using allied health activity data to compare allied health cost to drg based funding
Post on 16-Jun-2015
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By
Nathan Billing, Robin Beaumont, Brett Cornforth, Zina Ayar, Martin Orr.
Background Defining Allied Health Professionals (AHP’s) Diagnosis Related Groups (DRG’s)
Problem Research question
Methodology Results Conclusion Acknowledgement
DRG developed to identify products of hospital group together acute inpatients:
▪ Based on routinely available data on discharge (NMDS)▪ Clinically similar conditions (23 MDC)▪ Similar pattern of resource use (LOS)
Widely adopted to control costs & allocate funds Historical cost data used & data trimming (L3H3)
Health care is labour intensive cost of labour = 60-80% of operating costs1
Allied health staff provide 15-20% of all patient care2.
AHP input not coded alongside clinical information
Little evidence to show how allied health input contributes to the weighting of DRG’s
1. Buchan J, Ball J, O’May F Paper 3. Dept. of Organization of Health Services Delivery. Geneva: World Health Organization . 20002. Boyce R. International Journal of Health Planning and Management 1993; 8(3): 201-217.
There is a growing demand on health services in New Zealand
To meet these needs there is a need for greater efficiency
Hospital administrative data is available and may be a potential tool to help identify and quantify potential cost savings.
(Morgan & Simmons, 2010)
What is the Concordance/ discrepancy between Allied health activity cost and diagnosis related group based reimbursement?
Does allied health cost increase at same rate as actual cost over length of stay?
1. Identify top DRG groups with AHP input
2. To determine AHP contact for each episode
3. Convert AHP time to cost
4. To compare the costs and charges
5. To test the hypothesis that AHP and Actual
cost both vary over length of stay
Total number of inliers seen by Allied Health Professionals = 1360
Demeere N, Stouthuysen K, Roodhooft F. , Health Policy. 2009;92(2):296-304.
Activity Based
Costing
Cost centres
Physiotherapy
Respiratory
Occupational
Therapy
Speech Therapy
Social Work
Dietetics
New Appointment $3.7 $3.4 $3.5 $3.7 $3.4 $1.4
Follow up $4.0 $3.8 $3.8 $3.6 $3.6 $1.6
Dietetic Education - - - - $1.4
Rehabilitation Therapy
$2.0 - $2.8 $2.3 $3.3 -
New Appointment$3.2 $3.0 $3.1 $2.9 $3.0 -
Follow up $3.6 $3.3 $3.4 $3.1 $3.2 -
Rehabilitation therapy
$2.2 - $2.0 $2.0 $2.9 -
Total$18.6 $13.6 $18.6 $17.6 $19.3 $4.4
Resp + Physio$32.3
Number of cost centres
10 6 6 6 3
Mean Cost per minute
$3.23 $3.09 $2.94 $3.23 $1.48
Simple model:Cost ~ Allied Health cost +Actual length of stay
Complex Because looking at simultaneous influence of two
variables (allied health cost and Actual cost) on a third (length of stay)
check for an interaction term to check if the influence of two variables on a third is not additive
Cost ~ Allied Health cost +Actual cost+ (Allied Health cost:Actual length of stay)
P value for AHP costOutliers p=0.907 Inliers p= 0.250319
P value for interaction termIn & Outliers p=0.00000
P value for AHP costOutliers =0.00000 Inliers= .00000
P value for interaction termIn & Outliers p=0.00000
Z60A E65B
OutliersInliers
P value for AHP costOutliers p=0.00000Inliers p=0.00014
P value for interaction termIn & Outliers p=0.00000
P value for AHP costOutliers p=0.00033Inliers p= 0.00850
P value for interaction termIn & Outliers p=0.00000
F62B E62B
OutliersInliers
Cost centres and charges can be utilised to identify patient groups with high AHP input.
Allied health staff cost does not increase over length of stay as much as actual cost does.
The interaction term used in our regression model to highlight this had extremely significant results
Secondary data analysis and ? accuracy of data coding
Timeliness of data (2008-2009).
Issues of multiple admissions
DRG funding does not favour prevention
DRG codes not available on admission
Problems of mapping data from separate databases
Time taken to obtain data limited potential for more complex analysis
Further research into potential benefit of this AHP activity data for specific conditions needed
Supervisors R0bin Beaumont Martin Orr
Decision Support team Zina Ayar Brett Cornforth
Management support Phil Barnes Kevin Blair Stuart Bloomfield Tamzin Brott Info about university courses
www.fhi.rcsed.ac.uk
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