1. Case Costing at TBRHSC
June 2015

2. Contents
Overview of Case Costing
Implementing Case Costing
Next Steps

3. Overview of Case Costing

4. Case Costing in Ontario
1992: pilot project with acute inpatient population data
2007: First expansion resulted in 45 hospitals and 4 CCACs
2013: Second expansion with additional 45 hospitals and 10 CCACs which will bring the total count of case costing facilities in Ontario to 104
60% of hospital and 100% of CCAC healthcare data
TBRHSC is the only teaching hospital in Ontario not participating
QBP carve outs
Reference: MOHLTC. (2015). Welcome to Case Costing. [PDF Document].

5. What is Case Costing?
Case Costing is a cost distribution/allocation methodology.
It uses patient specific hospital data combined with overhead costs to determine the resources used for providing care to a patient.
Tracking patient costs by service date, responsible physician, unit/location, and type of service allows for detailed analysis.
It is not something that is installed and turned on. It is a journey, a series of events, and readiness.
Reference: MOHLTC. (2015). Welcome to Case Costing. [PDF Document].

6. What is Case Costing?
Reference: MOHLTC. (2015, April). Ontario Case Costing Information Session [PDF Document].

7. Hospital Benefits of Case Costing
Drill down to better understand what is driving cost variations
Decision Making
New physicians
New technologies
Budgeting and Impact Analysis
Peers
Health Quality Ontario best practice guidelines
Different clinical practices
Comparison
Analyze the detailed utilization data to improve the quality of care, adopt new care practices or define models of care for existing practices
Care Improvement
Inform rates for uninsured, out of province, and WSIB patients
Patient Billings
Funded vs Actual
Quality Based Procedures
Funding
Reference: MOHLTC. (2015). Welcome to Case Costing. [PDF Document].
Weeks, Penny. (2015, April 10). MedAssets Decision Support. [PDF Document].

8. Provincial and National Uses
Reference: MOHLTC. (2015, April). Ontario Case Costing Information Session [PDF Document].

9. Implementing Case Costing

10. Implementation Process and Timelines
A typical implementation is roughly months
Assess current state
Identify gaps and challenges
Education session and module, telephone support
Milestone 1
Assessment
Develop work plan
Implement case costing software
Extract development
Education module, OCC Standards, Telephone Support
Additional time may be needed to address facility challenges
Milestone 2
Preparation
Test 3 months of data
Audit reports
Resolution of system and data quality issues
Milestone 3
Test Submission
Submit one full year of data
Milestone 4
Data Submission
1-2 months
5-8 months
6-8 months
Reference: MOHLTC. (2015, April). Ontario Case Costing Information Session [PDF Document].
MOHLTC. (2015). Welcome to Case Costing. [PDF Document].

11. Costs Currently Implemented Requirements
Case Costing Analyst (budgeted and hired)
Decision Support resources (Lead and Manager) – project management support
Leverage Business Intelligence for data extracting to minimize interface costs
Case Costing Functional Centre
Core team site visits – $10-15k
Office support and professional development – $2k per year
Informatics
IT/IS Support – 4-6 weeks of extract development during implementation
IT/IS Support – ongoing (minimal expected)
Case Costing FC: not budgeted but hoping to find within portfolio

12. Ministry Support Ministry will provide:
Licensing - software license costs
Annual software maintenance costs
Implementation Support - MedAssets
Training - A standard software training module for the initial implementation team
Education resources
Subject matter expertise
Networking forum
Reference: MOHLTC. (2015). Welcome to Case Costing. [PDF Document].

13. Suggested Committees and Groups
Core Team: Decision Support Lead and Case Costing Analyst
Project Sponsor: CFO
Steering Committee
Ad hoc Meetings
CFO
Manager of Decision Support
Decision Support Lead
Senior Director of Informatics
Manager of Accounting and Management Reporting
EVP Patient Services
Working Group
Monthly Meetings
Case Costing Analyst
IT/IS Rep
Health Records Rep
Finance Rep
Clinical Reps
Specialty Groups
Content experts

14. Data Requirements
Case Costing
Meditech
Health Records
Finance
Other
Other: DI, Lab, any other work arounds that are not in the current systems

15. Current Known Gaps & Areas for Improvement
Nursing Workload
Not currently captured and can use patient hours as a proxy
For acute inpatient functional centres, a patient's hospital stay is measured in hours and is used to calculate unit costs
A suggested methodology by the Ministry and used by other hospitals
Workload for other areas
Not captured at a patient and service date level in most cases (ie. Pharmacy, Allied Health Services)
Potential work around
Significant Supplies
Not attributable to patient and service date (ie. OR, Cath Lab)
Data quality

16. Next Steps
Formal response to MOH to proceed with Milestone 1 of the Case Costing implementation is required by June 22, 2015
Starting the journey means deciding to champion and support the requirements that lead to readiness
Informatics acceptance
Buy in by management, core, project and functional teams and ultimately front line staff
Networking and site visits with other Case Costing facilities
Continued investigation for gaps and areas that need improvement
Ministry to issue orientation package outlining next steps

17. Questions?