independent hospital pricing authority and paxton...

Independent Hospital Pricing Authority and Paxton Partners

TEACHING

TRAINING AND

RESEARCH

COSTING STUDY Julian Maiolo

Director, Paxton Partners

Robin Auld

A/g Manager, Classification Development

OVERVIEW

• Project Recap

• Outcomes and initial findings

• Classification development

2 www.ihpa.gov.au

PROJECT RECAP

4 www.ihpa.gov.au

PROJECT CONTEXT

The Definitions and Cost Drivers Project set the foundation and scope

parameters for a TTR costing study

• IHPA engaged a consortium led by Paxton Partners to undertake the

TTR project of activity and cost data collection across a sample of

Australian hospitals;

• 19 sites participated - 13 from Queensland, 5 from WA and 1 from SA;

• Main project output - preparation of a costed TTR data file to inform

the development of a TTR classification.

• Data collection commenced in May 2015

• Included both prospective (May to October inclusive) and

retrospective (January to April) elements in an attempt to capture

seasonal impacts on TTR activity;

5 www.ihpa.gov.au

Definition of teaching and training (T&T)

Teaching and training describes:

“the activities provided by or on behalf of a public health service to facilitate the acquisition of knowledge, or development of

skills. These activities must be required for an individual to:

‒ attain the necessary qualifications or recognised professional body registration to practice;

‒ acquire sufficient clinical competence upon entering the workforce; or

‒ undertake specialist/advanced practice

in medicine, dentistry, nursing, midwifery or allied health.”

Definition of research

Research describes: “the activities undertaken in a public health service where the primary objective is the advancement of

knowledge that ultimately aims to improve consumer and patient health outcomes and/or health system performance. The

activity must be undertaken in a structured and ethical way, be formally approved by a research governance or ethics body,

and have potential for application outside of the health service in which the activity is undertaken.

For activity based funding (ABF) purposes, the definition of research relates to: the public health service’s contribution to

maintain research capability, excluding the costs of research activities that are funded from a source other than the state or

territory or provided in kind.”

DEFINITIONS OF TTR

T&T CLASSIFICATION FRAMEWORK

6 www.ihpa.gov.au

Phase (1st split)

Profession (2nd Split)

Discipline (3rd Split)

Student /

Pre entry

Early Graduate /

Pre vocational

Advanced scope

of practice /

Vocational

training

Allied Health

Nursing

Midwifery

Medicine

Dentistry

Trainee

Type

Physiotherapy

Dietetics

Social Work

Physician

Surgical

Anaesthetic

Unit of count

TTR COST TYPES Teaching and training:

• Direct : The costs incurred to support the theoretical or practical training activities to

support the transfer of knowledge that occurs independently from the delivery of

patient care (lectures / workshops conducted by the hospital).

• Embedded : describe events where TT occurs in conjunction with patient care. (ward

rounds, operating theatre, outpatient clinics, work based assessments)

• Indirect: support activities provided by health service that is essential to facilitate

teaching and training, but do not involve either a didactic or experiential

skills/knowledge transfer. (nurse education dept.).

Research capability activities the total cost to

support research endeavour across the hospital

(e.g. the cost for supporting research

grant submissions)

7 www.ihpa.gov.au

8 www.ihpa.gov.au

COLLECTION PROCESS

Stage 1

Project initiation

& planning

Stage 3

Develop & test

costing

methodology

Oct 2014

Stage 2

Site selection &

Implementation

planning

Oct - Nov 2014

Stage 4

Develop data

collection

infrastructure

Stage 5

Cost data

collection

Dec 2014 Jan 2015 – Nov

2015 Nov – Dec 2014

Stage 6

Data preparation

& reporting

Jan to Apr 2016

• Three tranches of hospital data collection using standard data request specifications to

capture costs, staffing profiles and training activities

• Driven by site coordinators at each site, appointed between Dec 2014 to final data

submissions

‒ Significant effort by Site coordinators to identify available systems, data custodians for

each of the clinical professional groups across the hospital

• Reasonable cost and staffing profile data was collected

• Embedded T&T and research functional data most challenging to collect

9 www.ihpa.gov.au

EMBEDDED TT

• Limited / patchy embedded data available from existing hospital systems

• Stakeholder consultation, survey and focus groups engaged to provide a basis for

assessing embedded TTR across professional groups.

• Consultation process provided a starting point to assess

‒ How embedded TT was undertaken during patient care activities

‒ Who was involved

‒ Estimated time spent by trainees and trainers either receiving / delivering

embedded TT or participating in direct patient care

• Results from survey and consultation provided key assumptions and parameters

that were applied back to Hospital provided data to derive the initial calculation of

the impact of embedded TT.

INITIAL

FINDINGS

KEY POINTS

1. Robust data set – starting point for a teaching and training classification

2. Data limitations – embedded teaching and training, research

3. Key data element for ongoing collection – number and type of FTE

trainee

4. Initial findings only – jurisdictions involved are still looking at the data

5. Draft Final Report is still progressing through IHPA’s committees – will

go to the Pricing Authority in July / August 2016

11 www.ihpa.gov.au

SAMPLE

12 www.ihpa.gov.au

Profession Ave. Headcount

per Month Overall

Records

Medicine 351 6,811

Nursing 196 1,399

Allied Health 46 1,156

0.0

1.0

2.0

3.0

4.0

5.0

6.0

Ave

rag

e C

ost

(F

TE

/mo

nth

$ ‘00

0s

)

Trainee Type

Overheads

Indirect

Direct

Embedded

13 www.ihpa.gov.au

COSTED RESULTS - NURSING

COSTED RESULTS – ALLIED HEALTH

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

U/grad P/grad Researchstudent

Grad AHprof

Grad assisAH

Med. rad.sci intern

Pharmintern

Psychintern

Spec/advscope ofpracticetrainee

OverheadsIndirectDirectEmbedded

14 www.ihpa.gov.au

Ave

rag

e C

ost

(FT

E/m

on

th $

‘00

0s)

15 www.ihpa.gov.au

ALLIED HEALTH – COST ANALYSIS AH prof n

Physio 176

OT 169

Rad. Sci. Med

imaging

115

Pharmacy 156

Speech path 123

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

Physio OT Rad sciencemed imaging

Pharmacy Speech path

OverheadsIndirectDirectEmbedded

Ave

rag

e C

ost

(FT

E/m

on

th $

‘00

0s)

Allied Health Profession

COSTED RESULTS - MEDICINE

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

U/grad P/grad PGY 1 PGY 2 PGY 3+ Bas. TraineeReg

Adv. TraineeReg

Inter. Med intraining

Overheads

Indirect

Direct

Embedded

16 www.ihpa.gov.au Trainee Type

Ave

rag

e C

ost

(FT

E/m

on

th $

‘00

0s)

17 www.ihpa.gov.au

COST ANALYSIS – GEOGRAPHY

MEDICINE BY PHASE - EXCLUDING EMBEDDED

$-

$200

$400

$600

$800

$1,000

Student / pre-entry early grad / pre-vocational

Adv / vocational

Metro

Non-metro

Ave

rag

e C

ost

(FT

E/m

on

th)

Trainee Phase

18 www.ihpa.gov.au

Type N

Avg cost per FTE/ month

95% CI low

95% CI high

Median CV

Grad reg.

nurse 498 $5,199 $5,099 $5,299 $5,070 0.22

COST ANALYSIS – STATISTICS EXAMPLE

Grad reg.

nurse

Ex.

embedded

498 $705 $644 $766 $379 1.03

Influence of embedded T&T

RESEARCH

• Data request aimed at functions and resources employed to support research

(not the research endeavour itself)

• Research data provided was variable across sites

• Most research data from principal referral metropolitan hospitals

‒ Difficult to capture data

19 www.ihpa.gov.au

CLASSIFICATION

DEVELOPMENT

THE AUSTRALIAN TEACHING AND

RESEARCH CLASSIFICATION

SYSTEM

• IHPA initiating a project to develop a teaching and

training classification system

• IHPA will be undertaking a public consultation in 2017

21 www.ihpa.gov.au

22 www.ihpa.gov.au

QUESTIONS?