Royal Berkshire NHS Foundation Trust
th
11 April 2013
Integrated Service Line Reporting
Dmitry Dorsky
Albatross Financial Solutions
Integrated Service Line Reporting
Traditional NHS Service Line Reporting
Functional budgetary control
New integrated SLR – internal tariffs & budgets
New integrated SLR – how it works…
Traditional Service Line Reporting
Is generally accepted to be the production of full cost and income trading accounts at
specialty or service level.
Produced using total cost absorption; summary of PLICS or other costing models
Generally produced annually, bi-annually or quarterly
Timescale: PLICS based SLR usually available two to three months after period end
(one or two Trusts deliver faster with major investment)
Traditional Service Line Reporting
Problems:
Generally focus only on patient care costs & income
Accounts often not “closed down” for stock takes, bad debts etc...
Cost transfer regimes use weightings rather than tariffs
 So profitability of one service can be affected by actions of another service
No comparison to plan
No clarity as to what drives apparent changes in performance
Uses significant resource and lengthy time to produce
External tariffs reviewed annually, so profitability can change, outside the control of service
 We cannot therefore just use profitability as an indicator of improved efficiency
Traditional Service Line Reporting
SLR
Information
Standard
Budgetary
Information
from GL
Traditional SLR exist along side main budgetary reports thus providing managers
with two versions of the truth
Guy’s & St Thomas’ 2010/11 – Functional Budgetary control
Financial Performance monitored against expenditure plan
 Directly controlled expenditure budgets
 Adjustments for under & over performance against income plan
BUT:
 Indirect costs rarely charged
 Income plan accounted for centrally, but variance allocated as above
 Overhead costs never charged
 Trading position not monitored
Guy’s & St Thomas’ 2011/12 – New integrated Service Line Reporting - iSLR
Financial performance monitored against trading position
 Income accounted for at Specialty Level
 Directly controlled expenditure budgets
 Indirect costs both volume related & standing charges
 Overhead costs as fixed or standing charge
 Trading position known
iSLR - Income
Income – All Income!
 Patient care
 Education
 Service Increment For Teaching (SIFT) – undergraduate medical & dental education
 Medical & Dental Education Levy – post graduate M&D education (MADEL)
 Non medical education and training (NMET)
 Research
 Clinical Excellence Awards
 Private Patients
 External contracts
iSLR – Direct & Indirect costs
 Direct costs
 Bad debts!
 Internal services transferred on an internal tariff set for the year where activity information available
 Volume & Mix variances sit with front line services
 Efficiency variances sit with providing departments
 Internal tariff calculation re-visited annually
 Demonstrate achievement of provider savings; zero net impact statement (ZNIS)
 Internal tariffs for:






Radiology
Nuclear Medicine
Wards
Theatres
Therapies
Pathology
 Internal services without “activity”, based on SLA, as an availability or fixed charge
 Pharmacists
 Physicists
 Emergency out-of-hours Operating Theatres
Internal tariff construction
 Standard cost exercise in volume driven internally charged departments
(or should we perhaps use an external provider tariff?)
 Directorate briefings on methodology
 Key Points:
 Based on actual Cost and Activity for first six months, or full year 2010/11.
 Tariff set to recover cost
 Derived by dividing relevant cost by relevant activity
 Recognise that this reflects current practice, not most efficient practice
iSLR – Overheads & Trading position
Overheads
Currently a fixed charge
Proposals for incentives to reduce demand on Overhead services in 2012/13




Space
Cleaning
Portering
Laundry
Contribution (planned Profit or Loss, Surplus or Deficit) to capital programme
Monitor all services against a bottom line plan
BUT - Income & Cost at Specialty (not patient) level
However – interactive drill down to transaction level for activity based internal charges - iSLR
iSLR – Timetable
 Financial reporting to Trust Exec & Board by working day 10
 FD review working day 9
 Head of Financial Management needs to review position on working days 7 and 8
 FM calculate and agree projections working days 4 to 6
 FM review current month position working days 2 and 3
 All SLR transactions therefore need to be posted by the end of working day 1
iSLR – Timetable
As all SLR transactions need to be posted by the end of working day 1
Potential Data quality issues
“Good enough” approach
Post as accrual journal for month just ended
Post “errors” to charging department
One month to resolve errors & improve data quality
Income: two month accrual
iSLR menu
Directorate or Service Line Report
Service Line Report - Directorate Summary Period - M05 August 2011/12
Directorate - Drill Down to Service Detailed
Current Period
Budget
Actuals
Directorate - Drill Down to Volume Related
SLR Line
Variance
Full Year
Description
Budget
Projection
Year To Date
Variance
Budget
Actuals
Variance
(31,791)
(34,859)
3,068 01
Income
Income
- Direct
- Direct
Credit
Credit
(381,496)
(274,410)
(107,086)
(158,955)
(118,118)
(40,837)
(6,599,856)
(6,624,652)
24,796 01 Income- -SLR
SLRIncome
Income
(79,198,274)
(79,770,281)
572,007
(32,999,281)
(33,256,412)
257,131
2,587,202
2,581,324
31,059,486
30,975,884
83,602
12,941,453
12,897,805
43,648
1,736,773
1,822,539
20,718,752
21,696,867
(978,115)
8,438,491
8,920,279
(481,788)
726,901
726,901
8,722,812
8,722,812
0
3,634,505
3,634,505
0
1,412,406
1,412,406
16,948,872
16,948,872
0
7,062,030
7,062,030
0
177,487
177,487
2,129,848
2,129,848
0
887,437
887,437
0
9,122
61,147
0
429,592
(429,592)
(194,320)
27,526
(221,846)
5,878 02
Direct
Direct
(85,767) 03
Indirect
Indirect Volume Related
0 03 Indirect Non Volume Related
Volume Related
Non Volume Related
0 04
Overheads
Overhead- General Support Services
0 04 Overhead - Contribution
- Contribution
To Capital
To Capital
Programme
Programme
(52,025) Trading Position
Directorate - Drill Down to Volume Related Transactions
Drill to volume based charges
Drill down analysis Period From: M01 April 2011/12 To: M05 August 2011/12 - version: V1
Directorate XXX
Speciatly 2
Specialty 3
Specialty 4
Period £
YTD £
21A - Orthopaedics
Period £
YTD £
21B - ENT
Period £
YTD £
21C - Plastic Surgery
Period £
YTD £
21D - Head & Neck
Adjustment
Current
Radiology
Drill-Down Link
Adjustment
Current
Drill-Down Link
-1,290
0
98,042
501,528
35,011
143,789
8,657
42,814
10,403
38,153
97,783
502,445
33,456
144,323
8,757
43,380
9,114
38,153
S2 21B - ENT S2
86
86
45,483
162,483
45,569
162,568
-0
0
S3 - Plastic Surgery
S3
21C
S4
S4
21D - Head & Neck
-0
-0
-0
1,406
3,849
9,968
1,027
2,538
1,406
3,849
9,968
1,027
2,538
S2 21B - ENT S2
S3 - Plastic Surgery
S3
21C
S4
S4
21D - Head & Neck
-14,406
-3,402
-2,216
3,275
7,379
-3,858
-99
Current
268,882
1,318,692
94,592
420,723
112,662
529,862
71,198
340,695
258,159
1,304,285
91,190
418,507
115,936
537,241
67,340
340,596
360
83,534
Adjustment
Theatre
Current
Theatre
Drill-Down Link
899
401,794
S1
4,376
12,437
S2
21BENT
0
12,290
39,866
S2
S4 & Neck
21DHead
0
7,338
S3 Surgery
21CPlastic
0
0
5,156
18,208
27,653
S3
S4
~
0
S3
~
0
S3 Surgery
21CPlastic
S4 & Neck
21DHead
17,805
78,068
S4
2,953
0
581
0
0
0
0
0
257,276
1,211,061
95,817
478,150
183,181
903,796
51,682
216,561
260,229
1,211,061
96,398
478,150
183,181
903,796
51,682
216,561
S1
21AOrthopaedics
Adjustment
Current
S2
~
-53
S1
21AOrthopaedics
Theatre
S2
21BENT
~
~
Drill-Down Link
-53
~
~
Adjustment
S1
~
S1
21AOrthopaedics
Current
Drill-Down Link
566
-10,722
Therapy IP SL
Therapies IP
Anaesthetics
100
Adjustment
Drill-Down Link
Anaesthetics
533
S1 - Orthopaedics
S1
21A
Ward
Therapy IP F Health
-1,555
S1 - Orthopaedics
S1
21A
Nuclear
Ward
918
~
Nuclear
-260
~
Radiology
Specialty 1
S1
S2
21BENT
S2
S3
21CPlastic Surgery
S3
S4
21DHead & Neck
S4
2,186
0
422
0
0
0
0
0
186,656
879,850
69,511
346,878
118,392
573,087
36,422
152,549
188,841
879,850
69,933
346,878
118,392
573,087
36,422
152,549
S1
S1
S2
S2
S3
S3
S4
S4
Drill to source transaction data
Analysis - Specialty 1 (Period - M05 August 2011/12)
Theatre
Surname
Total £
Early Start £
Planned £
Late Finish £
Used £
Anaesthetics
Unused £
Total £
Early Start £
PLanned £
Late Finish £
Used £
Unused £
Consultant 2
7,385
0
976
5,437
972
5,465
0
722
4,024
719
Consultant 3
16,642
683
0
11,954
4,004
12,316
505
0
8,847
2,964
Consultant 4
8,256
25
188
7,309
733
6,110
19
140
5,410
543
~
3,246
~
7,170
~
112
~
43
~
10,571
~
4,386
~
9,688
~
151
~
59
~
14,283
~
Consultant 1
Consultant 22
9,944
0
896
7,359
1,688
6,619
0
663
4,861
1,095
Consultant 23
6,346
0
314
4,344
1,688
3,957
0
233
2,546
1,178
Consultant 24
8,084
0
42
5,600
2,442
5,983
0
31
4,145
1,807
Consultant 25
6,915
38
846
5,646
385
4,350
0
626
3,608
116
Consultant 26
17,781
84
607
13,215
3,875
13,160
62
450
9,781
2,868
Consultant 27
1,039
0
34
1,005
0
769
0
25
744
0
257,276
1,973
13,031
186,731
55,542
186,656
1,432
9,619
135,179
40,425
Total
Drill to unused time in theatres
Source Data Drill Down Period From: M09 December 2011/12 To: M09 December 2011/12
Consultant 21
Service - 21A - XXX
Anaesth Anaesth Anaest
etics
etics
hetics Anaesth
Theatre Unused
Early Planned Late
etics
Unused
Value £
£
Start £
£
Finist £ Value £
£
Theatre
Session Code
Ana
Type
GDSU2
GDSU2FRIAM
GA
GDSU2
GDSU2FRIAM
GA
GDSU2
GDSU2FRIAM
GA
DELAY ON WARD
2,011
GDSU2
GDSU2FRIAM
GA
CHANGE IN ORDER OF LIST
GDSU2
GDSU2MONAM
LA
GDSU2
GDSU2MONAM
LA
GMT10
GMT10WEDAM
GMT10
Cancellation Desc
Late Start Reason
0
1,488
0
1,488
0
744
0
744
653
0
1,488
0
1,488
484
2,011
440
0
1,488
0
1,488
326
1,005
1,005
0
4
0
4
4
CONSENT UNSIGNED
1,005
553
0
4
0
4
2
GA
DELAY ON SAL
1,043
71
0
744
28
772
53
GMT10WEDAM
GA
LIST DELAYS - MORNING LIST OVER RAN
1,005
557
0
744
0
744
412
GMT10
GMT10WEDAM
GA
1,068
201
47
744
0
791
149
GMT10
GMT10WEDAM
GA
1,005
1,005
0
744
0
744
744
GMT10
GMT10WEDAM
GA
2,011
1,340
0
1,488
0
1,488
992
GMT11
GMT11TUEAM
GA
1,005
168
0
744
0
744
124
16,185
7,498
47
10,424
28
10,498
4,402
16,185
7,498
47
10,424
28
10,498
4,402
Total
CONSENT UNSIGNED
2,011
1,504
1,005
NO CX - SESSIONS COMBINED TO RUN ALL DAY
CHRISTMAS CLOSURE
CONSENT UNSIGNED
1,113
iSLR – Financial forecasts
Receiving departments should project both anticipated cost and income,
and share that with providing departments.
Providing departments to analyse the results of projections to their
internal income, and where they hold a materially different view, initiate a
discussion to reach an agreed forecast position for future monthly
reporting.
iSLR – Impact for “Provider”departments
Now have an internal income target to fund their budget.
Can no longer just appoint to a post when it becomes vacant but…
 Need to understand future anticipated demand changes to fund their ongoing
budget
Provider departments need to clear “their errors” each month
iSLR – How does it work? – 1. Data preparation
RADIOLOGY
STANDARD
TARIFFS
PATHOLOGY
THEATRE
THERAPIES
PHARMACY
WARD STAY
iSLR
DATA
REPOSITORY
JOURNALS
GENERAL
LEDGER
UN-BILLABLE
ACTIVITIES
iSLR
REPORTER
DIVISIONAL
MANAGER
iSLR
PROCESSOR
ORGANISATIONAL
HIERARCHY AND
ASSIGNMENT RULES
PROVIDER
DEPARTMENT
iSLR – data preparation
 Working day 1 – Month 8, reporting period Month 7 :
 Departments provide scheduled data download between midnight & 6.00 am
each day, containing at least 100 days data (i.e. m5,6,7).
 We take last months cumulative data file for iSLR (i.e. M1-6).
 We remove the last months (m6) data from that file so we have M1-5 data.
 We import last two months data from yesterday’s download i.e. M6 & M7.
 We now have a cumulative file for the whole years data.
iSLR – How does it work? – 2. Extract, Transform & Load
RADIOLOGY
STANDARD
TARIFFS
PATHOLOGY
THEATRE
THERAPIES
PHARMACY
WARD STAY
iSLR
DATA
REPOSITORY
JOURNALS
GENERAL
LEDGER
UN-BILLABLE
ACTIVITIES
iSLR
REPORTER
DIVISIONAL
MANAGER
iSLR
PROCESSOR
ORGANISATIONAL
HIERARCHY AND
ASSIGNMENT RULES
PROVIDER
DEPARTMENT
iSLR – Extract, Transform & Load
Visual Importer
A set of automated import tasks
 Ability to import data from any structured data source
(Excel, SQL, Oracle, csv, etc…)
 Full audit trail & Error tracking
 Set of reconciliation reports to valid import
 Ability to schedule batch run processes
iSLR – How does it work? – 3. Journal Creation
RADIOLOGY
STANDARD
TARIFFS
PATHOLOGY
THEATRE
THERAPIES
PHARMACY
WARD STAY
iSLR
DATA
REPOSITORY
JOURNALS
GENERAL
LEDGER
UN-BILLABLE
ACTIVITIES
iSLR
REPORTER
DIVISIONAL
MANAGER
iSLR
PROCESSOR
ORGANISATIONAL
HIERARCHY AND
ASSIGNMENT RULES
PROVIDER
DEPARTMENT
iSLR – Journal Creation
Journal processing
Based on user defined rules
Updated via easy to use graphical interface
Fast Processing time (minutes)
Full set of validation reports
Ability to track and analyse errors
Automatic upload into Oracle
iSLR – How does it work? – 4. Reporting
RADIOLOGY
STANDARD
TARIFFS
PATHOLOGY
THEATRE
THERAPIES
PHARMACY
WARD STAY
iSLR
DATA
REPOSITORY
JOURNALS
GENERAL
LEDGER
UN-BILLABLE
ACTIVITIES
iSLR
REPORTER
DIVISIONAL
MANAGER
iSLR
PROCESSOR
ORGANISATIONAL
HIERARCHY AND
ASSIGNMENT RULES
PROVIDER
DEPARTMENT
iSLR – Reporting
Reporting options:
Journals imported into General Ledger (Oracle at GSTT)
Users access financial performance reports through GL reporting (OBIEE)
For internal transactions, use Business Objects to drill to source data
that drives cost
Five clicks to patient activity record
Exportable to Excel & Other formats
Available through Trust Intranet