Stephen Cole Director – ABF Financial Reporting Gold...
Transcript of Stephen Cole Director – ABF Financial Reporting Gold...
GCHHS Finance
Stephen Cole Director – ABF Financial Reporting
Gold Coast Hospital & Health Service [email protected]
GCHHS Finance
Some GCHHS statistics… • Two facilities – Large University & Mid tier facilities • Full range of services including Mental Health & Rehab • Large ED • Growing fast • $1.1B HHS Budget
FY13-14 Inpats Outpats EDSouthport (530 beds) 70,773 338,335 83,050
Robina/Carrara (370 beds) 40,607 77,756 59,435 111,380 416,091 142,485
GCHHS Finance
Why an Activity Based Budget (ABB)? • Conventional budget build methodologies
– Not responsive to targeted/funded activity in our Service Agreement
– Were not good at assessing clinical arguments for additional resources
– Gave no indicators regarding efficiency • No clear relationship between revenue
and budget
GCHHS Finance
GCHHS’s approach to ABB • Not a lot of information around on implementing
ABB in Purchaser/Provider environment • Chose to take similar approach to building state-
wide ABF funding – Build a set of weights to allocate activity internally – Apply this to both purchased and forecast activity
GCHHS Finance
ABB Timeline Proof of
concept – Nov 2013
Built using Transition II,
MS Excel
New Costing System – Jul
2014 PPM
MS SQL Server
platform
ABB v1 – Oct 2014
Built using PPM & SQL
Server
Presented using MS
Excel
ABB v2 – May 2015
Enhanced features
Better documented
Integrated with standard
budget build
ABB v3 – 2015 2016
Integrated with benchmarks
Improved statistical analysis
Feeder to Management Information
System
Monthly performance
reporting
GCHHS Finance
Hypothetical ABF Encounter Timeline
• A hypothetical patient timeline – Resources usage and clinical practice may differ in real life
GCHHS Finance
Hypothetical ABF Encounter Timeline Admission to hospital for a Medical DRG with an ABF QWAU = 1
QWAU : Resource Usage
GCHHS Finance
Hypothetical ABF Encounter Timeline Admitted into a Surgical bed, so Nursing resources provided by SAPS
QWAU : Resource Usage
GCHHS Finance
Hypothetical ABF Encounter Timeline Some Imaging done Resourcing from DEMS
QWAU : Resource Usage
GCHHS Finance
Hypothetical ABF Encounter Timeline Transferred to ICU ICU resources provided by SAPS
QWAU : Resource Usage
GCHHS Finance
Hypothetical ABF Encounter Timeline Spends overnight in ICU
QWAU : Resource Usage
GCHHS Finance
Hypothetical ABF Encounter Timeline Transfer back to Medical Bed
QWAU : Resource Usage
GCHHS Finance
Hypothetical ABF Encounter Timeline Drugs from Pharmacy as part of CAS
QWAU : Resource Usage
GCHHS Finance
Hypothetical ABF Encounter Timeline Physiotherapy appointment also provided with CAS resources
QWAU : Resource Usage
GCHHS Finance
Hypothetical ABF Encounter Timeline Discharge, but overheads resources have been provided by indirect areas
QWAU : Resource Usage
GCHHS Finance
Basic relationship map Organisationa
l Structure
Cost Centres
Areas
Cost Types/Cost Categories
Encounters
Activity
Area Weights
Activity/Area Weights
Indirect Cost Weights
GCHHS Finance
What do you need to make ABB happen?
• Access to costing system tables • Understanding of SQL and some MS SQL
Server skills – Training is easily available
• A bit of patience to work it all through
GCHHS Finance
ABB Timeline Proof of
concept – Nov 2013
Built using Transition II,
MS Excel
New Costing System – Jul
2014 PPM
MS SQL Server
platform
ABB v1 – Oct 2014
Built using PPM & SQL
Server
Presented using MS
Excel
ABB v2 – May 2015
Enhanced features
Better documented
Integrated with standard
budget build
ABB v3 – 2015 2016
Integrated with benchmarks
Improved statistical analysis
Feeder to Management Information
System
Monthly performance
reporting
GCHHS Finance
New Costing System • Easily accessible RDBMS
– Multiple tools able to connect • Excel • Access • Crystal
– Normalised database • 3rd Normal form • Allows easy query design
GCHHS Finance
ABB Timeline Proof of
concept – Nov 2013
Built using Transition II,
MS Excel
New Costing System – Jul
2014 PPM
MS SQL Server
platform
ABB v1 – Oct 2014
Built using PPM & SQL
Server
Presented using MS
Excel
ABB v2 – May 2015
Enhanced features
Better documented
Integrated with standard
budget build
ABB v3 – 2015 2016
Integrated with benchmarks
Improved statistical analysis
Feeder to Management Information
System
Monthly performance
reporting
GCHHS Finance
Retain the WAU factor Activity (WAUs)
Areas (WAUs)
Direct Areas (WAUs)
Direct CCs (WAUs)
Total Of All WAUs
Indirect Areas (WAUs)
Indirect CCs (WAUs)
Equal To Initial WAUs
GCHHS Finance
Retain the WAU factor • Allocating WAU not $ allows
– Simple checksum at the end to make sure all activity has been allocated
– Allows for different pricing to be applied to the activity to evaluate
• Efficient price • Efficiency dividend • 45% on activity above target
GCHHS Finance
Multiple Target Sets
Purchased Targets in Service
Agreement
Forecast Targets
Over Target
Activity (at 45%)
Effect of Expanding Services
GCHHS Finance
Multiple Target Sets • Allows us to compare and contrast
between different scenarios • See the full effect on direct and indirect
cost centres • Multiple targets can be combined with
multiple pricing • Easily allows building of “What if?”
scenarios
GCHHS Finance
Budgets with Benefits • Allows you to connect actual WAUs to
CCs to compare with actual CC expenditure – Evaluate efficiency – Help identify information issues – Provides an evidence base for a budget
• No activity – no ABF budget!
GCHHS Finance
Wrapping it up with a bow • Build it into a tool to use with the service line directors and General
Managers and add in • non-ABF • Adjustments for new services, EB, other allocations, business practice
changes • Compare and contrast with your conventional budget build • Allows operational areas to take more control
Service Line Summary Service Line
2014 Expenditure 2015 Budget Purchased Forecast
Adj 2015 Budget
Select Revenue
Select Revenue Adjust Final Budget
Head, Neck And Spine Ent 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000 Forecast 1,000,000 1,000,080
Head,Neck,Maxillo-Facial,Dental Surgery 1,000,000 1,000,000 1,000,000 1,000,000 1,005,000 Forecast 1,005,000 1,005,000
Neurosurgery 7,000,000 8,000,000 8,000,000 7,000,000 8,028,000 Forecast 7,028,000 241,380 7,269,380 Opthamology And Orthoptics 2,000,000 2,000,000 2,000,000 2,000,000 2,033,000 Forecast 2,033,000 240,516 2,273,516
Plastic And Reconstructive Surgery 2,000,000 2,000,000 2,000,000 1,000,000 2,001,000 Forecast 1,001,000 88,808 1,089,808
Operating Theatre Management Central Sterilisation 4,000,000 5,000,000 4,000,000 5,000,000 5,411,000 Forecast 5,411,000 5,411,000
Theatre 40,000,000 40,000,000 50,000,000 50,000,000 43,130,000 Purchased 53,130,000 -11,421,630 41,708,370 Oral Health Adult Community 1,000,000 1,000,000 1,000,000 1,000,000 1,070,000 Forecast 1,070,000 1,070,000
Directorate 8,000,000 2,000,000 6,000,000 6,000,000 1,970,000 Budget 1,970,000 1,970,000 Maxfax 80,000 800,000 0 0 800,000 Budget 800,000 800,000 Oral Health Labour 5,000,000 7,000,000 4,000,000 4,000,000 6,902,000 Budget 6,902,000 6,902,000
GCHHS Finance
Outcomes • Multiple target sets
– Allow budgeting for forecast activity – Additional activity/different activity models
• Eg. 45% Commonwealth funding estimation
• Cost per WAU can be devolved to Department/Area level – And subsequently to CCs and Service Lines – Gives an efficiency indicator
• Provides an evidence base for your budget development
GCHHS Finance
Benefits • Focusses Clinician attention on activity • Highlights the need to capture information
– No evidence no budget • Improves data quality
– Suddenly Clinical Costing is your clinician’s best friend
GCHHS Finance
ABB Timeline Proof of
concept – Nov 2013
Built using Transition II,
MS Excel
New Costing System – Jul
2014 PPM
MS SQL Server
platform
ABB v1 – Oct 2014
Built using PPM & SQL
Server
Presented using MS
Excel
ABB v2 – May 2015
Enhanced features
Better documented
Integrated with standard
budget build
ABB v3 – 2015 2016
Integrated with benchmarks
Improved statistical analysis
Feeder to Management Information
System
Monthly performance
reporting
GCHHS Finance
Integration with Benchmarks
Target_Level Area CostOutputRollup CostingDataset EncounterType Costs CostWght Ear, Nose and throat (ENT) ALAH11-GCH Allied Health FDE-0 GCH 1415 O 50.92960338 5.29E-06 Ear, Nose and throat (ENT) ALAH11-GCH Allied Health VDL-NURSE GCH 1415 O 25.02232646 2.60E-06 Ear, Nose and throat (ENT) ALAH11-GCH Allied Health VDS-DRUGS GCH 1415 O 27.08313033 2.81E-06 Ear, Nose and throat (ENT) ALAH40-ROB Allied Health VDL-HPRAC GCH 1415 O 3719.781049 0.000386091 Ear, Nose and throat (ENT) ALAH40-ROB Allied Health VDL-OPER GCH 1415 O 51.82233226 5.38E-06 Ear, Nose and throat (ENT) IMRA40-ROB Medical Imaging Serv VDO-SUPER GCH 1415 O 2172.609698 0.000225504 Ear, Nose and throat (ENT) IMRA40-ROB Medical Imaging Serv VDS-IMAGX GCH 1415 O 669.2825358 6.95E-05
• Weights built on historical costing proportions • Need to include cost benchmarks to encourage change • Current weights are built to level of Cost Types and
Categories • Will allow alignment with benchmark costing information
from HRT
GCHHS Finance
What is GCHHS going to do with ABB? • Make it more sustainable
– Giving the ABB team more resources – Develop the skills in-house – Document and automate the process
• Make it more robust – Include benchmarking – Integrate statistical analysis to manage outlier costs
• Make it more available – Distribute it using the Management Information System – Increase the timeliness of information – Focus on the service lines including auxiliary services
• Imaging, Allied Health, Theatre, ICU, Pathology, Cath Lab, etc…
GCHHS Finance
ABB Timeline Proof of
concept – Nov 2013
Built using Transition II,
MS Excel
New Costing System – Jul
2014 PPM
MS SQL Server
platform
ABB v1 – Oct 2014
Built using PPM & SQL
Server
Presented using MS
Excel
ABB v2 – May 2015
Enhanced features
Better documented
Integrated with standard
budget build
ABB v3 – 2015 2016
Integrated with benchmarks
Improved statistical analysis
Feeder to Management Information
System
Monthly performance
reporting
GCHHS Finance
Questions