1. Placing a Value on Hospital activity Alison Rodgers Paul Leak

2. Hospital activity 55%-60% of NHS Board expenditure Variation: Geographical Care Group

3. Mapping Options PAS Datasets valued using: Cost Book SNT HRGs (& Cost Book Rates) Local Tariff/Costs

4. Tariff evolution in Highland Procedure level Costs SNT Local Tariff Patient Level Information & Costs

5. NHSH Interim Solution Fully absorbed site specialty specific level tariffs for –Ward –Pharmacy –Medical Time –Theatre and Anaesthetics –Diagnostics –OP Department –Day Hospital

6. Ward Cost A cost per day case and a cost per inpatient day Includes: Nursing Therapies (carried out as Inpatient) Diagnostics other than Radiology and Laboratories Other General Ward Costs Overheads

7. Pharmacy Charged on a bed day/day case/attendance rate Includes: Drugs Other Pharmacy issues Pharmacy Services Potential to charge per item basis using data from Pharmacy Information System

8. Medical Cost per unit of medical of time: Medical cost by specialty by point of delivery (IP, DC, OP, DP) including theatres Based on workplans Applied to: Estimated units per day – IP Estimated units per admission – IP and DC Theatre time cut to stitch – IP and DC

9. Theatre Theatre costs are charged against the patient record using OPCS4 code as follows: Theatre cost per min –applied to total time in theatre suite Anaesthetist cost per minute –applied to time from entry into anaesthetics to back to ward High Cost Prosthetics –applied on basis of procedure code

10. Diagnostics – Laboratories and Radiology Costs allocated to specialty (IP, OP etc.) or GP (Direct Access) based of number of investigation x cost per banded investigation. Inpatients treated as follows: Cost per admission - 80% of costs applied to admissions Cost per day – 20% of costs applied on per day basis

11. Outpatients & Day Patients Specialty based cost per attendance for –OPD –Medical –Laboratories –Drugs New and return for OP –English Reference Costs to weight where available

12. Sources of Data PAS data used to identify –LOS –New admissions –Specialty and Procedure Theatre System provides –Various theatre times RIS and Laboratory –Specialty Costs Linked by LOS/Admission/Proc Code NOT Patient

13. Future Developments Costs linked to patient record by unique identifier New systems will provide patient level data, e.g AHPS to allow future unbundling PAS TheatreRadiologyLabsPharmacy

14. Benefits Sensitive to LOS Relatively easy to understand calculate and apply Bed-day related costs can be applied before coding. OBDs, Admissions, Procedures can easily be summed, averaged, and grouped. Can create Board Average Tariff. Allows future refinement and further unbundling of costs

15. Intermediate Care Intervention Ten GP Practices – measured IP activity at Raigmore before and after IC team established. Results Reduction in beddays=1806 Change in value at 2008-9 prices: HRGs Increase of £218,217 Patient Level tariffDecrease of £666, 521

16. The Dilemma Tariff or Cost? Unbundling