Nhcdc round 19 Independent Financial Review

Peer Review

12.The peer review process

The Round 20 IFR involved a peer review process so that costing representatives could participate in site visits at other jurisdictions. The peer review allowed NHCDC peers to share information, processes, challenges and solutions, and provided a valuable opportunity to have costing staff and costing representatives visit other jurisdictions.

35. Participation in site visits

Jurisdictions were asked to nominate relevant personnel to participate in the peer review from either the hospital costing level or the jurisdiction level. Jurisdictions in New South Wales, Queensland, South Australia and Tasmania nominated peers (all peers were jurisdiction representatives). The remaining jurisdictions were unable to send representatives due to capacity, funding and timing constraints. Peer review participants attended the Tasmania, Northern Territory, Western Australia and South Australia reviews. 14 contains a list of the peer review participants.

The peer review nominees selected their preferred locations and the host site was informed of the peer review selection. The nominees attended the meetings together with the KPMG review team and IHPA representatives, and were encouraged to ask questions and actively participate during the site visits.

36. Survey

Following the site visits, KPMG sent a survey to peer review participants to gather their feedback on the peer review process. The survey requested feedback on the following two questions:

1. 
   Please provide details and/or examples of key learnings that you have taken away from your recent site visit.
   
2. 
   Can you please provide any ideas or suggestions for how the peer review may continue to add value to the IFR process in future rounds? This can be aimed at the actual peer review process or the types of information that you would like to see incorporated into the IFR.
   

13.Summary of feedback on the peer review process

During the Round 20 IFR, the ability of all jurisdictions to participate has been limited compared to previous rounds, with only four jurisdictions nominating representatives for the peer review. Despite this, participating peers reported that they received substantial value from attending the site visits and see the opportunity as a useful learning tool. One participant reported:

“I found that the opportunity to participate in the peer review is excellent. I always learn something new that I then implement in [State/Territory] from participating.”

37. Key learnings from the peer review

A key learning for most participants was the ability to compare health services with that in their own jurisdiction, including common issues/challenges, costing methodologies, costing frequency, maintenance of general ledgers, and costing system capacity. Peers recognised that the process allows them to share information across jurisdictions.

Another key learning included the importance of the continuing discussion regarding the costing of private patients in public hospitals. At present there are a number of different methods adopted by jurisdictions/hospitals/LHNs, and further work is required to better understand the area so these patients can be costed appropriately.

38. Suggestions for improving the peer review or IFR process in future rounds

The following suggestions were made by participants regarding both the peer review and the IFR process for future rounds:

• 
  Reducing the need for peer reviewers to travel by limiting the site visits to two hours per hospital/LHN and offering video conferencing where possible. This is in recognition of the current scope and testing in the IFR process is well established.
  
• 
  Improve the scope of the IFR to include more detailed consideration of costing processes. For example, examining the costing process for a service that crosses the continuum of NHCDC classification products. Chronic Disease is an example where in any given year, a patient will have non-admitted, emergency and admitted episodes.
  
• 
  Consider whether the current scope and testing of the IFR is adequate in meeting its objectives and provides value to all jurisdictions. The financial and activity reconciliation processes embedded within the IFR are well established across hospitals/LHNs/jurisdictions. This means there is scope to expand the testing during the IFR to consider other specific hospital costing issues and methodologies in more detail.
  

14.Recommendation for future rounds of the IFR

KPMG recommends that the peer review process continues in its current form in future IFR rounds as the process is still considered valuable. IHPA, jurisdictions and the IFR consultant should seek to confirm site visits earlier during the project, to ensure peer reviewers have adequate time for travel approvals within their State/Territory Departments. The use of video conferencing should also be considered as a viable alternative for peer reviewers, where facilities are available.

IHPA Process

15.Overview

KPMG reviewed IHPA’s process for compiling the Round 20 NHCDC and followed the data flow of the 14 participating sites from submission to Jurisdictions, through to the recording of their NHCDC data in the national data set.

The review objectives of the IHPA NHCDC data submission process were to:

• 
  understand IHPA’s processes for receiving data;
  
• 
  determine IHPA’s processes for validating and performing Quality Assurance (QA) procedures;
  
• 
  identify and understand any adjustments to the data; and
  
• 
  reconcile the data against the national data set.
  

The KPMG review team met with IHPA representatives to discuss the data management, validation and QA processes that IHPA applied in handling the Round 20 NHCDC submissions. During the meeting, the review team viewed the supporting reconciliations, validation and QA outputs relating to the participating hospital/LHNs. This information was subsequently provided to KPMG, which was used to complete the IHPA component of the NHCDC reconciliations for each participating hospital/LHN. Additional clarification of reconciliation items was sought during and after the meeting with the relevant IHPA representatives.

Key initiatives since Round 19 NHCDC

IHPA noted the following improvements to the NHCDC and processes since Round 19:

• 
  IHPA developed a data submission portal in a move towards using a cloud-based system for data submission by Jurisdictions. This was in response to the limitations of the Enterprise Data Warehouse (EDW) and the feedback received from Jurisdictions regarding facilitating a simple and efficient data transmission process. This first stage roll out focused upon ease of submission with emphasis on the front end of the portal. The next stage is to use the portal to shape and drive the analytical process, including a new QA reporting feature.
  
• 
  In response to the recommendations in Round 19, a signed declaration as part of the data quality statements was required from Jurisdictions. The declaration required jurisdictions to confirm that they have applied the AHPCS, or identify the underlying reasons where the standards were not applied. The consistency of application of the AHPCS is important for ensuring the NHCDC is comparable across a range of factors such as jurisdictions, DRGs, and hospital settings.
  
• 
  In response to the recommendations in Round 19, IHPA is currently piloting a financial reconciliation template to accompany the NHCDC submission with three volunteer jurisdictions (NSW, VIC and TAS). The template is similar to the summary NHCDC reconciliations included for each sampled hospital/LHN in this report. Any feedback obtained from the jurisdictions will be incorporated in Round 21.
  
• 
  IHPA, in conjunction with the Australian Commission on Safety and Quality in Health Care, is committed to develop “a comprehensive, risk adjusted model to integrate quality and safety into hospital pricing and funding”. This is in response to a Heads of Agreement between the Commonwealth and the States and Territories on Public Hospital Funding. During the discussions with IHPA it was noted that, in light of this commitment to move to pricing for safety and quality, the data submission process and the QA procedures will continue to be refined going forward from a safety and quality perspective, supported by the new capabilities of the new data submission portal.