1. Maximising the impact of Activity Based Funding with Engagement April 2012 Cheryl McCullagh Director of Clinical Integration

2. SCHN New Network Revised Executive Team Rapidly Evolving State and National Model New network goals DCI- new role – ICT – Performance – Efficiency and Revenue – Integration

3. SCHN Children First and foremost – Clinical excellence – Innovation – Maximising opportunities – Leading advocacy – Research and Education

4. ABF helping our strategy Measuring and understanding our network activity Recognising complexity Accurate reporting Better benchmarking Addressing variance, accounting for difference Improving clinical outcomes and efficiency Understanding of current data Shared education

5. Governance Episode funding Governance Group – Executive leadership Administration Medical Records Clinical staff ICT Coding Analysis Finance Business management

6. EGG Functions – Education/communication – Engagement – Target projections – Reporting on performance – Accuracy – Modelling for maximising ABF – Communication across functions – Problem solving process gaps – Addressing variance – Keeping up with changing policy

7. To Do List Basic program of education – Professional and functional groups Specialty based connections, making ABF relevant to clinical staff in their everyday work Engagement goals – Benchmarking, healthy competition and improvement – Good reporting, accuracy – Recognition of complex work – Maximising funding- last – Actions from the KPMG review

8. The education program Basic presentations – The model – Coding – Costing Clinician Coding guidelines developed locally Other resources sourced from various institutions Skills refresh for coders and costing staff Functional group education Specialty based Education, analysis and improvement Improving network relationships

9. COMMUNICATION  Board  Medical Staff Councils  NUM’s/ NM  Clinical Council  Clinical Executive  CNC’S  Allied Health  CNE’s  Nurse Practitioners  Operational Management Groups  SCH and CHW Staff Forums ABF Policy and Impact Education Sessions have commenced following have been held

10. SPECIALTY/ AREA MEETINGS Workshops with Speciality Groups to discuss ABF/EF Implementation has commenced with a range of workshops scheduled some specialities addressed so far (not limited to):  BMT  adolescent Med  Endocrinology  ENT  Gen Med  Neurology  Cardiology  Neonatal Intensive Care Units Meetings involve; clinical reps from all sites coding, records Analysis business management program leaders executive

11. Shared learning model Review data Benchmark Find variance Discuss Find detailed solutions Enact change Review and refocus Regular reporting Network learning

12. Example Endocrinology Facility Benchmarking Inpatient Activity comparison between states LOS low day cases high Indirect and direct costs proportionally different

13. Local level review Proportion of day cases different Large variation in LOS between clinicians Large variation in costs

14. Drill down to comparable data Proportionally different splits LOS 1.48 vs 2.86 Cost 2138 vs 7478

15. Endocrinology Very different proportional CWS and coding Review of variation increases understanding Local comparison of Inpatient, OPD and revenue Outcomes – Increased communication – Agreement about what can be compared – Working on shared coding guide

16. BMT High cost, high variance noted Established the clinical model in discussion Change coding strategy to accurately report clinical activity Standardised network coding Outcomes – more consistent reporting, shared coding guides – Meeting activity targets – volumes are small but the data suggests a proportional shift at A08B’s to A’s. – Reported activity increased by $200K ytd

18. UTI Care Path established 2 years ago Splits clinical care into simple UTI vs UTI with CC Revised care path to work concurrently with the DRG split Review all non complex admissions Outcomes – Recoding 30% – Increased CMI – Improved accuracy, and support for the care path – Clear link between a clinical decision making support process and the coding efforts – Renewed collaboration between clinical change and coding

19. Between the Flags eform for clinical and rapid response Available to coders Increased vigilance for complications Increased coding of arrests and resuscitation events Regular communication between the PICU team and coders

20. Advocacy Working with the Development of a set of Paediatric CCs and CCLs for Clinical Review Step 1- Identifying diagnoses with a demonstrated impact on cost and length of stay. Step 2 – Assessment of paediatric vs adult impact of CC diagnoses by ADRG Step 3 – Refine CC list to exclude CCs with high adult impact Step 4 - Addition of closely related diagnosis codes to resulting CC list

21. F91.8 Other conduct disorders Q90.9 Down's syndrome, unspecified F83 Mixed specific developmental disorders J21.9 Acute bronchiolitis, unspecified G40.91 Epilepsy, unspecified, with intractable epilepsy H35.1 Retinopathy of prematurity K90.4 Malabsorption due to intolerance, NEC L04.0 Acute lymphadenitis of face, head and neck N13.7 Vesicoureteral-reflux-associated uropathy R62.8 Other lack of expected normal physiological development Q02 Microcephaly Z93.1 Gastrostomy status G47.30 Sleep apnoea, unspecified G47.32 Obstructive sleep apnoea syndrome

22. Out of Home Care Build Stage 2 of this trial will be to investigate how we can implement a similar field across the two campuses. Potentially we may be able to use the data from this field to trigger an Out of Home Care Admin Alert in Patient Management as there is a similar field in SCHN –R system.

23. Biggest Gains Accuracy Understanding our business One size will never fit all in terms of education Finding the relevant variance for each group and peaking the interest, the lessons are then transferred to all areas of documentation Collaboration between all the content experts Translation of changing clinical models, to improved documentation to improved coding Network sharing and the realisation of common goals Contribution to advocacy Potential for research This is a long term plan…………………..