5 Key Learnings for Hospital Executives
Clinical Costing Improvement Program Workshop Summary (2018)
1. Over-the-horizon issue(s)
Avoidable adverse events are significant for patients, but they also have a significant impact on hospital costs. As Don Berwick has said for over 20 years, poor quality care costs more than quality, safe care. Public and private health funding providers will put measures in place to penalise
providers who do not prevent significant avoidable patient events.
IHPA on 4 March released the new National Efficient Price to apply for 2018/19. The new rate is $5,012 an increase of 1.6%. Australian hospitals should understand the impact upon their institution,
and in particular the implications for patient numbers that experience a significant defined Hospital Acquired Complication.
2. Current best / exemplary practice
A Choosing Wisely program developed at Gold Coast Health (GCH) to tackle inappropriate pathology testing has resulted in a reduction of unnecessary tests – thus causing less
issues for patients as well as a reduction in costs. A key success element of this program has been the engagement of clinicians supported by data and informatics in producing ‘dashboard’ reports that help support clinicians to understand their ordering behaviour
. The ‘QlikView’ developed reports allow clinicians to burrow down to individual patient or pathology testing orders. GCH encourages clinicians to benchmark their results against other intra-hospital services and to Health Roundtable benchmarks. Clinician buy-in has so far resulted in significant reduction in test ordering in Renal Medicine, ICU, Emergency Medicine, Obstetrics, Gynaecology, Haematology, Respiratory, Palliative Care, and other clinical areas. The project has only involved a 2 person team but has seen a 325% return on investment.
3. Significant or most interesting innovation(s)
Hospital Acquired Complications (HAC’s)
– Getting ahead of the Game. Townsville HHS has had a stubborn red indicator of a high rate for major HAC’s. Patients with such complications cost $26k more than patients without complications. The total impact of the complications adds $48m to patient care costs. A cross-department working group was established with an initial focus on understanding and improving the quality of data. An in-depth coding and clinical audit of 50 cases flagged as HAC’s found 40% did not meet coding standard to be classified as a HAC. In Feb 2018, a first round of education sessions were rolled out to clinical staff.
Creation of a dashboard allows timely display of data and local trend identification. Data is leveraged direct
from the iEMR
. Costs are now better understood. Outcomes to date- 18% reduction of HAC’s from same
period last year. Estimated 255 NWAU improvement for 6 months (not risk adjusted
). 150 clinical staffed trained in 2 days. Next rollout phase will focus on improvements in clinical pathways and calculating
risk adjustments to NWAU.
4. Metric(s) to watch
The number of hospital acquired
complications per 100 admission episodes. (In 2014/15 IHPA data showed there were 2.91 HAC’s per 100 episodes). HRT data for all hospitals in the Patient Safety Improvement Group showed participating member hospital had 3.9 HAC’s per 100 episodes in 2016/17).
5. Suggestions for action (Observations from HRT surveys & reports, data trends, recent research or innovations)
Hospitals should review their HAC rates in Health Roundtable reports
at hospital, division & department level. Significant variation exists between jurisdictions and between hospitals often those in the same network.