Integrated Service Line Reporting

Dmitry DorskyAlbatross Financial Solutions

Royal Berkshire NHS Foundation Trust11th April 2013

Integrated Service Line Reporting

Traditional NHS Service Line Reporting

Functional budgetary control

New integrated SLR – internal tariffs & budgets

New integrated SLR – how it works…

Traditional Service Line Reporting

Produced using total cost absorption; summary of PLICS or other costing models

Generally produced annually, bi-annually or quarterly

Timescale: PLICS based SLR usually available two to three months after period end (one or two Trusts deliver faster with major investment)

Is generally accepted to be the production of full cost and income trading accounts at specialty or service level.

Traditional Service Line Reporting

Problems:Generally focus only on patient care costs & incomeAccounts often not “closed down” for stock takes, bad debts etc...Cost transfer regimes use weightings rather than tariffs

So profitability of one service can be affected by actions of another service

No comparison to planNo clarity as to what drives apparent changes in performanceUses significant resource and lengthy time to produceExternal tariffs reviewed annually, so profitability can change, outside the control of service

We cannot therefore just use profitability as an indicator of improved efficiency

Traditional Service Line Reporting

Standard Budgetary

Information from GL

SLR Information

Traditional SLR exist along side main budgetary reports thus providing managers with two versions of the truth

Guy’s & St Thomas’ 2010/11 – Functional Budgetary control

Financial Performance monitored against expenditure plan Directly controlled expenditure budgets Adjustments for under & over performance against income plan

BUT: Indirect costs rarely charged Income plan accounted for centrally, but variance allocated as above Overhead costs never charged Trading position not monitored

Guy’s & St Thomas’ 2011/12 – New integrated Service Line Reporting - iSLR

Financial performance monitored against trading position

Income accounted for at Specialty Level

Directly controlled expenditure budgets

Indirect costs both volume related & standing charges

Overhead costs as fixed or standing charge

Trading position known

iSLR - Income

Income – All Income! Patient care Education

Service Increment For Teaching (SIFT) – undergraduate medical & dental education Medical & Dental Education Levy – post graduate M&D education (MADEL) Non medical education and training (NMET)

Research Clinical Excellence Awards Private Patients External contracts

iSLR – Direct & Indirect costs Direct costs Bad debts! Internal services transferred on an internal tariff set for the year where activity information available

Volume & Mix variances sit with front line services Efficiency variances sit with providing departments

Internal tariff calculation re-visited annually Demonstrate achievement of provider savings; zero net impact statement (ZNIS) Internal tariffs for:

Radiology Nuclear Medicine Wards Theatres Therapies Pathology

Internal services without “activity”, based on SLA, as an availability or fixed charge Pharmacists Physicists Emergency out-of-hours Operating Theatres

Internal tariff construction

Standard cost exercise in volume driven internally charged departments

(or should we perhaps use an external provider tariff?)

Directorate briefings on methodology

Key Points:

Based on actual Cost and Activity for first six months, or full year 2010/11.

Tariff set to recover cost

Derived by dividing relevant cost by relevant activity

Recognise that this reflects current practice, not most efficient practice

iSLR – Overheads & Trading position

OverheadsCurrently a fixed chargeProposals for incentives to reduce demand on Overhead services in 2012/13

Space Cleaning Portering Laundry

Contribution (planned Profit or Loss, Surplus or Deficit) to capital programmeMonitor all services against a bottom line planBUT - Income & Cost at Specialty (not patient) levelHowever – interactive drill down to transaction level for activity based internal charges - iSLR

iSLR – Timetable

Financial reporting to Trust Exec & Board by working day 10

FD review working day 9

Head of Financial Management needs to review position on working days 7 and 8

FM calculate and agree projections working days 4 to 6

FM review current month position working days 2 and 3

All SLR transactions therefore need to be posted by the end of working day 1

iSLR – Timetable

As all SLR transactions need to be posted by the end of working day 1Potential Data quality issues

“Good enough” approach

Post as accrual journal for month just ended

Post “errors” to charging department

One month to resolve errors & improve data quality

Income: two month accrual

iSLR menu

Directorate or Service Line Report

Service Line Report - Directorate Summary Period - M05 August 2011/12

Directorate - Drill Down to Service Detailed Directorate - Drill Down to Volume Related

SLR Line

Budget Actuals Variance Budget Projection Variance Budget Actuals Variance

(31,791) (34,859) 3,068 01 Income - Direct CreditIncome - Direct Credit (381,496) (274,410) (107,086) (158,955) (118,118) (40,837)

(6,599,856) (6,624,652) 24,796 01 Income - SLR Income - SLR Income (79,198,274) (79,770,281) 572,007 (32,999,281) (33,256,412) 257,131

2,587,202 2,581,324 5,878 02 DirectDirect 31,059,486 30,975,884 83,602 12,941,453 12,897,805 43,648

1,736,773 1,822,539 (85,767) 03 Indirect Volume RelatedIndirect Volume Related 20,718,752 21,696,867 (978,115) 8,438,491 8,920,279 (481,788)

726,901 726,901 0 03 Indirect Non Volume Related Non Volume Related 8,722,812 8,722,812 0 3,634,505 3,634,505 0

1,412,406 1,412,406 0 04 OverheadOverheads - General Support Services 16,948,872 16,948,872 0 7,062,030 7,062,030 0

177,487 177,487 0 04 Overhead - Contribution To Capital Programme - Contribution To Capital Programme 2,129,848 2,129,848 0 887,437 887,437 0

9,122 61,147 (52,025) Trading Position 0 429,592 (429,592) (194,320) 27,526 (221,846)

Directorate - Drill Down to Volume Related Transactions

Year To DateCurrent Period

Description

Full Year

Drill to volume based chargesDrill down analysis Period From: M01 April 2011/12 To: M05 August 2011/12 - version: V1

Directorate XXX

Period £ YTD £ Period £ YTD £ Period £ YTD £ Period £ YTD £

Radiology Adjustment -260 918 -1,555 533 100 566 -1,290 0

Current 98,042 501,528 35,011 143,789 8,657 42,814 10,403 38,153

97,783 502,445 33,456 144,323 8,757 43,380 9,114 38,153

S1 S1 S2 S2 S3 S3 S4 S4

Nuclear Adjustment 86 86 -0 -0 -0 -0

Current 45,483 162,483 1,406 3,849 9,968 1,027 2,538

45,569 162,568 0 1,406 3,849 9,968 1,027 2,538

S1 S1 S2 S2 S3 S3 S4 S4

Ward Adjustment -10,722 -14,406 -3,402 -2,216 3,275 7,379 -3,858 -99

Current 268,882 1,318,692 94,592 420,723 112,662 529,862 71,198 340,695

258,159 1,304,285 91,190 418,507 115,936 537,241 67,340 340,596

S1 S1 S2 S2 S3 S3 S4 S421AOrthopaedics 21BENT 21CPlastic Surgery 21DHead & Neck

Therapy IP F Health Adjustment -53 -53 0 0 0 0 0 0

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

Therapy IP SL Current 360 899 4,376 12,290 5,156 17,805

83,534 401,794 12,437 39,866 7,338 27,653 18,208 78,068

S1 S1 S2 S2 S3 S3 S4 S4

Theatre Adjustment 2,953 0 581 0 0 0 0 0

Theatre Current 257,276 1,211,061 95,817 478,150 183,181 903,796 51,682 216,561

260,229 1,211,061 96,398 478,150 183,181 903,796 51,682 216,561

S1 S1 S2 S2 S3 S3 S4 S421AOrthopaedics 21BENT 21CPlastic Surgery 21DHead & Neck

Anaesthetics Adjustment 2,186 0 422 0 0 0 0 0

Current 186,656 879,850 69,511 346,878 118,392 573,087 36,422 152,549

188,841 879,850 69,933 346,878 118,392 573,087 36,422 152,549

S1 S1 S2 S2 S3 S3 S4 S4

Theatre

Drill-Down Link

Anaesthetics

Drill-Down Link

Therapies IP

Drill-Down Link 21AOrthopaedics 21BENT 21CPlastic Surgery 21DHead & Neck

Ward

Drill-Down Link

Nuclear

Drill-Down Link 21A - Orthopaedics 21B - ENT 21C - Plastic Surgery 21D - Head & Neck

Radiology

Drill-Down Link 21A - Orthopaedics 21B - ENT 21C - Plastic Surgery 21D - Head & Neck

21A - Orthopaedics 21B - ENT 21C - Plastic Surgery 21D - Head & Neck

Specialty 1 Speciatly 2 Specialty 3 Specialty 4

Drill to source transaction data

Total £ Early Start £ Late Finish £ Used £ Unused £ Total £ Early Start £ Late Finish £ Used £ Unused £

Consultant 1 14,283 59 151 9,688 4,386 10,571 43 112 7,170 3,246

Consultant 2 7,385 0 976 5,437 972 5,465 0 722 4,024 719

Consultant 3 16,642 683 0 11,954 4,004 12,316 505 0 8,847 2,964

Consultant 4 8,256 25 188 7,309 733 6,110 19 140 5,410 543

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~

Consultant 22 9,944 0 896 7,359 1,688 6,619 0 663 4,861 1,095

Consultant 23 6,346 0 314 4,344 1,688 3,957 0 233 2,546 1,178

Consultant 24 8,084 0 42 5,600 2,442 5,983 0 31 4,145 1,807

Consultant 25 6,915 38 846 5,646 385 4,350 0 626 3,608 116

Consultant 26 17,781 84 607 13,215 3,875 13,160 62 450 9,781 2,868

Consultant 27 1,039 0 34 1,005 0 769 0 25 744 0

Total 257,276 1,973 13,031 186,731 55,542 186,656 1,432 9,619 135,179 40,425

Analysis - Specialty 1 (Period - M05 August 2011/12)

Surname

Theatre Planned £ Anaesthetics PLanned £

Drill to unused time in theatres

Consultant 21

Service - 21A - XXX

Theatre Session CodeAna Type Cancellation Desc Late Start Reason

Theatre Value £

Unused £

Anaesthetics Early

Start £

Anaesthetics

Planned £

Anaesthetics Late

Finist £

Anaesthetics

Value £Unused

£

GDSU2 GDSU2FRIAM GA CONSENT UNSIGNED 2,011 1,504 0 1,488 0 1,488 1,113

GDSU2 GDSU2FRIAM GA 1,005 0 744 0 744

GDSU2 GDSU2FRIAM GA DELAY ON WARD 2,011 653 0 1,488 0 1,488 484

GDSU2 GDSU2FRIAM GA CHANGE IN ORDER OF LIST 2,011 440 0 1,488 0 1,488 326

GDSU2 GDSU2MONAM LA NO CX - SESSIONS COMBINED TO RUN ALL DAY 1,005 1,005 0 4 0 4 4

GDSU2 GDSU2MONAM LA CONSENT UNSIGNED 1,005 553 0 4 0 4 2

GMT10 GMT10WEDAM GA DELAY ON SAL 1,043 71 0 744 28 772 53

GMT10 GMT10WEDAM GA LIST DELAYS - MORNING LIST OVER RAN 1,005 557 0 744 0 744 412

GMT10 GMT10WEDAM GA 1,068 201 47 744 0 791 149

GMT10 GMT10WEDAM GA CHRISTMAS CLOSURE 1,005 1,005 0 744 0 744 744

GMT10 GMT10WEDAM GA CONSENT UNSIGNED 2,011 1,340 0 1,488 0 1,488 992

GMT11 GMT11TUEAM GA 1,005 168 0 744 0 744 124

16,185 7,498 47 10,424 28 10,498 4,402

Total 16,185 7,498 47 10,424 28 10,498 4,402

Source Data Drill Down Period From: M09 December 2011/12 To: M09 December 2011/12

iSLR – Financial forecasts

Receiving departments should project both anticipated cost and income, and share that with providing departments.Providing departments to analyse the results of projections to their internal income, and where they hold a materially different view, initiate a discussion to reach an agreed forecast position for future monthly reporting.

iSLR – Impact for “Provider”departments

Now have an internal income target to fund their budget.Can no longer just appoint to a post when it becomes vacant but…

Need to understand future anticipated demand changes to fund their ongoing budget

Provider departments need to clear “their errors” each month

iSLR – How does it work? – 1. Data preparation

RADIOLOGY

PATHOLOGY

THEATRE

THERAPIES

PHARMACY

WARD STAY

iSLRDATA

REPOSITORY

STANDARDTARIFFS

ORGANISATIONAL HIERARCHY AND

ASSIGNMENT RULES

iSLRPROCESSOR

JOURNALS

UN-BILLABLEACTIVITIES

iSLRREPORTER

GENERALLEDGER

PROVIDER DEPARTMENT

DIVISIONAL MANAGER

iSLR – data preparation

Working day 1 – Month 8, reporting period Month 7 :

Departments provide scheduled data download between midnight & 6.00 am each day, containing at least 100 days data (i.e. m5,6,7).

We take last months cumulative data file for iSLR (i.e. M1-6).

We remove the last months (m6) data from that file so we have M1-5 data.

We import last two months data from yesterday’s download i.e. M6 & M7.

We now have a cumulative file for the whole years data.

iSLR – How does it work? – 2. Extract, Transform & Load

RADIOLOGY

PATHOLOGY

THEATRE

THERAPIES

PHARMACY

WARD STAY

iSLRDATA

REPOSITORY

STANDARDTARIFFS

ORGANISATIONAL HIERARCHY AND

ASSIGNMENT RULES

iSLRPROCESSOR

JOURNALS

UN-BILLABLEACTIVITIES

iSLRREPORTER

GENERALLEDGER

PROVIDER DEPARTMENT

DIVISIONAL MANAGER

iSLR – Extract, Transform & Load

Visual ImporterA set of automated import tasks

Ability to import data from any structured data source (Excel, SQL, Oracle, csv, etc…)

Full audit trail & Error tracking Set of reconciliation reports to valid import Ability to schedule batch run processes

iSLR – How does it work? – 3. Journal Creation

RADIOLOGY

PATHOLOGY

THEATRE

THERAPIES

PHARMACY

WARD STAY

iSLRDATA

REPOSITORY

STANDARDTARIFFS

ORGANISATIONAL HIERARCHY AND

ASSIGNMENT RULES

iSLRPROCESSOR

JOURNALS

UN-BILLABLEACTIVITIES

iSLRREPORTER

GENERALLEDGER

PROVIDER DEPARTMENT

DIVISIONAL MANAGER

iSLR – Journal Creation

Journal processingBased on user defined rulesUpdated via easy to use graphical interfaceFast Processing time (minutes)Full set of validation reportsAbility to track and analyse errorsAutomatic upload into Oracle

iSLR – How does it work? – 4. Reporting

RADIOLOGY

PATHOLOGY

THEATRE

THERAPIES

PHARMACY

WARD STAY

iSLRDATA

REPOSITORY

STANDARDTARIFFS

ORGANISATIONAL HIERARCHY AND

ASSIGNMENT RULES

iSLRPROCESSOR

JOURNALS

UN-BILLABLEACTIVITIES

iSLRREPORTER

GENERALLEDGER

PROVIDER DEPARTMENT

DIVISIONAL MANAGER

iSLR – Reporting

Reporting options:Journals imported into General Ledger (Oracle at GSTT)Users access financial performance reports through GL reporting (OBIEE)For internal transactions, use Business Objects to drill to source data that drives costFive clicks to patient activity recordExportable to Excel & Other formatsAvailable through Trust Intranet