NordDRG full version based
productivity reporting
Jorma Lauharanta
Director of
Helsinki University Hospital Area
Nordic Casemix Conference 2010
Cathedral
We are here
Olympic stadium
Meilahti campus
The goal is health gain
How to increase?
Input
Output
Resources
Visits
Episodes etc
Effectiveness
Health gain
No health gain
Productivity
= output/input
How to minimize?
Jorma Lauharanta
How to maximize health gain?
Evaluation of
effectiveness
Application of
treatment methods,
health technology
Some
rejected
Productivity
improvement
Maximal
health gain
(with moderate
costs)
Jorma Lauharanta
Requirements for productivity improvement
A. Productivity measurement and monitoring system
B. Productivity development programme
some important items:
1. improvement of process fluency
2. increase in labour productivity
3. increased efficiency in use of capacity and use of space
4. elimination of overlap, centralisation, and economies of scale
5. new operating models
etc.
Productivity support in HUCH
• Long-term productivity development programme created
• Clinicians/ clinical managers’ accountability increased
-> new management system
• Clinicians receive monthly reports of
intermediate product utilization
-> intermediate products per DRG group
-> product level price-cost reports
-> feedback about cost effects of clinical decisions
• DRG-based productivity reporting
Price – cost comparisons
euros
Accumulation of the patient related costs
1750
1500
1250
procedure
Sum of intermediate products:
Costs / day
1000
750
3 750 euros
lab
rtg
500
pathology
250
basic care at the ward
1
2
3
4
5
days
Determination of the average DRG cost
(-> billing price, DRG weight)
various total costs
per individual patients
expensive
inexpensive
cost per patient
“untrimmed”
average
I phase
outliers
< - 3 SD
II phase
outliers
< - 2 SD
“trimmed” average
DRG cost
II phase
outliers
> +2 SD
I phase
outliers
> +3 SD
Jorma Lauharanta
Cost distribution of DRG 112D
Kustannusjakauma /1-11/2009/sisätaudit/hoitojaksot
1001- 1500 EUR
outliers
1501- 2000 EUR
2001- 3000 EUR
- 1 SD = 2 933 euro
3001- 4000 EUR
billing price 5 190 euro
4001- 6000 EUR
+ 1 SD = 9 286 euro
6001- 10000 EUR
10001- 15000 EUR
outliers
15001- 49999 EUR
0
20
40
60
PCI w/o myocardial
w cc
DRG 112D Sepelvaltimon
laajennushoitoinfarction
infarktittomassa
komplisoit.
tilanteessa
80
Billing
distribution of DRG 112D
Cost distribution/1-11/2009//sisät/hoitojaksot
1001- 1500 EUR
outliers
1501- 2000 EUR
2001- 3000 EUR
- 1 SD = 2 933 euro
3001- 4000 EUR
billing price 5 190 euro
4001- 6000 EUR
6001- 10000 EUR
+ 1 SD = 9 286 euro
10001- 15000 EUR
outliers
15001- 49999 EUR
0
DRG 112D
50
100
150
Sepelvaltimon
laajennushoito
infarktittomassa
PCI
w/o myocardial
infarction
w cckomplis tilant
200
Treatment cost vs. surplus/deficit
lower
limit
1 500 €
Mean cost
= billing price
3 000 €
upper
limit
4 500 €
total
cost/€
NordDRG-group
cost limits: mean + 2SD
Influence on
surplus/
deficit
Intermediate
products vs
average process
surplus
deficit
= ”normal process”
billed using the billing price
little
average
some
more
no influence
= outlier
billed using the
intermediate cost sum
much
more
Jorma Lauharanta
Productivity measurement
Determination of the DRG cost weight
Mean cost of the DRG group
DRG cost weight =
Mean cost of all DRG groups
Methodology
1. Production volume  DRG weight sum = “DRG points”
- sum of DRG weight x number of cases for all DRG groups
- same definition for outpatient and inpatient care
- clinical unit employing “short therapy” instead of an
inpatient/classic method receives the same cost weight as
from the classic method
(when number of cases in a NordDRG-O group is increased)
2. Productivity measures
a)
b)
-
Overall productivity  DRG productivity index
calculated as total costs /DRG point sum = “DRG point cost”
Labour productivity  DRG labour productivity index
calculated as DRG point sum/FTE’s* (person-years)
* FTE = Full Time Equivalent (labour input calculated as ”person years”
as if all labour input was produced by full time employees)
Method decribed in Finn Med J 47/2009,4055-4061
Increase in labour productivity 2009 vs 2008
Hospital
area
HUCH
DRG
DRG
points
points
Department
1-12/2008 1-12/2009
Medicine
420 317
447 475
Operative
608 070
636 737
Women/children
287 403
298 040
total 1 315 790 1 382 252
Labour
Labour
years w/o years w/o
psychiatry psychiatry
1-12/2008 1-12/2009
2 162
2 199
3 140
3 187
1 850
1 881
7 173
7 282
DRG
DRG
points /
points /
labour
labour
years
years Change
1-12/2008 1-12/2009
%
194,4
203,5
4,7 %
193,7
199,8
3,2 %
155,4
158,4
2,0 %
183,4
189,8
3,5 %
Länsi-Uusimaa
47 600
47 982
221
224
215,4
214,2
-0,5 %
Lohja
65 613
76 224
359
372
182,8
204,9
12,1 %
137 568
145 950
739
752
186,2
194,1
4,3 %
74 405
79 041
324
338
229,6
233,8
1,8 %
Hospital district w/o support serv
1 640 976 1 731 448
8 816
8 970
186,1
193,0
3,7 %
Hospital district ww support serv
1 640 976 1 731 448
13 939
14 266
117,7
121,4
3,1 %
2 319
2 317
Hyvinkää
Porvoo
Psychiatry
Increase means
improved productivity
Overall productivity (DRG point cost)
change 2009 vs 2008 (deflated*)
Costs from
book
keeping
1-12/2008
Hospital area Department
deflat. t eur
Medicine
310 255
Operative
406 843
Women/children
214 708
HUCH
total
932 376
Costs from
book
Eur/
Eur/
keeping
DRG
DRG Change
1-12/2009
point
point
%
t eur 1-12/2008 1-12/2009
309 130
738,1
690,8
-6,4 %
418 124
669,1
656,7
-1,9 %
216 019
747,1
724,8
-3,0 %
943 171
708,6
682,3
-3,7 %
Länsi-Uusimaa
28 682
28 268
602,6
589,1
-2,2 %
Lohja
42 998
45 493
655,3
596,8
-8,9 %
Hyvinkää
79 575
80 360
578,4
550,6
-4,8 %
Porvoo
41 487
42 706
557,6
540,3
-3,1 %
1 125 118
1 139 998
685,6
658,4
-4,0 %
Total
* Deflated by 1,6 per cent
(change in hospital cost index)
Descending figure =
improved productivity
Treatment cost vs. productivity
lower
limit
1 500 €
upper
limit
4 500 €
Mean
cost
3 000 €
NordDRG-group
cost limits: mean + 2SD
Influence on
productivity
Intermediate
products vs
average process
increasing
total
cost/€
slightly decreasing strongly decreasing
= ”normal process”
gives one DRG weight
little
some
more
= outlier
gives one DRG weight!
much
more
average
Jorma Lauharanta
Improvement of productivity 2000 - 2009
2008 vs
2007
2009 vs
2008
+2,9 %
+1,7 %
+3,5 %
+3,8 %
+2,1 %
+1,6 %
+3,1 %
+4,0 %
HUCH (University hospital)
Labour productivity
Overall productivity*
Hospital district
Labour productivity
Overall productivity*
*using deflated costs
Jorma Lauharanta
Overall productivity 1-3 /2010 vs 2009 (not deflated)
HUCH
DRG
DRG
points
points
Department
1-3/2009 1-3/2010
Medicine
110 701 109 239
Operative
163 315 160 212
Women/chilren 74 368
74 836
total 348 384 344 287
Book
keeping
costs
1-3/2009
78 315
102 900
54 437
235 459
Book
keeping
Eur/
costs DRG point
1-3/2010
1-3/2009
77 360
707,4
106 126
630,1
54 203
732,0
237 545
675,9
Eur/
DRG
point Change
1-3/2010
%
708,2
0,1 %
662,4
5,1 %
724,3
-1,1 %
690,0
2,1 %
Länsi-Uusimaa
12 456
12 074
7 196
7 310
577,7
605,4
4,8 %
Lohja
17 959
20 248
10 685
12 187
595,0
601,9
1,2 %
Hyvinkää
36 142
35 893
20 212
20 686
559,2
576,3
3,1 %
Porvoo
19 312
19 478
10 493
10 941
543,3
561,7
3,4 %
434 253
431 980
284 045
288 669
654,1
668,2
2,2 %
Total
Descending figure =
improved productivity
DRG point cost in various clinic groups/
Dpt of Medicine 1-4/ 2010 vs 2009 (not deflated)
Ward episodes:
Clinic group Cases Cases
2010
2009 2010
Intermediate
costs
2009
Intermediate
costs
2010
Mean Mean
EUR EUR /
DRG DRG
DRG
DRG
/ DRG
weigt weigt points points DRG point
2009 2010
2009
2010 point 2010
Inflammation
2 690 3 419
9 226 656 11 164 508
4,57
4,27 12 283 14 574
751
766
Artery
3 491 4 579 16 167 360 20 228 385
6,81
6,05 23 772 27 686
680
731
Emergency
1 464 1 286
5 207 073
4 458 690
5,66
5,67
7 279
629
613
Cancer
1 376 1 391
7 867 257
8 019 310
7,30
8,97 10 044 12 448
783
644
11 395 10 721 46 846 383 44 008 315
5,80
5,81 66 080 62 217
709
707
Total
8 281
Descending figure =
improved productivity
DRG point cost in various clinics /
Inflammation clinic group 1-4/ 2010 vs 2009
(not deflated)
Ward episodes:
Cases Cases
2009 2010
Clinic
GASTROENTER
187
503 680
1 036 865
3,91
3,75
732 1 528
688
679
INFECTIONS
694 1 243 3 577 568
4 983 483
4,99
4,52 3 463 5 604
1033
889
1 544 1 553 4 220 661
4 555 465
4,45
4,20 6 873 6 521
614
699
588 695
4,59
4,26 1 216
921
760
639
Total 2 690 3 419 9 226 656 11 164 508
4,57
4,27 12 283 14 574
751
766
PULMOLOGY
DERMATOL
265
407
InterMean Mean
EUR / EUR /
mediate
Inter- DRG DRG DRG DRG DRG DRG
costs
mediate weigth weigth points points point point
2009 costs 2010 2009 2010 2009 2010 2009 2010
216
924 747
Descending figure =
improved productivity
DRG point cost per major products /
Dermatology clinic 1-4/ 2010 vs 2009
(not deflated)
InterInterEUR /
mediate mediate
DRG DRG DRG
Cases Cases
costs
costs DRG points points point
2009 2010
2009
2010 weight 2009 2010 2009
DRG DRG
272
273
Major skin disorders w cc
Major skin disorders w/o cc
11
50
283
Minor skin disorders w cc
19
5,78
5,30
64
265
17
222
619
673
406
543
12 871
5,71
108
29
791
451
284A Minor skin disorders w/o cc >16
114
years107 316 354 251 151
3,86
440
413
719
608
4,34
877
682
706
575
Total
194
3 39 378
7 049
42 178 054 120 676
EUR /
DRG
point
2010
5
85 798
157 619 584 391 747
Conclusive remarks
Benefits from the present
productivity measurement system
• Support to productivity improvement
-> Productivity (both labour and overall productivity) has
shown an improving trend since starting its measurement
-> Clinicians’ interest in productivity and process management
issues increased
-> Long-term productivity improvement programme created
• Using the present system
-> Impact of various arrangements and interventions on
productivity can be monitored without a delay
-> successive years can more reliably compared despite a
continous shift towards ambulatory treatments
Features of a well-managed clinic
• proper clinical coding
• clinical protocols in active use
• monitoring objects:
-> quality indicators (treatment outcomes, patient
satisfaction, complications, readmissions etc.)
-> productivity indicators -> process control/ improvement
-> staff satisfaction
• optimization of resource utilization:
-> in-patient care, intermediate products and control visits