.
Comparison with actual cost is a better
indication of goodness of fit, but does not
consider inefficiency.
Cost vs Q16 Summary
Component
Variance
Correlation
MAPE
Acute Inpatients
-5.1%
99.51%
12.59%
SNAP
-8.58%
96.43%
42.98%
Non SNAP subacute
-19.3%
98.99%
22.74%
Comment:
Acute inpatients has a reasonable goodness of
fit but this is not the case with SNAP and
Subacute.
SNAP V3 data classification questionable as Qld
currently uses SNAP V1 and developed a SNAP
V3 grouper internally.
Peer Groups – Acute Inpatients Only
Component
Variance
Correlation
MAPE
Large Teaching Hospitals L3 ICU
-8.18%
97.5%
8.12%
Paediatric Hospitals L3 ICU
-6.06%
N/A
6.06%
Medium Hospital L2 ICU
-1.64%
95.4%
5.66%
Medium Hospital L1 ICU
-1.87%
98.3%
17.61%
All peer groups
-5.1%
99.51%
12.59%
Comment:
There is a clear differential between peer groups
which would support a change in the national
model. This may be addressed when a
Teaching/Training/Research component is
added.
Unintended Incentives
Reduced private patient incentives
‘Own Source’ revenue retention
Acute inpatients
Critical care LOS
Mental Health
Unintended Incentives
SNAP vs Non SNAP Non-acute
SNAP long stay per diem vs Care Type per diem
Rehab DRGs
Outpatients
Classification failure
Provider hierarchy
Issues Raised by Sites
Critical Care
•
bundling vs unbundling (provider risk)
Peer Groups
•
differential infrastructure costs and DRG relativities
Outpatients
•
•
•
new/repeat differential cost
counting rules
telephone consults
Other Issues
Trim points
Fractional days
• Percentiles rather than L3H3
•
Summary
Structural Differences (localisations)
Implementation and Results
State funding model changes
Fit to actual cost
Unintended Incentives
Other Issues
Contact Details:
[email protected]
[email protected]

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