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IHPA revenue modeling

IHPA revenue modeling. Comparing to costings in the private sector Dr David Phillips. Why. Activity Based funding model Cabrini - around 57% of our overnight activity is episodically funded St Andrews – around 80% overnight activity

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IHPA revenue modeling

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  1. IHPA revenue modeling Comparing to costings in the private sector Dr David Phillips

  2. Why • Activity Based funding model • Cabrini - around 57% of our overnight activity is episodically funded • St Andrews – around 80% overnight activity • More health funds are looking at episode funding as well as newer models • Cabrini’s largest funders use models based on round 6 and round 7 DRG 4.2 • Interest both internally and externally • How our inpatient and ED costings will compare

  3. Overview • Some Background • Some Comparisons • Methodology • Some Results

  4. Overview - IHPA revenue modelling • Compare inpatient and ED costs to IHPA revenue model • How would a private hospital fare with NEP • Impact of DRG versions

  5. Private hospitals …in Australia • Treated 40%of all patients(AIHW, 2009-10a, pp. 139, Table 7.1) • 3.5 million patients admitted(AIHW, 2009-10a, pp. 139, Table 7.1) • 2.1 million occasions of service in non-admitted patients services(ABS, 2009-10, p. 18) • 8.4 million days of hospitalisation to patients (ABS, 2009-10, p. 6) • Performed 65% of elective surgery(AIHW, 2009-10a, pp. 250, Table 10.2) • Provided a total of 28,038 beds, just over 33% of all hospital beds. (AIHW 2009/10)

  6. Some Background • Cabrini Health, Melbourne • Catholic Not for Profit Organisation, 832 beds, 2 acute sites, palliative and rehab services • Established over 60 years ago by the Missionary Sisters of the Sacred Heart of Jesus • St Andrews Hospital, Adelaide • Not for Profit, affiliated with the Uniting Church, 207 acute beds, located on edge of picturesque southern parklands • Both have a high oncology workload • Both have a level 3 ICU • Both have Emergency Departments

  7. Comparisons between private and public • Similarities • Tertiary level services including • Cardiothoracic surgery • Level 3 ICU • Emergency Department • Cabrini 24/7 • St Andrews – 0800 to 2200 • Obstetrics / Paediatrics at Cabrini • Overnight OBDs emergency – 50% Cabrini Malvern, 20% St Andrews • Teaching and research, undergraduate and postgraduate • Medical and nursing students • Outreach / Mission Work

  8. Comparison between private and public • Differences • Salaried Medical Officers • ICU and ED, at Cabrini – small number in wards (on the increase) • Cabrini has accreditation for registrar training – • Internal Medicine • General Surgery • ICU • ED • Capital • Pathology service • Medical Imaging • Trauma Centres

  9. Casemix • Overnight Acuity • Using Round 14 Public Weights

  10. Replicating the model • What adjustments to include/exclude • Private patient adjustment • Paediatric adjustment • Indigenous adjustment • Rural adjustment

  11. Which buckets to include/exclude • Using published round 14 National Public DRG6 Weights • Include • Ward Nursing • Nonclinical Salaries • Allied Health • Pharmacy • Critical Care • Theatre / SPU • Supplies • Oncosts • Hotel

  12. Which buckets to include / exclude • Exclude • Ward medical • Depreciation • Emergency Department • Pathology • Radiology • Prosthetics • Theatre Medical • Giving a revised total and % of original total – overall of 63% • Provides a revised % for each DRG

  13. Methodology • Base of $4,575 NEP for 11/12 • Use IHPA DRG6 weights * revised % • ICU addon as per IHPA model

  14. Comparisons – InpatientCostings • SRG • Stay type • Admission Category • Procedure vs Non Procedural • SS/Inlier/LS split

  15. Overall • Overnight Costs per weight of one

  16. SRG

  17. SRG Overnight

  18. SRG Sameday

  19. SRG

  20. SRG Overnight

  21. SRG Sameday

  22. Stay Type

  23. Admission Category

  24. Procedural

  25. Overnight Stay type

  26. Comparisons – EmergencyDept costings

  27. Comparisons – RND 7 vs RND 14 • Which SRGs show significant movements in weights

  28. Summary • Acute private hospital would survive quite well on the NEP – even with chemoRx correction • Possible areas for review – chemotherapy, pharmacy, long stay outliers • Movement in weights will be of interest and possibly impact in the future • Private emergency department funding is poor • Issue of capital costs between the sectors and how it is handled • Importance of contributing to NHCDC

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