Nhcdc round 19 Independent Financial Review

Peer Review

A.9.The peer review process

The Round 19 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.

14. 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 Australian Capital Territory, New South Wales, Northern Territory, 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. A peer review participant did not attend the Australian Capital Territory site visit due to timing constraints. Appendix K 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.

15. 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 three questions:

1. 
   What were your expectations of the peer review before you participated in the site visit?
   
2. 
   Please provide details and/or examples of key learnings (a minimum of two) that you have taken away from your recent site visit.
   
3. 
   Please provide any ideas or suggestions for improving the peer review process in future rounds of review.
   

A.10.Summary of feedback on the peer review process

Overall, the peers who participated reported that they received substantial value from attending the site visits. One costing staff participant reported:

“I was thrilled with the offer of an opportunity to be a peer reviewer as this was an opportunity for me to experience firsthand how another jurisdiction undertakes its costing study. I have only recently commenced in the [Activity Based Funding] environment and am thirsty for any valuable information I can obtain on this to enable me to better perform my role.”

16. Expectations of participation in the peer review

Participants commonly reported that by participating in the peer review, they expected to gain a better understanding of how different jurisdictions managed various costing issues in comparison to how they managed their own. The peer review was seen as an important opportunity to identify ways they could improve their own jurisdiction’s processes. There was also an interest in identifying how costing data is used by jurisdictions in their reporting and planning, and in how the hospital teams work with the jurisdiction in the costing process.

17. Key learnings from the peer review

One key learning for most participants was that many of the issues surrounding costing are similar across jurisdictions. For example, issues experienced with rural and remote services (such as patient transport, staff accommodation, economies of scale, and outreach services) were identified as common to a number of jurisdictions. As such, peers recognised that it is important to establish networks with other jurisdictions to regularly discuss, provide support and receive advice on issues experienced.

Other key learnings included the importance of having a skilled costing and analysis team to ensure the effectiveness of Activity Based Funding, and the need for continuous improvement to costing processes. A number of participants also noted that the peer review had provided them with ways to develop improvements to their own costing processes by observing different approaches to calculating costs.

18. Suggestions for improving the peer review process in future

An improvement noted by a number of participants was to include more information in the review on how costing data is used by clinicians in their reporting, business planning and in developing improvements to hospital practices. Feedback was also received that more input from the full costing team during the review would be beneficial, along with a more in-depth presentation on the costing process in that state or territory.

One participant also noted that including a team member in the review process who understands how the clinical services are managed would be beneficial (such as the Director of Nursing). This would enable valuable input into the clinical questions that impact on how the local clinical and business organisational structures translate into the cost outcomes.

IHPA Process

A.11.Overview

KPMG reviewed IHPA’s process for compiling the Round 19 NHCDC and followed the data flow of the 18 participating sites from submission to the jurisdictions, through to the recording of their NHCDC data in the national data set.

The objective of the IHPA NHCDC data submission process review was 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 NHCDC milestones are published in IHPA’s Three Year Data Plan. The milestones reflected a process, which involved submission to the NHCDC through the Enterprise Data Warehouse (EDW), validation and quality assurance of submitted data and finalisation of the costing database for the publication of national cost weights by 30 September 2016.

IHPA noted the following improvements to the NHCDC and processes since Round 18:

• 
  Access to the NHCDC drop box was provided to jurisdictions in February 2016 this enabled earlier submissions and response times for validation reports and QA of submitted data.
  
• 
  Following feedback from jurisdictions post Round 18, a review of the information provided in QA reports was conducted by the NHCDC Advisory Committee. Following that review, IHPA improved and re-developed the QA reports for Round 19. These reports are designed to critically view submitted data in light of learnings from previous rounds and flag known issues at the time of data collection for the development of the National Efficient Price. The outputs provided in the improved QA reports resulted in a number of jurisdictions who identified issues and re-submitted their data for Round 19.
  
• 
  IHPA highlighted that the number of hospitals submitting to the NHCDC decreased in Round 19, as a number of smaller Queensland hospitals did not submit cost data. However, there was no major change to the number of costed records and the breadth of costed records across product types actually increased.
  
• 
  There has also been a continued focus on Tier 2 data collection, which has been maturing over recent rounds. IHPA noted that South Australia submitted non-admitted data for the first time in Round 19.
  
• 
  The Data Request Specifications (DRS) were updated to enable the submission of the Palliative Care Phase of Care.
  

The KPMG review team met with IHPA representatives to discuss the data management, validation and QA processes that IHPA applied in handling the Round 19 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.