Service Line Reporting & Management
- The demands on IM&T (and Finance) staff....
Steve Bridge
Assistant Director of Finance
Introduction – The Countess of Chester Hospital NHS FT
• North West England on border with North Wales
• Serves population of c250,000
• 600 beds / £160m turnover
• 1st Wave FT
• Record of good performance
• Good relationship with Monitor
• However 20% of our activity not funded at tariff…
2
PLICS / SLR Timeline
1. Decision to Implement PLICS
January 2007
2. SLM Pilot Site
April to May 2007
3. System Shortlisting
June 2007
4. Supplier Decision – BPLAN (Synergy)
July 2007
5. Initial System Implementation
Sept to Dec 2007
6. 1st cut Reports
January 2008
7. Initial Dashboard Implementation
Jan to March 2008
8. Monthly Patient Level SLR Reports
April 2008 Onwards
9. Dashboard Development
Ongoing
10. Business Objects Development
Starting
3
Data Flows & Monthly Processes
Pre PLICS
PAS (Meditech)
Data Repository Patient Activity
PBR Income (SLAM)
Post PLICS
Ledger Costs (Cedar)
Synergy Staging Area
PLICS (Synergy)
Intranet Reports (Active
Dashboards)
Business Objects Reports
4
Top-Down Costing Process
E.g’s Energy, Porters,
Capital Charges & Training
Levies
Overhead Costs
Allocation
Tables
Support Service Costs
Allocation
Tables
Patient Treatment Service Costs
Specialty
POD
POD
E.g’s Pathology,
Radiology &
Divisional Admin
E.g. Wards, Theatres,
Medical Staff
Specialty
POD
Pathology
POD
Physio
POD
Wards
Specialty
POD
POD
POD
POD
Theatres
5
Top Down Costs – Assumptions & Allocations
Cost Type
Cost Category
Allocation Method
Information Source
PTS
Wards
Bed days
Patient Level from PAS
PTS
Theatres
Theatre Minutes
Patient Level from
Theatre System
PTS
Medical Staff
Job Plans
Divisions
SS
Radiology
Weighted Exams
Patient Level from Rad
System
SS
Pathology
Weighted Tests (where
weighting available)
Pathology systems –
mostly at patient level
OHC
Capital Charges
Actual Charges for
Equip & Sq Mtrs for
Depreciation
Estates – paper based
OHC
Energy
Sq Mtrs
Estates – paper based
6
Bottom-Up Costing Process
Patient Episode Example
Name: John Smith
Procedure: W401 Primary Total Prosthetic Replacement of Knee
HRG: H04 Primary Knee Replacement
Specialty: Trauma & Orthopaedics
Point of Delivery: Elective
Specialty
POD – Elective
Cost Pool
Cost Driver
Episode Example
Episode Cost
Pathology
Weighted Tests
2 Haematology Tests
£5.50
Physio
Physio Contacts
2 Contacts
£75
Wards
Length of Stay
3 days
£600
Theatres
Theatre Minutes
74 minutes in theatre
£1100
Total Episode Cost = £1780.50
7
Bottom-Up Costs – Assumptions & Allocations
Cost Type
Allocation Method
Patient Level Information
Available
A&E
Weighted Attendances
Yes
Medical Staff
Activity/LOS
No
Critical Care
Weighted LOS
Yes
Pathology
Weighted Tests (where
weighting available)
Mostly
Drugs
Activity/LOS
No
Wards
LOS
Yes
Other - General
Based on Activity & LOS
No
8
Costing System – Patient Level Detail
Chart illustrating B-U process
Ward Costs
Patient: John Smith
Specialty:
Procedure:
HRG
Point of Delivery
9
The ‘Bubble’ Chart
Trust Portfolio Contribution Matrix @ M9 2008-09
5
Benchmark
Setter
Improve
Cost
4
Bubble Size = Proportionate Cost
Relative Activity Size
Net Contribution = Total Income - Total
Costs
Net C M argin = Net Contribution / Income
3
2
1
Mean Size
Reassess
Economics
-100.0%
-80.0%
General Surgery incl Subs
Urology
Trauma & Orthopaedics
ENT
Ophthalmology
Oral Surgery
Orthodontics & MFU
Plastic Surgery
Cardiothoracic Surgery
A&E
Pain Management
General Medicine
Gastroenterology
Endocrinology
Clinical Haematology
Diabetic Medicine
Clinical Genetics
Palliative Medicine
Cardiology
Dermatology
Thoracic Medicine
Genito-Urinary Medicine
Nephrology
Rheumatology
Paediatrics & Neonatology
Geriatric Medicine
Obstetrics incl Comm Midwifery
Gynaecology
Potential
Growth
-60.0%
-40.0%
-20.0%
0
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
120.0%
Net Contribution Margin %
10
Tools of the Trade 1 - SB
• Patient Level Information & Costing System
- Demonstration & Examples
11
Patient Level Costing
12
Patient Level Costs - 1
PATIENT ID
CC NUMBER
1st Name
Surname
NHS_Number
DOB
Sex
Con Code
LOS
EPI Start Date
EPI End Date
Adm Date
Disch Date
CCU Days
PCT
Type
ORDER
Specialty
HRG
PDIAG
DIAG1
DIAG2
DIAG3
DIAG4
DIAG5
IP0397888/08
CC00397888
Anon
Anon
4521352758
22/09/1947
F
C2632773
22
01/04/2008
23/04/2008
01/04/2008
23/04/2008
0
IP0040593/08
CC00274270
Anon
Anon
4389908278
15/11/1919
F
C2632773
17
20/05/2008
06/06/2008
17/05/2008
06/06/2008
0
IP0040564/08
CC00592824
Anon
Anon
4028620384
11/06/1936
F
C2632773
15
19/05/2008
03/06/2008
17/05/2008
03/06/2008
0
IP0042475/08
CC00341710
Anon
Anon
4888625506
28/03/1935
M
C2632773
10
27/05/2008
06/06/2008
25/05/2008
06/06/2008
0
IP0044775/08
CC00760253
Anon
Anon
4521346308
01/09/1947
F
C2632773
3
03/06/2008
06/06/2008
03/06/2008
06/06/2008
0
IP0031179/08
CC01024583
Anon
Anon
6325206657
05/05/1936
M
C2632773
1
14/04/2008
15/04/2008
13/04/2008
15/04/2008
0
5NN - Western
Cheshire PCT
5NN - Western
Cheshire PCT
5NN - Western
Cheshire PCT
5NN - Western
Cheshire PCT
5NN - Western
Cheshire PCT
5NN - Western
Cheshire PCT
EM
1
300
EM
3
300
EM
2
300
EM
2
300
EM
1
300
EM
2
300
D13 - Lobar, Atypical D13 - Lobar, Atypical D13 - Lobar, Atypical D13 - Lobar, Atypical D13 - Lobar, Atypical D13 - Lobar, Atypical
or Viral Pneumonia or Viral Pneumonia or Viral Pneumonia or Viral Pneumonia or Viral Pneumonia or Viral Pneumonia
w cc
w cc
w cc
w cc
w cc
w cc
J181 - Pneumonia
organism
unspecified Lobar
pneumonia unspec
J440
I269
J189 - Pneumonia
organism
unspecified
Pneumonia
unspecified
A047
N390
J181 - Pneumonia
J181 - Pneumonia
organism
organism
unspecified Lobar
unspecified Lobar
pneumonia unspec pneumonia unspec
B953
J90X
J440
I259
J189 - Pneumonia
organism
unspecified
Pneumonia
unspecified
R91X
K920
J181 - Pneumonia
organism
unspecified Lobar
pneumonia unspec
J440
I48X
13
Patient Level Costs - 2
Cost Type
DIAG6
DIAG7
DIAG8
DIAG9
DIAG10
DIAG11
DIAG12
DIAG13
PROC1
PROC2
PROC3
PROC4
PROC5
PROC6
PROC7
PROC8
PROC9
PROC10
PROC11
PROC12
U_CAT1
CC00397888
E852 - Non-invasive
ventilation NEC
CC00274270
CC00592824
CC00341710
CC00760253
T124 - Insertion of
tube drain into
pleural cavity
U212 Computerised
tomography NEC
U071 - Computed
tomography of chest
Y532
T128
Y031
Y981
Z401
CC01024583
U081
Y982
Y973
IP0397888/08-1 IP0040593/08-3 IP0040564/08-2 IP0042475/08-2 IP0044775/08-1 IP0031179/08-2
14
Patient Level Costs - 3
Cost Breakdown Cost Type
Drugs
Medical Staff
Divisional Admin
Health Records
Specialist Nurses
Corporate Clinical
Other
ECG
Physio
Occ Therapy
Dietetics
Haematology
Histopathology
Phlebotomy
Microbiology
Biochemistry
Wards Pay
Wards Non Pay
Patient Appliances
Dressings
Blood Products
Tests Referred
Pharmacy
Overheads
Total Costs
Total Income
Surplus / (Loss)
CC00397888
£328.83
£614.76
£227.58
£0.99
£9.54
£22.26
£182.71
£44.02
£342.99
£321.94
£0.00
£26.57
£18.73
£2.69
£35.98
£11.41
£2,000.94
£109.05
£0.63
£22.09
-£7.68
£9.31
£83.67
£1,210.88
£5,619.89
CC00274270
£257.35
£486.68
£178.11
£0.99
£7.47
£17.42
£142.99
£22.01
£190.55
£35.77
£93.28
£26.57
£14.66
£2.69
£3.56
£11.41
£1,565.95
£85.34
£0.63
£17.29
-£6.01
£7.29
£65.48
£947.64
£4,175.12
CC00592824
£228.75
£435.45
£158.32
£0.99
£6.64
£15.49
£127.10
£49.94
£19.06
£0.00
£23.32
£26.57
£13.03
£2.69
£51.36
£11.41
£1,391.96
£75.86
£0.63
£15.37
-£5.34
£6.48
£58.21
£842.35
£3,555.64
CC00341710
£157.27
£307.38
£108.84
£0.99
£4.56
£10.65
£87.38
£0.00
£190.55
£23.85
£0.00
£26.57
£8.96
£2.69
£0.00
£11.41
£956.97
£52.15
£0.63
£10.57
-£3.67
£4.45
£40.02
£579.12
£2,581.34
CC00760253
£57.19
£128.07
£39.58
£0.99
£1.66
£3.87
£31.78
£0.00
£0.00
£0.00
£0.00
£26.57
£3.26
£2.69
£6.55
£11.41
£347.99
£18.96
£0.63
£3.84
-£1.34
£1.62
£14.55
£210.59
£910.46
CC01024583
£28.59
£76.84
£19.76
£0.99
£0.83
£1.94
£15.89
£0.00
£0.00
£0.00
£0.00
£0.00
£1.63
£0.00
£0.00
£0.00
£173.99
£9.48
£0.63
£1.92
-£0.67
£0.81
£7.28
£105.29
£445.20
£3,344
£3,344
£3,344
£3,344
£3,344
£3,344
-£2,275.89
-£831.12
-£211.64
£762.66
£2,433.54
£2,898.80
15
PLICS / SLR – Next Steps
1. Continue developing dashboards
2. Drug costs identified at patient level
3. Nurse costs based on patient acuity
4. Use of Business Objects for detailed reporting within Finance
5. Working with Service Lines to continue development of SLR
16
PLICS / SLR - Learning
1. Time to implement depends on starting point
2. Data quality, completeness, architecture
3. Requires dedicated resources in Finance & IM&T
4. IT infrastructure – server speed & capacity
5. Honest relationship with system supplier
6. Don’t underestimate time & resources required
7. Reporting mechanisms are key
8. Iterative process
9. Volume of queries generated – both Finance & IM&T
17
Questions ?
18