Who is responsible for ABF Reporting?

Journey so far...

patient

service

captureclassify

report

Cheryl McCullaghDirector Clinical IntegrationMay 2013

Why do kids cost more?

1. All Children require supervision2. All Children are vulnerable and need protection3. Children need more support for interventions4. Children’s hospitals provide care to carers5. Low volume dis-advantage, in stock, pricing, dosage and

standardisation of care6. Requirement to maintain capacity to manage all sized care from

neonates to adults in the paediatric environment e.g. beds, ET tubes, monitoring

7. No mechanism to shift increases in demand, planned and unplanned8. Simple cases are kept locally, complex cases are transferred to Tertiary

centres for the same DRGs9. Provision of expert consultancy to all patients everywhere

(consultation liaison clinician to clinician)10.Additional specialty training costs11.Expectation in paediatrics of a life to be saved, all measures are taken-

always

Who is involved in ABF?

Analytics

Coders

Patient

Pharmacist

Finance

Allied

Revenue

Medico

MRDOPD

ManagersExec.

Nurse

Costers

Pathology

IT

EMR

Aims

• Use resources wisely• Document once for many purposes• Count everything we do• Improve costing of events• Report activity as a by product of good documentation

• Improve safety and quality

• Do more with less?

One Year In... What does it cost us to provide ABF data?

Admitted stream

National classification with adjustmentsWell definedCoding/costing workforce Refreshed

Patie

nt

Adm

issi

on

Dis

char

ge

Code

Cost

Repo

rtRFASelf-checkPre-admitWaitlistReferralAdmin/PASDiagnosis

RecordsHistoryDiagnosisDocumentationCC attributes

DocumentRecordsCodingAdminScanningEMRIT

AdminScanningCodingAudit

AnalysisReviewcorrectAuditMap

ReviewcorrectTransmit MOHIHPA

Is there anything left to do?

Patie

nt

Adm

issi

on

Dis

char

ge

Code

Cost

Repo

rt

• E-RFA• Self

check in• Duplicate

s• Audit• System

interfaces

Patie

nt

Adm

issi

on

Dis

char

ge

Code

Cost

Repo

rt

•EMR•Documentation•CC’s

•TAT scanning and coding•Access•workforce

•Specialty coding guidance

•SAC splits•MH splits•Private?

•New standards•Workforce•SPT

•Reports to clinicians•Benchmark•Projections•influence classification•Automation

ED stream

• EMR• Error correction• Standardise coding• Costing• Reporting

Patient

Admission

Discharge

Code

Cost

Report

ED stream

1.Mixed history of costing in ED2.Consults in ED are rarely

captured and are likely to see the events under-costed

3.No paediatric adjustment

Patient

Admission

Discharge

Code

Cost

Report

ED and Admitted stream

• Well defined• Long captured and reported• Processes to support coding• Admin and IT support• Many improvements are ‘behind the scene’• Clinician involvement in documentation and reviewP

atient

Admission

Discharge

Code

Cost

Report

We are not there yet!!

NAP stream

• EMR -scheduling• Error correction• mapping• Costing/weighting• Reporting• Gaps

Patient

Arrive

Depart

Code

Cost

Report

NAP stream

ReferralAdminCorrections

Patient

Arrive

Depart

Code

Cost

Report

AdminCorrectionsProviders

BillingAdminCorrectionsProviders

MappingNAPOOSto SE

MappingCC to events

Pt level dataMultiple systemsautomation

NAP Gaps

• Not our patient• Not a scheduled patient• Telehealth • Outreach• Costing – no paed adjustment• Reporting

Patient

Arrive

Depart

Code

Cost

Report

Improved reporting - At what cost?

What is 5 minutes of staff time ?

Admin 3 /coder 06ADMN302 $2.69

MRD manager 01HSM0300 $5.32

Staff specialist 37STSPS00 $14.71

VMO VMO $22.02

CNC 02CNC202 $5.23

Nurse 02RN08 $3.94

Pharmacist 14PHM203 $4.65

HSM 3 analyst 01HSM0300 $5.32

$63.88

16

Unscheduled activity – PowerChart CHW

1. Enter the Service (Performed) Date/Time: mandatory

2. Enter your Team/Specialty (Service Unit): mandatory

3. Enter the communication type (Modality): mandatory

4. Enter your clinical notes (as normal)5. Select option for inclusion in ABF statistics:

• No (if already captured e.g. in Scheduling) but still want a clinical note

• Yes (to open next section for additional ABF items)

This form derives ABF information from clinical capture workflow

17

Unscheduled activity – PowerChart- CHW

1. Enter your Provider Type (Role): mandatory

2. Enter the Visit Location (Setting): mandatory

3. Enter the Referral Source (Referred from): mandatory

4. Enter the Financial Class (Group): mandatory

5. Enter the Referral Date and Referral Received Date (if known): not mandatory

This section enables direct capture of the remainder of the required ABF information during clinical documentation.

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Improving Health Service & Outcomes

Information collected for ABF can be used to:

• summarise & analyse any combination of reported patient attributes and cost detail (e.g. What patients are using my service the most?)

• support service utilisation review (e.g. what tests are being ordered and when, by patient type)

• enable benchmarking and variance analysis

• Provide evidence to change practice, and change the funding model

Quality relationshipsNational Safety and Quality Health Service Standards

Quality relationshipsEQuIP National Guidelines

Using resources wisely

• Minimise queues• Maximise process output• Reduce duplication and rework• Touch data once, use it multiple times• Correct data from anywhere• Document as we go• Report from anywhere• ? include patients in keeping information correct

• Focus on the EMR...

The Life of the eMR - like ABF

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A journey......• can support data capture• Mobile solutions are needed for accuracy and

reality• We need to meet the needs of clinicians

• The most expensive resource• The most in touch with activity

Investment in a comprehensive EMR

• Quality and safety• Reduce omission errors• Remove unclear or incomplete orders• Address administration and transcription error• Secure records• Save time- reducing duplication and Reporting

The most common reasons cited for incidents are:

» failure to read or misread (issues with legibility)» failure to have a complete picture of the patient’s

medications» failure to follow protocol (issues with compliance).

Outcomes

Improved governance for Safety and Quality in Health Service Improving efficiency and workflowLinking elements of careImproved information infrastructureAccess to recordsSharing of recordsImproved records for research and reporting purposes,Reducing clinician effort in finding patient informationReducing organisational effort in maintaining hard records

Cost benefit in investment in systems which reduce workforce hours

25

Future Development Aims

• To capture all activity• To improve documentation

•Include mobile solutions•To have a universal network approach•To reduce system and documentation duplication•To create systems that support capture with minimal effort•To enable ABF capture as a by-product of the eMR•Support more time delivering care

Good documentation

Good Patient care

Good access to information

Who is responsible for ABF – we all are...

Analytics

Coders

Patient

Pharmacist

Finance

Allied

Revenue

Medico

MRDOPD

ManagersExec.

Nurse

Costers

Pathology

IT

EMR

patient

service

capture

classify

report

27

The Journey continues

•Governance and communication•Health service administrators have a responsibility to enable clinicians to document well•Systems for documentation should reduce the burden of data collection•Development of EMRs with the output of reporting in mind•Focus on the patient and clinician•Information will better inform the accuracy of the model, pricing, classification and projections