end project report - parliament.qld.gov.au...officer, lyn rowland, was invited to sit on the ppgb to...

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End Project Report Privat� Practice Re·form and Revenue Recovery Program Finance Branch, System Support Services Division

July 2014 V2.0

Prepared by: Emily Wilhelm, Eugene McCiuskey and Travis Hodgson

Title: Project Directors and Senior Program Director

Business area: Finance Branch

Great state. Great opportunity. QueenslanC: Government

Docurnent details Coil�ct fo•· enquiries and proposed changes If you have any questions regarding this document or if you have a suggestion for improvements,

please contact

Contact officer. Emily Wilhelm

Title:

Phone.

Project Director, Pnvate Pract1ce Reform and Revenue Recovery Program

07 323 54185

Email. emily.wilhelm2@health qld gov au

Ve1·nion his·tory

Emily WilhelmJ Fmal cop�-

--- -

-------- · - --[;;;;;;,�

1-1atJ�u-l_y_2_-0 __ 1-_4-_��-------.--C-ha -n-ged by ! Description -- -- .. ----- �-2.0 18 July 2014 , Cella ��t .. - 1 U�date�;Eu��-McCiuskey Final copy ___ � ·--

Copyright© The State of G-luaansland, Queensland Health 20'i4 Copyright protects this publication Except for purposes permitted by the Copyright Act. reproduction by whatever means is prohibited without the prior written permission of Queensland Health Inquiries should be addressed to the Deputy Director-General, System Support Services Division, Department

of Health.

Commercial-in-confidence This document may contain commercial-in-confidence mformation The document has been produced for the sole use of Queensland Health, and should not be provided to external organisations without the wntten approval of the Deputy Director-General, System Support Services Division, Department of

Health.

Moral rights Queensland Health acknowledges the work by staff in the Department of Health in preparing this document Emily Wilhelm, Travis Hodgson

End project report

(Version· 2.0)

l I

,.

Docurnent sign o·ff The following officer has approved this document

Name. Susan Mlddleditch, Deputy Director General, System Support Services

Position· Project Executive

Signature: �\�L,.L_J · Date: �� 1·14 - -----

The following officers have endorsed this document

Name. Malcolm Wilson, Ch1ef Finance Office1, System Support Services

Date: 18/7/14-____

Name. Trav1s Hodgson. Senio1 Director, P1ivate Practice Reform and Revenue Recovery

Program

Position: Sen1or Supplier

. -�': � :,...,,._;, y·' /":':"'�� ..... _.;/ __ , S1nnature· �- -��:--4 ,;:..-;:;/ ....!-;:.,.,.. . � ____;!£_ .,.. £< ,- - tiC' ·� ·:- .:.._� -- ----�----=

.J,/l � -

�-�/

End project report (VersiOn� 2 0)

Date: /2- /' ./ .l-/ ------- ·----

Contents Project manager's report ............................................................................... ................... 5

r-teview o·i the project business case ...................................... .............................................. 6 Overall performance __ .

Business case outcomes. Authonsed changes

.6 7

17

J.Jst or the project's products ............................................................................ ,. .................. •19

Summary of follow·on action rP.commendations ......................................................... 22 Outstanding Jssues . . ... .. .. .. . . . . . . . . .. . . .. .. . . . .. . . . .. . . . . . . .. .. . . .. .. . . .. .. .. . ......................................... 22

Post hand over risks .. . .. . . ... .... . ... ••.••••• ... ........ ...... . ......... ... .... .. .. .. ... . .. . .. ... . 22 Outstanding products/activities .. ... .. . . .... ·--·· ·-..... ......... . ........ .......... .. .. .................................. 23

Projec·� closure notification·····················································�···········��·························· 24 File archiving._ .............. .

End project report {Vers10n· 2.0}

. •. 24

---------. . ------. .

Project rnanager's report The Pnvate Pract1ce Reform and Revenue Recovery Program (PPRRRP) is now complete. The program was established following the Queensland Audit Office (QAO) performance audit of private practice m Queensland public hospitals, tabled 1n Parliament 1n July 2013. The aim of the program was to improve the governance and management of private practice arrangements aligned to the recommendations arising from the QAO report, develop and implement a new governance framework and business model and recover revenue from the previous two years.

fJrivate practice scheme reform

The private practice scheme reform was required to:

• redesign private practice arrangements to ensure they are financially sustainable, meet core objectives and are governed effectively

• educate all staff involved in or Impacted by private practice to ensure a full understanding of the objectives of the redesigned scheme

• harmomse delivery of the new prtvate practice scheme with the Employee Contract reform.

This project achieved the objectives set out in the bus1ness case within the allocated time, cost and scope In addition, the project assumed the responsibility of coordmating a nght of private practice (RoPP) audit across the Hosp1tal and Health Serv1ces (HHSs) m response to the OAO report.

The new scheme will go live on 4 August 2014 in line with the medical contracts. The scheme Is underpinned by a health service directive, framework and guideline The Revenue Strategy and Support Unit (RSSU) team will prov1de go live support to stakeholders as a busmess as usual activity.

Private practice revenue recovery

The revenue recovery task.force was established to centrally coordinate the recovery of foregone revenue An audit of patient billing and fmanc1al systems was conducted, and data files were delivered to HHSs and the Health Support Queensland (HSQ) for validation and act1on where feasible The revenue recovery taskforce was established in August 2013 and provided various data packages to HHSs m this time, includmg medical imaging, surgical procedures, anaesthetics, incorrect facility and administration fees, administration of blood products and pathology (HSQ). The taskforce coordmated the recovery of $11.3 million.

Process Improvement and system enhancement

The process improvement and system enhancement (PriSE) project was required to develop the following for all administrative, climcal and billing systems supporting private practice.

• develop generic process maps to inform local management of private practice patients

• capture key IT issues that are affecting the management of private practice

• Integration to realise effic1enc1es and enable monitoring of clinical and non-clinical activity

PriSE achieved the outcomes allocated to it in the program business case and has extended further to develop a business requirements document for a private practice management solution. PriSE was also onginally mandated to focus on Private Practice only but extended scope to lnclud� broader patient billing and the wider patient journey, where possible, to provide maximum benefit to HHSs and CB Us PriSE findings were shared with Corporate Solutions Portfolio (CSP) whlch in April 2014 had officially taken over the management of the IT and business improvement issues for integrated billing.

End proJect report (Version 2.0)

------·----·-------

Revie\� of the project business case The business case clearly identified the three projects of PPRRRP as; private practice scheme reform, private pract1ce revenue recovery and PriSE. A clear set of objectives/outcomes were outlined for each of the three projects.

The project business case was signed in October 2013 by. -

Susan Mlddleditch Deputy Drrector·General, System Support Servrces l Mark Davey

Travis Hodgson

Acting Chief Finance OffiCer � Senior Director Private Practice Reform and Revenue Recovery Program

The governance approach outlined in the business case was implemented successfully by the program with the establishment of the Private Practice Governance Board (PPGB) and Private Practice Management Adv1sory Network (PPMAN). A Private Practice Reform Reference Group was established at the commencement of the program to work as a multi-disciplinary group to provide feedback and expert advisory on proposed reforms to Queensland Health's pnvate pract1ce arrangements The PPGB met monthly, unless no decisions were required, and minutes were recorded and added to the project file

The private practice reform project had a strong Interdependency with the med1cal contract implementation (MCI) project as highlighted in the business case. The Chief Human Resources Officer, Lyn Rowland, was invited to sit on the PPGB to facilitate engagement between the two projects. Following the project closure, the PPGB will continue to play an important role in the ongoing governance of private practice in Queensland Health as outlined in the terms of reference

Another strong interdependency developed at the start of 2014 between the PriSE project and the CSP. The CSP initiative intended to achieve greater f1scal management of the health network by enabling HHSs to manage their own business independently, incorporating billing and interim solutions to address press1ng business process problems. The PPGB instructed the pro;ect team to feed PriSE billing and business process work into CSP to ensure common requirements were built into any new fmance system implementation Following the release of the Information and Communication Technology (ICT) strategic roadmap, McKinsey and Company report, and a discussion at the ICT portfolio board, a decision was made to pause CSP and undertake a revtew in line with the recommendations within the McKinsey and Company report. The outcome of this decision resulted in the CSP program's closure on 30 June 2014.

Overall performance r------·--··- ·-·--------Target Planned

----·-- ·--·-----------�-

Time Completion October 2014

Coat $2,551,000 :---·---Scope The scope/outcomes of

each of the three projects

Is outlined In the business

case

'----·

. r--·- . ----------------Actual -Completion July

2014

$1,852,730

The status of each

of the outcomes Is

Detail r-·----

The proj ect closed early on completton of all

bles. delivera

The Pro.t ect fimshed stgntficantly under budget ---The out comes set out were largely achieved by the

program

outlined 1n the I scope to

"Business case specifi

. The PriSE program could have expanded its

Include a detatled business requirements

catton document for a billing solution, but this

outcomes· secbon I was rule

of this document i CSP.

d out due to the unexpected closure of the

---·-�--·--· ··-----------

-

-·-

---

--

--

End project report (Version. 2.0)

I I I ' I ' ; I

Business case outcomes The following tables detail the outcomes set in the business case for each of the three projects and their status.

Private practice scheme refonn business case outcomes

# Outcome description

1 Redesign private practice so that 1t is more finaflcially sustainable

Identify reform options, model ccm1mphcatJons and agree recommended

optlon(s)

2 Rev1ew fees· and charges applicable to private practice to ensure reasonable cost recovery 1n the operation of the scheme. The fee structure and the situations in which fees should apply is to be reviewed


[Status ��'-d

t

I I I � t t r

I. I I

' COrnpfet.ad

I I I I j \ I l

I Comments

Products

• Private practice 1n the Qld public health sector

� framework �

Private practice in the Old public health sector j • r

I gwdehne l I I • Health service directive

' • Pnvate l)fadlce In the Q!cl pubr.c he;:.�llh sector policy �

j • Private practice tn the Qld public health sector l implementation standard

1 In consultation with PPGB and key stakeholders, the :; private pracbce model has been reformed

I i Products .

! • Paxton Partne!"l report

i t • Fees and charges reg1ster

l Paxton Partners provided assistance in understanding the j financial relationship between HHS facility fee 1ncome

I

1 l derived from medical specialists' MBS billings and the ; alignment of costs incurred to su12pert these !2rivate patient I

Page7of24

,- �-- --�, actiVIties. The objective of the engagement was to provide a high level financial analysis to inform future dtrections of private practice fees and charges

The fees and charges register was approved and published on 1 July 2014

1--!--- --------------------- ------+--- ------+---------------------l 3

4

5

RevieW the objectives and the prinoples govemng the use of the study, I Cctmpleted Products educa tion and research funds (SERTA and SERTF) to ensure maximum benefi1s are denved for the slate

,. Pnvate practice in the Qld public,; health sector framework

The guideline ellmmated the mandatory requirement to

�� L;;�:�.;�;::: to trust accounts ��udy

_

.

___ _ --------------· -------· - ' If it is identified that SERT A funds are viable, clear cnteria and an overardling framework are to be developed Within the new framework

�leted ! Products i I .. Private practice m the Old public health sector �� l framework I ; Through the guiding pnne�ples outlined in the framework, I ; HHSs have the delegation to establish trust funds m I

accordance With Treasury and Trade policy. � Ensure that a licenced pnvate practice opbon 1s avai�--b-le-f-or-m-ed_ica_l_s_la_ff __ _,r�-..... --efed------t-P- rod--uc_i:s ____ , .. --

·---- . ··---

I (SMOs and VMOs) to engage in mtermediate activity where appropriate under a • Private practice In the Qld public health sector I model that is financially sustainable. , framework i The Private practice framework stipulates that licenced pnvate practice agreements are to be •tormally agreed between the parties in wribng as fike any other commerctal

I agreement, to be developed at the local level.· Each HHS : will be responsible for drafting their own agreement

!--+-----�-·----------- ·--·-·· --·-··--·! I ---···•-

·

··· --� Products I 6 � : Define policy and provide guidance In relation to private admiss1ons through ; emergency departments.

----··. _i __ !--��!�-�ctlce in_!!l�_Q)d_ P.�bli_c.,b�l!!!._s��__!_____!

---------------------------------------------------------- -End project report (Vers10n 2 0)

·

-

·

----·

--_ ..

__

_

__

_

Page8of24

7 Harmonise pnv:ate practice reform and the mediCal contracts project

8 Develop an appropriate governance framework for private practice

arrangements. Group to 1nclude statewlde oveTSJght With appropriate delegabon

of responsibilities at the facality level to monitor and enforce contractual

obligations.

9 Rev1se performance metncs at a statewlde, HHS and mdivldual clinician lt"Vel �o

momtor the scheme·s overaU performance and of mdividual HHSs, Director of

Medical Servfces (DMSs) and Sen•or Medical Officers (SMOs)

I I I ! I

EstabrlSh a s1ngle common doctor Identifier for the integration of payroll and � Practix Data.

ErJd proJect report �ersion: 2.0)

r ·' --I l � I L , COMpleted I � I I i

��

�

I I I guideline I i 1 The guideline provides guidance in relation to private

c; admiSSIOns through emergency departments -··- '�

i The Ch1ef Human Resource Officer holds a seat on the .! PriVate Practice Governance Board. The Senior Director j of private pract1ce reform and teve�'lUe recovery holds a ... l seat on the Medical Contracts Board

I 1 Products

i • Health serv1ce a1recbve I . I I i • Private practice 1n the Qld public health sector I I . I ! framework

I . ' . l • Pmtate Praa1ce Governance Board terms of I reference I

I The governance framework and HHS obligations are J dear1y articulated in the health seMce directive and 1 guideline

-! 1 Products

.. Dec1sion Support Services (DSS) cube

·•· PPGB metnc dashboard

StateWJde and HHS performanc:l9 metncs were endorsed

by the PPGB and a moFlthly report is generated . HHSs

are able to generate reports on individual cliniCians

through the DSS cube.

See Outcome #46

Page9of24

r I I 11 , Develop performance reporting suites, where feasible, rn DSS to provrde

r---1 I ; .1 Completed ! Products

monitoring metrics to support private practrce.

I ! ,,

1 • DSS cube

A DSS cube has been established and released through

the Necto platform. 1---+-------- ·------ I ·-·· ----·- t-------------1 12 I Identify metncs to monrtor.

The prioribsation of private and public patients and report at HHS level across all

relevant patient categories (e.g. rnpatient, outpatient, etc) NB. DoH to develop

policy position on the issue of "prrvate patients being seen sooner than public

patients".

Review performance management metrics in relation to Intermediate patients, to

include Visiting Medical Officer {VMO) monitoring where feasible

Investigate the incorporation of radiology exam�natlon report1ng rates into regular 1 private practice performance reporting. i I

CGI'IIpleted

I I I

i I I I

Products

• Health service directive

• Private practice In the Qld pubRc health sector

j frameworl< I Wording has been mcorporated into the health service

! directive and framework to ensure that private practice

I enhances and supports the delivery of public practice. I I In the fees and charges register, additional codes have

been added for licensed private practrce arrangements

that Will enable the drstlndion between pnvate patients of

the hospital and priVate patients of the doctor

HHSs quality and safety committees are tasked wrth cllmcal serv1ce performance HSO (radiology support)

provide regular diagnostic reports to HHSs on services

reported

113 I

-- ---... ...-.····-··-----·- --·-·----....... __ --�· .... -..... -� -···-···· .... ·-·� ---------------------------------=-��---:�==��-f·�::::��-------------�-; � Produce performance reporting on the utilisation of existing SERT A to Inform the

PPGB where rnconsistencies are Identified and facilitate appropriate action. Products

I !

14 DSS cube

The DSS cube enables local rnporllng wlth1n SERTA

----·--

j accounts where establiShed- I Depending on the framework rn relation to emergency SMO's • rev1ew report1ng I CotnpMei!d. l Emergency SMO activity is now monrtored through practlX I 1 to monitor emergency SMO's as a distll'ld group if applicable. I: �� vra the rmplementation of a speciality field. j

15 I Investigate options for the collectron and central analysis of rnfonnation to report .1 Products j' I I on the pelformance of the · te ·ce_ Efforts will focus on what is re ired I ------·-·--------···-

End project report {VersiOn. 2.0)

of24

I I to meet the 'go live' date of 1 July 2014 Any consb'a1nts that limit the scope of delivery of infonnation and performance management to th1s deadline will be captured by the PP scheme refonn team and passed across to the PriSE project team to JJrogress.

] I

j

<t

•

DSS cube I PPGB metric dashboard ·

; Statewlde and HHS perfonnance metncs were endorsed 1 by the PPGB and a monthly report is generated. HHSs r. l are "'ble to generate reports on mdivldual clinicians i through the DSS cube

116 I The PP scheme reform proJect Intends to produce a tool to asSist HHSs with ·-·-"-�� i

• Products information to support local decision making 1n relation to the v1abihty of private practice activities

n Strategic Analysis of Revenue Tool (StAR)

In partnership with Or Paul Tndgen pty Ltd. thP- StAR tool was released to HHSs for local implementation with

. continued support fi'om Dr Paul Tridgefl under the Health j SeMces Purchasing Team and Prtvate Practice Working Group. ��------------------------------------;-----------;--------------------------� 17 I The PP scheme reform project wfll assess configuration requirements for

existing bHiing systems to prepare them for 1ntroduct1011 of any revised scheme on 1 July 2014 llle MCI PI"'ject will be responsible for defimng the business requirements to support the new contract remuneration arrangements for doctors. Th1s Will be designed, built. tested and delivered by the payroll portfolio to the MCI proJect.

18 I Provide comprehensive education material for all staff tnvolved in the new PP scheme, communicating what services are billable, and m what circumstances

they should be biled.

End project report (Version: 2.0)

�

Compteted

I

RSSU worked With HHSs to ensure billing systems were prepared for go live on 4 August 2014

i Products I l • lntroducbon to private practice for all staff (onllne I ; module)

l • Introduction to practiX: Bulk b1lling outpatient I 1 servtcef> (online module) j

• Private practice in the Qld public health sector I I framework- summary presentation l I l ! Private practice 1n the Qld pubic health sector : • I gu1deline- summary presentation

of 24

r---�=�--,

A comprehensive education curriculum was developed

and deployed through the lleam platfonn.

-------�--------1----�--- --·--------i 19 I Communicate with the medical wort<force to ensure they are fully aware of the1r

contractual obhgat10ns and respons1bHitles under the revised PP modeL

20 I Provide clear guidance for all stakeholders and staff involved in the scheme's

operation, Including the alignment of PP activities wrth the new funding model

Completed

Comp�

I I

Products

• PriVate practtCA in the Qld pubr•c health sector

framework - summary presentation

• Pnvate practiCe in the Old public health sector

guidehne - summary presentation

i A comprehensive education cumculum was developed 1 and deployed through the oleam plalfonn

ucts ... � - ··--·� I • Introduction to private practice for all staff (onlme j

module)lntroductlon to practiX: Bulk billing I outpatient seMces (onhne module)Private 1

practice in the Qld public health sector framework i - summary presentation I ! • Pnvate practice in the Qld public health sector I i guideline -summary presentation l A comprehensive education rurriculum was developed� ! and deployed through the ileam platfonn

, _______ " __ . · - ...__ ____ _____ .____ � ---

End project report (VersiOn. 2 0)

of24

�_ .. _.._ _ ___ _

Private practice revenue recovery o�:siness case outcomes

# Outcome description J status ! Comments ' j

21 lnvest�gate central revenue recovery opportunttles for the tonowing potential � Cornpfeted ,1 Revenue recovery opportumtles listed by the QAO were I uplift areas Identified by the QAO for the finanaal years 2011-12 and 2012-13 � �; 1nvestt�ated by the taskforceWith the exception of I (Note: Billing can only be done retrospedrvely for 2 'IfS). I � inpatient admissions through the emergency department,

I ab nt b dsld ltat. : due to difficultie� with data sources and manually pulling np e e e consu 1ons 1 l

1 · records. Inpatient admission through emergency department !I 111 1 As at 8 July 2014 the> Revenue Recovery Taskforce has Inpatient diagnostic 1maging consultations 11 coordinated the recovery of $11.3 million in what would r

Inpatient pathology j_1 otherwise have been m1ssed pnvate oatient revenue

Incorrect faCility and admrmstration fee charging 11

22 Investigate further revenue uplift opportunities Completed In addition to the categones hsted by the QAO. the taskforce investigated prosthetics, anaesthetics and

surgrcai!Jrocedures.

23 Centrany coordinate the recovery of foregone revenue for each of the data Cclmcl-led ) The taskforce Implemented a methodology whereby data I

1 categories l1sted above, by conduding pabent billing and financial systems ] packs were developed for HHSs and HSQ for action

j auditing and deiM!rlng data mes tc HHSs and 1l1e HSQ (pathology) !Or adlon. i I 11 24 Receive data files from the recovery taskforce, validate them and action billing(s) Co� by HWSs. Completed by HHSs

if feasible and cost effective . . .

, HSO �· HSQ have commenced validation and Will manage at the 1

local level. ·

25 Where possible, develop tools to assist HHSs and the HSQ to retrospectively Cornptefed Products audit pnvate practice accounts. .

• Ravenue recovery gwde •

HHSs and the HSQ were provided with data packages j and an accompanying revenue recovery gwde. I

26 Identify data quality and integrity Issues dunng the process of Investigations that � Products I End projeCt report (Vers1on: :tO)

of24

.--------., ; ;p�e Queensland Health's abrllty to integrate data from vanous systems ;I 1 .. Revenue recovery report J I These lessons will be used to rnform the other proJects within the program (r e · Any issues identified are highlighted rn the revenue l l I pp scheme redesign and PriSE projects). l re<oVeJY �ort- accompanying nocommend...,s I . . where feasrble. ----··· - · - -- - ---·----·-·---------· ·-·--

-----·

Process improvement and system enhar.cement (PriSE) l>usiness case outcomes

r;- Outcome-�escripti�n

-- I Status I Comments -·-- ·----- � 29 Map processes associated With inpatient diagnostic imagrng and provrde case i Competed l Products j

34

146

study to HSIA for IT rnformabon systems review. j, 1 . Process mapping pack covering pnvate practice I I brlltng processes (Vrsio and POF formats) ,. --L--�-- , See also item 53 below Systems interaction and 'I processes captured and mapped j I Products I �� Ccmple(fd Retention of Medicare assignment forms.

Medicare assignment forms are the only evidence of a patrcnt's election to be 1 .! • Communique sent to HHS revenue managers treated as a private patient and are critical In supporting the validity of all 1 i HHSs have been informed by RSSU of the rmportance of outpatient revenue that is billed. Queensland Health guidance is currently that I t . . Med' . t « 1 re arnmg rcare asS�gnmen .orms . . 1 these can be destroyed shortly after recerpt of funds DoH to dartfy the : approach for HHSs to implement. I / � a single ...;,�on dDciDr ;de.....;· .. aid lnldng of data 1\c� exlst;;;;;-·t1. ��pteted =--·--···-··- -�;��ucts: ----··--·------

-4 disparate IT systems tn use across the state. 1 I . Single common identifier

' • Cleansed & Quality assured 'linked' data ·: Single doctor ID has been compiled for Pnvate Practice ! doctors after analysis and mapping of data and this has j been quality assured by HHSs. A regular matchrng I routine has been designed to capture monthly exceptions ! for adion by HHS teams.

I i

1--+---------- -------·-------------- ----! ---------+-------·---------------! PriSE phase 1 For admrnrstratron. clinrcal and binrng systems supporting pnvate i CO�

i

End project report (Version· 2.0)

l Products

·-· .. ·---·

of24

prnctice;

Review system integration (PP Activity) to realise effic:iencles and enable monitoring of cHniC81 and n�ilical Onduding finane�al) activity

s� PriSE phase 1 Investigate and document opportunities for Improvement of transactiOnal processes In relation to private practice receipts and disbursement and mplement changes where feasible and within fiscal scope of the project

53 PriSE phase 1. Develop best practice billing process maps through rev1ew1ng a , select number of HHS's. Map existing practices In detail With a view to achieving

efficiencres through leaner processes

Scope detailed In the original program business case_

"PrfSE - Process mapping - Given time and 18S0Urce constraints, this JS unlikely to be reviewing and redeStgfling each individual HHS's processes .30 would involve producing generic process maps to inform local managemem of pnvate

End project report (Vers10ro 2.0)

I

I'

Coft'lptele!l

I l

Ccmpleted

I

I'

" DSS Dataset linking payroll aNI b111ing data, for use by HHSs to suit local needs

The single common identifier detailed In Item 46 Is being used to help match doctor data from payroll with private practice biDing data� HHSs can use th1s data to b1.1ld local specific reports to monitor clinical and non-clinical

; Onduding financial) activity to meet local perfonnance 1 management neeas. Th1s is Intended to address some of I

1 the core crltlcisms from the QAO I RoPP report which highlighted Queensland Health's inability to link payroll data wdh clinical b1lhng actiVIty

-.... .

1 Produc<.s

i • Revenue disbursement proce$5 maps (VISIO and i PDF formats) I Processes documented in detail to prOVIde an example of ! a number of IT and manual (resource lnte_nsiVe) steps l that are aJrrently followed by HHS teams. Investigations l i have shown that each facility has the1r own site specific l approach that they need to tailor or amend based on tht'l � departments and resources involved in the management ! of disbursement

Products

• Process mapping pack covenng pnvate practice I billing processes (Vis1o and PDF formats)

• Process mapping notation guidance document

Additional Items to scope produced: Process maps of

wider private patient revenue bll6ng and key points whers thrs biffing interacts with the Wider patient journey and systems.

i

of24

r I practice patients. n .

In order to provide maxtmum use tor all stakeholders, the l I origmal scope of process mapping work was extended

because Queensland Health ts not likely to find a solution

to the current Wide ranging IT and bus1ness issues � without a hohstic understanding of how private practice

i fits wrthin broader private patient billing and Its interaction i with the patient journey processes

• Note. Once approved intending to send the process pack I ; to Chief lnfo. Officer by 25th July 2014 for constderation

I - -- •

' in any future IT proJectS � 154 Phase 2 - Funcf1onal specification, procurement and implementation ptann1ng, I Not Funded

Identify fundtng reqUirements A separate busines.c; case will need to be :

Latter phases (2 and 3) were shown for Information 1n the j 1 ong�nal program buSiness case to make clear to all ! I I I

presented for approval to proceed with phase 2.

will be subject to a separate busmess case approval

---·-·- --·---.. ·--·-t ..

stakeholders at program commencement what the ! boundanes of the PriSE phase 1 proJect were. Funding ! was subsequently approved for the PPRRR program to

. include PriSE phase 1 only. ----- ·-L .. j See phase 2 notes in item 54 .. I . 55 I Phase 3 -Implementation -will depend on the outcomes of phase 1 and 2 and lNot Funded

�T�ustness

-

Requirements D�ent

·· · · ·----------·-· - · · i ('.amel�eted--· --" • Business Requorements for- Practice I During the course of the proJect tt became dear there was significant HHS

I demand to address IT issues so the project team endeavoured to proVIde a :1· business reqUirements document for Private Practice to share With Corporate

Solutions Portfolio to help ensure PP billing requtrements were understood.

---··-·· .. -·--··--··--·--·-

I I Management System

_ _j .. • Key IT issues Paper

In addition to the outcomes listed above, the business case included a list of recommendations for other departments (i.e HHSs, HSIA, HSQ, SSS, etc ... ) Many of these departments have already commenced work to address the issues highlighted in the QAO report, some w1th internal teams, some with external agencies brought in to assist them As part of the closure process the program team is intending to send out a self assessment health-check to prov1de a final reminder of the key QAO RoPP Report issues for these organisations, to aid their continued improvements in these areas.


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Authorised changes The folloWing key changes were authorised through the duration of the project impacting on the scope within the indiVidual projects.

Change ! Ch ange No.

1

3

Contract implementation date

Announced by the Or rector-General on 15 Apnl 21 04

The initial contract commencement date of 7 July 2014

was moved to 4 August 2014 on advice of the Director-

General

ploy

Approved by the Drrector-General, effective 1 July 2014

The directive sets out the terms and conditiOn$ of rnteri!TI

pnvate practice arrangements from 1 July 2014 up to and

including 3 August 2014, whrch will apply to SMOs

1 engaged by the Department of Health (the Department) I

or a HHS.

Licenced private practice

PPGB, on 7-April-2014

The proJect Initially planned to provide a template to

HHSs to assist with the implementation of licenced

pnvate practice agreements. The board asked the

project to hold off on distributing thrs document in case rt negatively impacted negotiations with med'real contracts.

The board agreed that a dedicated section Within the

framework would be wntten setbng the pr1nC1ples for

licenced private practice and assoaated criteria rather

than directing HHSs to utilise a standard template.


I I Impact on project i The project updated documentation as •1 related to the contract commencement date and communicated the I change to private practice stakeholders. ,

p

manage pnvate pracbce activities betWeen the end of the FY13114 finanaal year and the commencement of

the employment contract on 4 August 2014. This cost impacted on the project budget

The framework incorporates clear guJdelines as to the requirements. for licenced private practice

arrangements. The project removed the template from scope

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I

I I --- '

g Change ! Impact on proJect ----------· --------------,

Chan e .

I :0• I The right of private practice au�t -· ! This change required the pro�� to-add ��-onal products to its scope Including a proposed scope of worl<

i and letters to each of the HHS Chief Executives. The proJect has also been managing all correspondence. Approved by the Director-General, on 21 May 2014 Including enquiries and results, relating to the audit

The Director-General approved an audit to be conducted across HHSs to revtew the extent of private patient acbvities occurnng without the nght of private practice

' ;

------------------------------------------------------- ---------------------------------------------------------------------------------

End project report (Version: 2.0)

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List of the projec;t's products ·- ---------- - -- - --

PBS No. Product name

,__

____

_

_

---- ---1 Project management ..... . ... -- - . -2 Scheme design

2.1 Private practice framework

- - ·--

2 2 Private practice guideline

---· --- ·-- - - -

2.3 Private practice health seN1ce directive

I

--

-2 ,4 Private contract schedule (SMOs)

2.5 Pnvate contract schedule (VMOs)

-·----2.6 Paxton Partners service fee report

- - ·--.. d

2 7 Health employment directiVe

- · --·---· -

-·

-

-

_

_

_

__

_

_

..

2 8 Med1cal Supermtendents with Priv9te

Pr9.ctlce (MSPP) and Medical Off1cets

with Private Practice (MOPP)

agreements - - - - ·- - ---- - --2 9 Private practice policy

2.1 0 Pnvate practice Implementation

standard

" ··- ·- · 2 1 1 National ABF and Pnvate Revenue

. - ....... Desctlpt•on - a All deliverabl� perta�lng ��-t�e management of the proJects

-- - - -- -- -- --- - - ----- - --

A framework to suppCJrt the delivery of quality and financially

&ustainable private patient seNices in the Queensland public

health sector. -- · · - --- - - -- - ·

A guide to assl$l medical practitioners, practice managers and

support staff m mte1ptetmg the requirements and arrangements of

private practice actiVIties m the Queensland public health sector - -- --

To ensure private practice activities undertaken dunng employed

time in the: Queensland public health sector are financially

sustainable and support patient chorea and workforce retent1on. - ---- - · -·-

Schedule 3 of the medical contract Incorporates specific terms for

private practice .. -

Schedule 3 of the med1cal contract incorporates specific terms for

private practice - ·-------Paxton Partners provided ass1stance m understanding the financial

relationship between HHS facility fee Income derived from medical

specialists· MBS billings and the alignment of costs Incurred to

support these private patient activities The objective of the

engagement Is to provide a high level financial analysis to inform

futUie directions of RoPP reform ·-

To set out the terms and conditions of intenm pnvate practice

arrangement& from 1 July 2014 up to and Including 3 August 2014.

which will apply to semor medical officers engaged by the

Department of Health or a HHS - -An example agreement to support HHSs In MSPP and MOPP In

recognised rural private practice).

-

-To ensure pnvate pract1ce act1v1Ues undertaken during employed

time in the Queensland public. h�:�alth sector are financially

sustainable and support pat1ent choice and workforce retention - -This document identifies the minimum requirements for

implementing the private practice tn the Queensland public health

sector policy. lt also tdenttfles the responsibilities (and audit

crltena) of individual positions In relation to these requirements.

KPMG was commissioned to develop a report in relation to the ---- ·-· -·--------------------··�-'·· ·-- ---·- ·-- ----------End proJect report (Version: 2.0)

of 24

PBS No. I Product name Description - --·--·- -·-· --· ·- - -- - -···----r- ----- - ------ ---·--·- --�-- · · -·

---1 Vrabiltt; Report (KPMG) impl��-�t��on of Activrty Based Funding�� establishing the

3.2

I vrability of continuing prrvate patrent activity in Queensland Health ---i---------Implementation · ------- - - -- - ----

Example terms of reference

·------

------ -- --------- - ··-Terms of reference developed for HHSs to use when settrng up local pnvate practrce governance boards . . ---- - - - ------------+------------ -·· · · · ------ -· · . - - - - -- ----- -- -- - --

elearntng modules Based on the project curriculum, elearnrng modules were created

-t �for training purposes

r-;;· ---

I Education docu�entati�-- ----··- -;;�ddition t; �e ;�ject ��-��s�s�m�--- -· l j presentations have been developed to providA further explanafion 1----l. __ _

I 1: Information and perfonnance , management

4

1---------+ 4. 1 Strategic analysis of revenue tool

regardmg the gurdeline and framework ---· ---- -----·--- -- - --�--------·--

The StAR tool was established to assist HHSs in determrnlng the viability of private outpatient chmcs post 1 July 2014 when new ABF funding arrangements are Introduced. In addition, it supports

I pnvate outpatient data quality issues which may rmpact ABF growth funding for 2013/14 and need to be addressed by HHSs

I ---- --r- -----

4.2 l DSS cube

-- ----t -·--- -4.3 I PPGB metric dashboard

I

The purpose of this product is to provide a mechanrsm to momtor cost (wages) and revenue (billings) for an SMONMO. lt consolidates patient morbidity information and financial systems Information to support HHSs in business intelligence of pnvate patient actrv�ttes ----------· . --------------

--I Sys;;,., :�figurabon ----

- Electronic data that has been captured from signed contracts

In response to the QAO report, a mechanism Is needed to momtor aspects of the RoPP and other key areas of Queensland Health business As such, a hst of KPI's have been defrned to provtde monrtonng over RoPP, outstanding debt, overtune, pnvale health insurance utrlisation and trme to generate invoicrng.

1-------------- --- --- ·-- - - - ------il passed onto HHS (revenue/practtX) managers to assist wrth the configuration of newly appointed SMONMO doctors

5 -- I •:,��:=gementand -+----·----- ---------

-·--------1� 5.1 keholder engagement and A d�ument �umman�tng t�e �pproa�� for.stakeholde;--·-l

1-------11-c-o_m_m

_u_

n_

ica_

tr_o_ns_st

_ra_te_g

__ Y _____ -+

_e_ngage

_�ent and communications throughout the program -�

5 2 Commumcatron materials

6 Queensland Audit Office, Right of Private Practice: Senior medical

......._

__

_ __._:__ ______ __ -


A suite of communrcatron materials tncluding fact sheets, j questrons and answers, web content, etc to support the 1 fmen-n of the progJa.a I ---�-

---·-·-·----------

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PBS No. Product name r--·· --officer conduct r--- - ···- - --

6.1 Action plan

-

6.2 ROPP audit framework

_ ____ _ ... 1-·-- ·--· -- ----------7 Process Improvement and systems

enhancement

7.1 Summary paper of IT and bus1ness

process Jssues affectmg PP billing

,. .. 7. 2 HHS communique

- - -

7. 3 Process map packs

7 4 Busmess Requirements

8 Revenue recovery

8. 1 R\!!venue recovery guide

8 2 Revenue recovery report

End project report (Vera1on 2.0)

-

Description --� ---

----·-·-----------� ----------- --

--- ·- ·--- - · · · · ---- - - · - - - - -

An action plan relatang to each of the recommendations in the

QAO report and the responsible busine&& owners within System

Support Services. ·- - _ ____ ____ _____ _ ... __

An audit framework for HHSs to use when undertaking the RoPP

audit. . -·-· · · · -·------�-------·--------- . ------------

·- -- ·---- - - - ·· -· -- ___ .., _ ·-------·----.. ----- - - ----- --·--- -Summary of key IT and business process 1ssues aftectang Private

Practtce (PP) bid1ng inc high level d1agram of syRtem& and core

processes and manual/ labour mtemwe/ duplicated steps

A commumcation to HHSs advising on PriSE related activities. ·- --- -----

Process maps covering private ptactlce billing and revenue

disbursement activities. - - -- - - · - - ----- . - ··-·-·

Business requirements for Private Practice Management System ·-----·-- · --- - ·-- ·---------

·-------·--- --- . -----------A guide produced for HHS$ and the HSQ to ass1st them with

understandlnQ the data packs and revenue recovery process. - - - ·---

A report summansfng thB methodology utilised and outcomes

achieved of the taskforce · -

of24

I

Surnmary of fol low-on action recon1mendations

Outstand;ng !ssues

Issue No.

046

050

Issue �escript:or. T Rating I, Recommended action 11 Recomn:��

litydatr 1i

respor.s11 .• : ,

I The private practice reform cumculum deployed through 1 Low t-A workarou�d 1s 10 place �-n-

d_w_il_l c_o_nt_

l_nu-e-to--t ·-��-

U-----· ·--·-·· ·· .. ·---.. -.. 1

the ileam platform 1s unable to produce a completion I be facil.itated by RSSU il certificate 1 __j_ Stakeholders have expressed concern with the �-

rr-e_n

_t -+�-H

-1-gh

-------- � l�corporate thework of the PriSE pro�� I ChiefTechn�-l�gy Officer

billrng solutions whrch are resource intens1ve and : when considenng future billing solut1ons. require manual rntervention to collect all sources of [

1 revenue. The unexpected early closure of CSP means j I I that a billing solution is not on the current work plan 1 • Th1s may result 1n miSsed revenue opportunitres and continued rneffioency I I

I I j ___ _ _

! _____ _j

Post handover risks

R!s� No. ! Risk descripti..,;----

----··----� Rati�g i R�e".�d�ction

0 1 1 --r;e Implementation of the full services fees 10 FY15/16 ! High f HHSs and HSQ to manage the risk internally (currently at 50% of the full rate) will result in a negative remuneration impact for some speoalties. The most

' . Recommended responsibility

·,· Chtef Executive Officers,

I Hospital and Health 1 Services I I

I t_ significant 1mpact wrU be rn radiology and radiatron 1 oncology. These speciafists may choose to :

=Jeave ·

Queensland Health which could have negative Implications for service deflvery.

- ..... ---- . L i Chief Executive Officer.

I Health Support

_ _______ __ , ___ ____ _ _ 1 O_u_e

_e_

n_sl_an_d ____ __.

__ ... ,.__ � ............. ,_._...--...._�·---.-,

End project report (Vers10n: 2.0)

------ - -- - -·--· - - --- -

of24

Risk description Rating Recommended action I Recommended

- J responsibility

048 Closure of the private pracfica refonn proJect early may I Medium

reduce go liVe support to HHSs

Reporting lead (Stephen Haggarty) to be kept I RSSU

on for 1 / 2 months into new financial year to

assist with busrness as usual reporting need&

RSSU to provide ongoing support

Outstanding products/ acthtit,es Activity

Training

Right of private practice audit

QA02 action plan

maintenance

Secretariat PPGB

Reporting of

revenue

disbursement

End project report (Vers10n· 2.0)

Recommended action Recommended responsibility

The ongoing development of traimng material as they relate to the private oractice reform RSSU

curriculum. Thrs work has been handed over to and accepted by Scott Ponting, Director of RSSU

i I The audit framework has been distributed to liHSs for actron and 8 HHSs have responded With RSSU

mtentlon to undertake the audit. The next steps wr11 involve collating responses and preparing

a summary bnefing note forthe Director-General

A monthly update to the existing QA02 action plan for presentation to the Executive Office of the Chief Governance Officer

Management Team. Involves coordrnatrnp responses from action owners across the System

Support Services aiVisron

Schedullng PPGB meetings, typing minutes, preparing correspondence, etc RSSU

ProJect reporting resources have rdentified potential opportunities for central extraCtion of RSSU

rnformatron to assist with revenue drsbursement and at the time of writing the feasibility of these rs stiR being rnvestigated with HHS revenue managers This work has been handed over

to and accepted by Scott Ponting, Director of RSSU i

Pape 23 of24

I

I I

•

J

Project c!osure notification

I • - ----.. -. _, -.. 'P

� - r •

The following draft project closure notification is provided for Project Board rev1ew:

Good afternoon,

I am pleased to Inform you that with the support of Malcolm Wilson, I have rnstructed the Revenue Recovery, Private Practice Reform and PriSE projects to commence proJect closure actiVIties I am conftdent we have now achieved the outcomes set out in the program business case and are m a position to transition private practice reform support to Revenue Strategy and Support Umt

Revenue Recovery Revenue recovery will continue to be actioned from an HHS and HSQ perspective at the local level The monitoring of effort by the department Will cease in hne with the project closure As at 8 July 2014 the total net revenue recovered is $11.3 m1t11on

Private Practice Reform The outcomes and objectives set out in the bus1ness case for Private Practice Reform have been completed or transitroned to bustness as usual in advance of the project closure

Business Process Improvement and System Enhancement The PriSE project has completed srgnihcant process mapp1ng actiVities m line with the business case objectives. The mtended second phase of the proJect (Funcllonal specification. procurement and 1mplementatron planning of a billing solution) was aligned with the work of the Corporate Solutions Portfolio prior to its closure. The completed process maps will be handed over to the Health Servtces Information Agency to be incorporated into any future programs of work that will mcorporate a billing solution

I tntend to ctrculate I he project closure reports for you1 rev1ew late next week and will book individual conversations with each of you to ensure you are comfortable with the project closure and busmess as usual transition

As you are aware, the PPGB W1ll continue to play an 1mportant role 1n the ongotng governance of Private Practice In Queensland Health. We are tn the process of amendmg the PPGB terms of reference to reflect thts change and will crrculate it for your consideration prior to the next board meeting

Regards Travis Hodgson Semor Director Private Practtce Reform 1 System Support Services Division

This notiftcation was distributed to

• The Private Practice Governance Board and subsequent meetings facilitated with each of the board members

• The Private Practice Reform Program, the Revenue and Support Services Unit, Chief F1nance Offtcers and Revenue Managers.

�cue archiving Project records have been filed on corporate file QCOS/022378 and Private Practice Governance Board records have been filed on corporate file QCOS/022377.

-- · -- ·----

End project report (Version 2.0)

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end project report - parliament.qld.gov.au...officer, lyn rowland, was invited to sit on the ppgb to...

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