Supporting care with PLICS: Embracing and embedding patient-level costing to create value

Transcription

1 Supporting care with PLICS: Embracing and embedding patient-level costing to create value Dr Stuart Murdoch - Dave Tunstall - Clinical Director Abdominal Medicine Service, Consultant Anaesthetist and Intensivist Senior Costing Accountant

2 We are The Leeds Teaching Hospitals NHS Trust. Overview Structure What helped us win the HfMA Costing Award The Blueprint A case study in Cardiology The impact Wider usage

3 Challenge: Small Team. Massive Organisation!

4 From Ambition to Business as Usual : What Underpinned our Award in 2017 Clinical engagement focus on the quality of both activity and finance information Development quality improvements from feedback as well as participating in internal and external networks Monthly PLICS deliver promised changes, accessible, timely and open to scrutiny Stretch the art of the possible Innovation for growth - training videos, internal quality assurance, increased skills not wte Delivering benefits increasing the use of PLICS information in the Organisation but also maximising the use and value of the data you hold

5 Cardiology - The importance of clinical involvement This is a 3D Mapping Catheter The Consultant spotted this straight away on the patient bill It wouldn t have been used in a standard ablation procedure A review of the patient notes confirmed this should have been coded as a complex procedure Consequently this episode made a loss against the tariff It wasn t the only one, nor was it confined to one procedure

6 The Repercussions and Outcome Training and up to date information made available for coders Monitoring and internal review of coding set up Coding invited to the PLICS meetings

7 In October 12,775 additional income was correctly recouped There has been an improvement since we ve sorted out the incorrect codes that the Coders were using. October December This was 95k for one procedure but the benefits were across all of them

8 PLICS at the Heart of Coding Activity The meetings Multidisciplinary approach Clinical, Coding, Management, Finance Reviews are more focused, PLICS data driven and proactive Internal coding systems developed and automated to reduce errors More collaboration less confrontation Superseded the Coding Team monthly meeting not added to it

9 How Quality PLICS Information Benefits the Specialty Service redesign Implantable Loop Recorder pathway validation Business cases PLICS data used in managed service contract negotiations Review of length of stay highlighting measures to improve discharge time Review Cath Lab staffing and turnaround time at procedure level to reduce variation and improve patient flow Improved financial position rolling programme of audit and income recovery All of these contribute to a better patient experience

10 Other Projects & Achievements Kidney Transplant Service - 100k a year identified due to incorrect coding Renal Dialysis - 96k of billable AKI activity identified, service benchmarked against national costs Paed Robotic Surgery Identified which procedures benefit from using the robotic procedures, clinical outcome versus cost study Oncology ACE cancer pathway quality improvement initiative Urology TURPS LoS and procedure costs study Obstetrics OASI study, cost impact of changes to procedure HfMA Value Challenge in Orthopaedics and Diabetic Medicine GAPI Work on Orthopaedics procedures Pivotal role in the introduction of day 1 Service Line Management

11 Where next? Focusing on Variation and Improvement HRG Scoping Tool SQL fed analysis tool to highlight variation and identify savings opportunities rather than just income recovery and growth Introduce Red and Green days signpost areas of inefficiency Identify and incorporate Readmissions activity Further develop the coverage and use of S4S consumable data Continuous model improvements WIP, DNA, Theatre downtime, A&E acuity and implement the CTP standards Active participant of the Trust s IT Redevelopment strategy to improve the coverage and quality of data feeds available there are 300+ in the Trust, we currently use 28

12 Embracing and embedding patientlevel costing to create value Dr Stuart Murdoch Clinical Director of Abdominal Medicine Service, Consultant Anaesthetist and Intensivist

13 My use of PLICS as a Consultant. Data key for understanding the business Knowing your business Tony Whitfield (DoF) Data is key and data set is broadly accurate Tim Briggs Internal variation With need for cost saving (CIP) where are the costs? How do we identify them? Develop business cases for new activity PLICS allowed me as CD to get hold of data, make sensible choices and have discussions with teams.

14 Data is becoming increasingly available to doctors.

15 GIRFT and the Relationship to PLICS The Getting It Right First Time (GIRFT) Programme is helping to improve the quality of care within the NHS by reducing unwarranted variations, bringing efficiencies and improving patient outcomes

16 The importance of PLICS PLICS allowed me as CD to get hold of data, make sensible choices and have discussions with teams.

17 Spinal Surgery Local Data Spine two teams Orthopaedics and Neurosurgery Same but very different Combined Obvious differences Pre-admission; Catheters; LOS Audit would have shown difference taken 6months PLICS contained all data on HRG Gave data to the surgeons

18 Spinal Data HC04C (Extradural Spine Intermediate 1 without CC) Neurosurgery Orthopaedics Activity LOS Activity LOS HC04B (Extradural Spine Intermediate 1 with CC) HC03C (Extradural Spine Intermediate 2 without CC

19 Urology Surgeon Cost Activity Average Cost LOS ABP 46, , CSB 18, , IE 20, , JJC 23, , MK 16, , NMH 30, , OJK 91, , SJ 36, , Concentrate service in fewer hands Build case for new technology Reduce LOS/Increase in day case activity

20 Length of Stay - TURP Surgeon 1 Day LOS 2 Day LOS 3 Day LOS >3 Days ABP (19) 47% 42% 11% CSB (9) 67% 22% 11% IE (7) 29% 29% 29% 14% JJC (13) 62% 23% 8% 8% MK (7) 57% 14% 29% NMH (12) 42% 17% 17% 24% OJK (40) 45% 18% 28% 9% SJ (12) 58% 25% 16%

21 Urology TURP Concentrate service in fewer hands Build case for new technology Reduce LOS/Increase day case activity Able to maintain activity over Winter

22 Bariatrics Question of should we do more or less? Costs per surgeon Data per surgeon Disposable costs Length of stay data Variation between teams

23 Organ Transplant Kidney Transplant and impossible coding Looking at data and coding some patient being coded as acute when elective and vice versa 5,000 difference per case Mechanism in place to stop it happening Confidence of the team Doctors should not be coding every case but need visibility

24 Challenges - Theatre Costs Laparoscopic Cholecystectomy Theatre Minutes Cost Cost Per Minute Bexley Wing 01 3,807 81, Bexley Wing 02 3,495 74, Clarendon C Wing , Clarendon C Wing , Clarendon D Wing 01 David Beevers 01 1,873 69, David Beevers 02 4, , David Beevers , David Beevers Endoscopy 02 Geoffrey Giles 01 3,659 41, Geoffrey Giles 02 2,509 28, Geoffrey Giles , Geoffrey Giles , Geoffrey Giles 09 2,590 53,

25 Conclusion PLICS gives me easy access to vital data Activity volumes Resource usage Cost information Accurate information at a granular procedure or consultant level Used to: Start discussions Highlight variations in procedures Review and optimize patient pathways with the Clinical Team Improve quality / Reduce waste Deliver better care

26 Thank you