NordDRG full version based productivity reporting productivity reporting Jorma Lauharanta Director of Helsinki University Hospital Area Nordic Casemix.

Slides:



Advertisements
Similar presentations
Narne E, MAST 5th May 2010, Berlin How will decision makers of Azienda Ospedaliera of Padova/ Padova University Hospital use MAST in practise?
Advertisements

OECD/NBS Workshop on national accounts October 2008 Paris Towards measuring the volume of health and education services Draft OECD Handbook Paul.
Mexican Export and Import Unit Value Indices. Introduction Export and import price indices are useful for the analysis of foreign trade statistics. Besides.
CAPACITY LOAD OUTPUT.
© Nuffield Trust 29 April 2015 Trends in health spending & productivity Anita Charlesworth, Chief Economist, Nuffield Trust.
1 Wisconsin Partnership Program Steven J. Landkamer Program Manager Wisconsin Dept. of Health & Family Services July 14, 2004.
Ozcan: Chapter 9 Productivity Lecture 2
Monitoring and Evaluation Frameworks Kyiv, Ukraine May 23, 2006 MEASURE Evaluation.
Calculating & Reporting Healthcare Statistics
Decision Trees Farrokh Alemi, Ph.D.. Coming Up How to construct a decision tree? –Components of a tree –Interviewing decision makers How to analyze a.
Pharmacy 483 Outcomes & Cost Management in Pharmacy Practice Janet Kelly, Pharm.D., BC-ADM February 22, 2005.
Measuring Clinical Performance in Secondary Care Bill Shields Director of Finance & Performance Portsmouth Hospitals NHS Trust.
Monitoring and Evaluation Frameworks   What is an M&E Framework?   Why do we use M&E Frameworks?   How do we develop M&E Frameworks? MEASURE Evaluation.
Getting out what we put in: how productive is the NHS in England? Adriana Castelli, Mauro Laudicella Andrew Street & Padraic Ward.
0 Prepared by (15pt Arial) [Insert name of presenter 15pt Arial Bold] [Insert title] [Insert Hospital name] Month 200X (12pt Arial Bold) Understanding.
Operations Planning Horizons
Uniform Coding and Simplified Pricing HEALTH AUTHORITY – ABU DHABI Health Systems Finance May, 2007.
Provider Peer Grouping: Project Overview James I. Golden, PhD Director, Division of Health Policy Minnesota Department of Health SCI National Meeting May.
Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, Република Србија МИНИСТАРСТВО ЗДРАВЉА Prof Ric Marshall Interim.
1 OECD Handbook on Measuring Volume Output of Education and Health Chapter 3: Health Sandra Hopkins OECD Health Division June 2007.
Connected Health: Using patient-centric technologies to change behavior and improve outcomes Joseph C. Kvedar, MD Director Center for Connected Health.
Incentives & Outcomes Committee Draft Recommendations Public Employer Health Purchasing Committee October 25, 2010.
DRG as a quality indicator 4th Nordic Casemix Conference 3-4th June 2010 Paasitorni, Helsinki, Finland Lisbeth Serdén National Board of Health and Welfare.
The Alithias Transparency Platform Healthcare Work Confidential, Alithias, Inc.
Unit 10. Monitoring and evaluation
Dispensing to in and out patients or Drug distribution system
The EuroHOPE- project: Comparison of treatment and outcome for AMI and stroke patients in Europe On behalf of the EuroHOPE-team: Terje P. Hagen Department.
Abcd 2001 Healthcare Conference Learning from Experience October 2001 © Peter Turvey.
Financing of hospital care in Finland Unto Häkkinen Centre for Health and Social Economics Finland.
1 The Measurement of Output and Productivity in the Health Care Sector in Canada: An Overview Dr. Andrew Sharpe Executive Director of the Centre for the.
How does DRG-funding affect quality - seen from the patient’s perspective Anni Ankjær-Jensen Danish Rheumatism Association Nordic Casemix Conference Helsinki.
HSCRC Quality Initiatives: Maryland Hospital Acquired Conditions Program October 2, 2009 Dianne Feeney, HSCRC.
“Reaching across Arizona to provide comprehensive quality health care for those in need” AHCCCS/ADHS Report Summary & Recommendations.
WHY IS UNIT DOSE DISPENSING (UDD) DIFFICULT TO IMPLEMENT? Case study in three public hospitals Naswir 1 & Sri Suryawati 2  INRUD—Padang, Indonesia  Department.
Mar. 22, 2010 MA HDC Meeting1 MA Health Disparities Council Working Group on Interpreter Services Update on ISWG Recommendations for Reimbursement for.
ST ELEVATION MYOCARDIAL INFARCTION (STEMI) PATIENT DISCHARGE INSTRUCTION CHECKLIST: CAN WE DO BETTER? Maryann Rabusic-Wiedener, Shauna Johns, Tina Ainsworth,
Effectiveness and Cost of a Transitional Care Program for Heart Failure Arch Intern Med. 2011;171(14): September 11, 2012 Brett Stauffer MD MHS.
Microeconomics and Macroeconomics FCS 3450 Fall 2015 Unit 2.
PSHP Annual Assembly 2015 Importance of Measuring Pharmacy Department Data: How to Enhance Productivity Through a Scorecard Jill Rebuck, Pharm.D., MBA,
Evaluation Plan Steven Clauser, PhD Chief, Outcomes Research Branch Applied Research Program Division of Cancer Control and Population Sciences NCCCP Launch.
How Plans Influence Physician Practice Patterns. Plan for Today How Plans Influence Practice Patterns Team Meeting.
Casemix Funding James Downie A/ Project Director, National Reform Projects.
Does Continuity of Care Matter? The Issues and the Evidence Doug Kutz MD.
Towards an Agenda for Measuring Efficiency in Health Care Michael Chernew Sept. 27, 2007.
CMI usage and calculations By: Deborah Balentine M.Ed, RHIA, CCS-P
Evaluating health outcomes: the experience of a national evaluation programme Luigi Pinnarelli Rome, 15-16/10/2012.
Characteristics of Health Activation Solutions
Impacts achieved but not expected Impacts expected and achieved
Background and purpose
Telewound Management: A Model for Value-Based Care
Virtual Provider in Triage
Copyright © 2004 American Medical Association. All rights reserved.
By Ann Lisbet Brathaug Measurement of Health Output – experiences from the Norwegian National Accounts by Ann Lisbet Brathaug
1.03 PP3 Healthcare Trends.
Measurement of non market volume output Clarification item C10
Evaluating Policies in Cardiovascular Medicine
Measuring Efficiency HSCRC Performance Measurement Workgroup
Surviving in a Fee-for-Service World
Can we link productivity improvements to patients’ experience and how can we ensure value is as much about experience of care as clinical outcomes?
Effect combined IMPACT on achieving outcomes Organizational OUTPUTS
Comprehensive Medical Assisting, 3rd Ed Unit Three: Managing the Finances in the Practice Chapter 15 – Outpatient Procedural Coding.
Planning, Organizing, Staffing
Provider Peer Grouping: Project Overview
Pharmacy practice and the healthcare system Ola Ali Nassr
Efficiency in P4P: Guiding Principles for Implementing a Successful Physician Efficiency Profiling Program Dr. Jonathan Niloff Tuesday, March 10, 2009.
October 2, 2009 Dianne Feeney, HSCRC
Measuring Efficiency HSCRC Performance Measurement Workgroup
GUARANTEE OF CARE: What is acceptable readmission Ilkka Vohlonen, Professor Health Policy Eastern Finland University Casemix Conference Helsinki,
Research project on explicit quality adjustments of the volume indicator for hospitals Aksel Juel Clemmensen TF price and volume measures October,
Capacity Planning For Products and Services
Presentation transcript:

NordDRG full version based productivity reporting productivity reporting Jorma Lauharanta Director of Helsinki University Hospital Area Nordic Casemix Conference 2010

Meilahti campus Cathedral We are here Olympic stadium

Input Resources Output Visits Episodes etc Effectiveness Health gain Productivity = output/input The goal is health gain Jorma Lauharanta No health gain How to increase? How to minimize?

Jorma Lauharanta Some rejected Productivity improvement Evaluation of effectiveness Application of treatment methods, health technology Maximal health gain How to maximize health gain? (with moderate costs)

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

days Costs / day euros basic care at the ward procedure rtg pathology Accumulation of the patient related costs lab euros Sum of intermediate products:

inexpensive “trimmed” average DRG cost various total costs per individual patients “untrimmed” average II phase outliers < - 2 SD II phase outliers > +2 SD I phase outliers > +3 SD I phase outliers < - 3 SD Jorma Lauharanta expensive cost per patient Determination of the average DRG cost (-> billing price, DRG weight)

outliers - 1 SD = euro + 1 SD = euro billing price euro Cost distribution of DRG 112D PCI w/o myocardial infarction w cc

billing price euro - 1 SD = euro + 1 SD = euro outliers Billing distribution of DRG 112D PCI w/o myocardial infarction w cc

NordDRG-group cost limits: mean + 2SD lower limit € upper limit € Mean cost = billing price € = outlier total cost/€ Treatment cost vs. surplus/deficit = ”normal process” surplusdeficitno influence Influence on surplus/ deficit Intermediate products vs average process littlesome more much more average Jorma Lauharanta billed using the intermediate cost sum billed using the billing price

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 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) Overall productivity  DRG productivity index - calculated as total costs /DRG point sum = “DRG point cost” b) 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,

Increase in labour productivity 2009 vs 2008 Increase means improved productivity

Overall productivity (DRG point cost) change 2009 vs 2008 (deflated*) * Deflated by 1,6 per cent (change in hospital cost index) Descending figure = improved productivity

NordDRG-group cost limits: mean + 2SD lower limit € upper limit € Mean cost € = outlier gives one DRG weight! total cost/€ Treatment cost vs. productivity = ”normal process” gives one DRG weight increasingslightly decreasing Influence on productivity Intermediate products vs average process littlesome more much more average Jorma Lauharanta strongly decreasing

Improvement of productivity Jorma Lauharanta

Overall productivity 1-3 /2010 vs 2009 (not deflated) Descending figure = improved productivity

DRG point cost in various clinic groups/ Dpt of Medicine 1-4/ 2010 vs 2009 (not deflated) Ward episodes: Descending figure = improved productivity

DRG point cost in various clinics / Inflammation clinic group 1-4/ 2010 vs 2009 (not deflated) (not deflated) Ward episodes: Descending figure = improved productivity

DRG point cost per major products / Dermatology clinic 1-4/ 2010 vs 2009 (not deflated)

Conclusive remarks

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 Benefits from the present productivity measurement system

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 Features of a well-managed clinic