IHPA revenue modeling
Comparing to costings in the private sector
Dr David Phillips
Why
• Activity Based funding model
• Cabrini - around 57% of our overnight activity is episodically funded
• St Andrews – around 80% overnight activity
• More health funds are looking at episode funding as
well as newer models
• Cabrini’s largest funders use models based on round
6 and round 7 DRG 4.2
• Interest both internally and externally
• How our inpatient and ED costings will compare
Overview
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Some Background
Some Comparisons
Methodology
Some Results
Overview - IHPA revenue modelling
• Compare inpatient and ED costs to IHPA revenue
model
• How would a private hospital fare with NEP
• Impact of DRG versions
Private hospitals …in Australia
• Treated 40% of all patients (AIHW, 2009-10a, pp. 139, Table 7.1)
• 3.5 million patients admitted (AIHW, 2009-10a, pp. 139, Table 7.1)
• 2.1 million occasions of service in non-admitted patients
services (ABS, 2009-10, p. 18)
• 8.4 million days of hospitalisation to patients (ABS, 2009-10, p. 6)
• Performed 65% of elective surgery (AIHW, 2009-10a, pp. 250, Table
10.2)
• Provided a total of 28,038 beds, just over 33% of all
hospital beds. (AIHW 2009/10)
Some Background
• Cabrini Health, Melbourne
• Catholic Not for Profit Organisation, 832 beds, 2 acute sites, palliative and
rehab services
• Established over 60 years ago by the Missionary Sisters of the Sacred
Heart of Jesus
• St Andrews Hospital, Adelaide
• Not for Profit, affiliated with the Uniting Church, 207 acute beds, located
on edge of picturesque southern parklands
• Both have a high oncology workload
• Both have a level 3 ICU
• Both have Emergency Departments
Comparisons between private and public
• Similarities
• Tertiary level services including
• Cardiothoracic surgery
• Level 3 ICU
• Emergency Department
• Cabrini 24/7
• St Andrews – 0800 to 2200
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Obstetrics / Paediatrics at Cabrini
Overnight OBDs emergency – 50% Cabrini Malvern, 20% St Andrews
Teaching and research, undergraduate and postgraduate
Medical and nursing students
Outreach / Mission Work
Comparison between private and public
• Differences
• Salaried Medical Officers
• ICU and ED, at Cabrini – small number in wards (on the increase)
• Cabrini has accreditation for registrar training –
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Internal Medicine
General Surgery
ICU
ED
Capital
Pathology service
Medical Imaging
Trauma Centres
Casemix
• Overnight Acuity
• Using Round 14 Public Weights
Hospital
Average Overnight Weight
Cabrini Brighton
1.26
Cabrini Malvern
1.90
St Andrews
1.73
All sites
1.75
Replicating the model
• What adjustments to include/exclude
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Private patient adjustment
Paediatric adjustment
Indigenous adjustment
Rural adjustment
Which buckets to include/exclude
• Using published round 14 National Public DRG6 Weights
• Include
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Ward Nursing
Nonclinical Salaries
Allied Health
Pharmacy
Critical Care
Theatre / SPU
Supplies
Oncosts
Hotel
Which buckets to include / exclude
• Exclude
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Ward medical
Depreciation
Emergency Department
Pathology
Radiology
Prosthetics
Theatre Medical
• Giving a revised total and % of original total – overall
of 63%
• Provides a revised % for each DRG
Methodology
• Base of $4,575 NEP for 11/12
• Use IHPA DRG6 weights * revised %
• ICU addon as per IHPA model
Comparisons – Inpatient Costings
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SRG
Stay type
Admission Category
Procedure vs Non Procedural
SS/Inlier/LS split
Overall
• Overnight Costs per weight of one
Hospital
Cost per weight of 1
Av LOS
All sites
$2,706
4.43
SRG
SRG Overnight
SRG Sameday
SRG
SRG Overnight
SRG Sameday
Stay Type
Stay Type
Avg Profit % of NEP
% Activity
Overnight
6.27%
42%
Sameday
3.39%
58%
Admission Category
Category
Avg Profit % NEP
% Discharges
ALOS
Emergency
-9.33%
15%
6.12
Overnight -10.54%
6.51
Sameday 6.56%
Elective
7.06%
Overnight 14.71%
85%
1.78
3.39
Sameday 3.32%
Overall
4.59%
2.44
Procedural
Theatre Procedure
Avg Profit % NEP
% Discharges
Procedural
6.95%
59%
Overnight 10.58%
Sameday 3.91%
NonProcedural
1.09%
Overnight -1.7%
Sameday 2.71%
41%
Overnight Stay type
Stay Type
Avg Profit % NEP
% Discharges
Shortstay
12.54%
1.7%
Inlier
10.91%
93.7%
Longstay
-91.37%
4.6%
Comparisons – Emergency Dept costings
Hospital
Average Cost
Average Revenue
IHPA Revenue
Combined
$601
$356
$576
Comparisons – RND 7 vs RND 14
• Which SRGs show significant movements in weights
SRG
RND7 WTD RND14 WTD
Seps %
Seps %
% change
SRG
RND7 WTD RND14 WTD
Seps %
Seps %
% change
Cardiology Interventional
8%
4%
-50%
Medical Oncology
2%
2%
22%
Pain Management
0%
0%
-30%
Paediatric Medicine
0%
0%
25%
Medicine
2%
2%
-28%
Head and Neck surgery
0%
0%
30%
Drug and Alcohol
0%
0%
-26%
Plastic Surgery
2%
3%
30%
Cardiology
3%
2%
-24%
Gastroenterology
4%
6%
30%
Rheumatology
1%
1%
-22%
Perinatology
0%
0%
31%
Neurology
2%
2%
-21%
ENT
1%
2%
35%
Geriatrics
1%
1%
-11%
Dentistry
0%
0%
56%
Immunology and Infections
2%
1%
-10%
Chemotherapy
3%
5%
78%
Cardiothoracic Surgery
7%
6%
-10%
Social Admissions
0%
0%
117%
Summary
• Acute private hospital would survive quite well on the
NEP – even with chemoRx correction
• Possible areas for review – chemotherapy, pharmacy,
long stay outliers
• Movement in weights will be of interest and possibly
impact in the future
• Private emergency department funding is poor
• Issue of capital costs between the sectors and how it is
handled
• Importance of contributing to NHCDC