Nhcdc round 19 Independent Financial Review

Queensland

1. Jurisdictional overview

   1. Management of NHCDC process

The Queensland NHCDC process is a shared responsibility between both the Queensland Department of Health (Queensland Health) and the State’s sixteen (16) Hospital and Health Services (HHS) and the Mater Adult and Mater Mothers Public Hospitals in Brisbane that support the provision of public health services throughout Queensland. Each HHS, with the exception of four Rural and Remote HHSs where the costing function is managed by the Department of Health, is responsible for the preparation and submission of the costing data that contributes to the NHCDC submission. Queensland Health, through the HHS Funding and Costing Unit (a part of the Healthcare Purchasing and System Performance branch) provides overall oversight, quality control and reconciliation of the final data submitted. The costing data submitted by the HHS’s supports the costing function in Queensland, with cost data seen as an essential component of the State’s healthcare funding model, including through its submission to the NHCDC.

The HHS’s have costing staff who undertake patient costing at the hospital level. Once the costing process has been completed, the HHS costing staff inform Queensland Health that the data has been finalised and it is submitted to a central state-wide database.

There are two costing systems used across Queensland Health, Transition II and Power Performance Manager (PPM2). The majority of HHSs use Transition II as their clinical costing solution. Four HHSs use PPM2. Queensland Health’s Funding and Costing Unit has direct access to the HHS costing system database where the site uses the Transition II costing system. The submission files are extracted from the database (or supplied as a load file from Power Performance Manager (PPM) sites) once notification has been received from the respective site and a series of validation processes and reports are run for quality assurance purposes. The interview process identified that Queensland Health has implemented a number of additional data validation and reconciliation processes since Round 18. There are also extract data audit reports that assess records for errors in activity and mismatching of costed data to source activity systems. These audit reports also assess if there are new cost departments (hospital departments) that require mapping to local and national requirements.

There are two approaches to the recognition of work in progress (WIP) transactions. Transition II is a multi-year costing system and data is extracted for patients present in the reference year regardless of admission or discharge date. All transactions are date stamped and this means that no WIP adjustments are required to be processed at year-end. The four PPM2 sites are responsible for providing WIP data and adjustments on an annual basis.

Once finalised, a State costing report is produced for each hospital that includes all episodes costed. This report includes information on costs for Diagnosis Related Groups (DRGs), Tier 2 and subacute activity for the current round and previous round of the NHCDC. The report is provided to each HHS costing team. The costing results are reviewed and compared to the previous round and variances in the results of less than 10 percent are deemed insignificant. Additionally, costs for emergency departments and emergency services are reported by Urgency Related Group (URG) and Urgency Diagnosis Group (UDG) cost weights. All reports are provided to hospitals for review prior to the submission of the data for the NHCDC. It is noted that comparative data using cost weight reports is provided at LHN level for the current and previous five years, with a summary table of average cost outcomes.

Where data quality issues are identified, hospital costing staff address these and prepare for final submission to Queensland Health. Hospital Chief Financial Officers will sign off on the data. This cost data submission is used for both the Queensland state funding model and NHCDC submission. Queensland Health prepared the NHCDC submission according to the NHCDC Round 19 Data Request Specifications (DRS) provided by IHPA.

Queensland nominated three hospitals to participate in the Round 19 IFR: Gold Coast University Hospital, Toowoomba Base Hospital and Logan Hospital. Each of these hospitals are members of separate HHSs.

Queensland Health selected these three hospitals as they included a tertiary hospital, a medium sized hospital and a hospital with some rural services. These facilities have not been involved in any previous IFR’s.

Key initiatives since Round 18 NHCDC

The following initiatives have been implemented since the Round 18 NHCDC submission:

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  In prior years, where costs were excluded for Transition II sites, all relevant overhead costs were mapped to goods and services. The revised process for Round 19, for excluded Transition II sites sees the total cost of these overheads costs allocated to cost records based on an allocation statistic relevant for each overhead cost area. For example, where there are overheads associated with Nursing Administration for Nursing Salaries and Wages, a percentage of these overheads are allocated to the relevant patient record. These overheads are then reported to their respective cost bucket.
  

Further improvements for Round 19, see Queensland Health undertake a full reconciliation of the system produced overhead cost amounts for each patient record to ensure that all overheads have been allocated.

• 
  Improved reconciliation processes whereby Queensland Health undertook an end-to-end reconciliation process from General Ledger (GL) data through to final submission. In total there are seven stages:
  
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  Reconcile costing system general ledger (GL) load file to source GL data from the Decision Support System (DSS). HHS Costing and Dead ending process
  
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  Initial Extraction
  
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  Cost Type Category Validation. The Queensland Health Activity Costing Team completes a reconciliation as part of the final NHCDC data transformation process.
  
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  Virtual Patient Generator (VPG) Management. A reconciliation is completed by the Department of Health Activity Costing Team as part of the final NHCDC data transformation process.B2A/ Initial Cost Weight Report (Activity Based Funding (ABF) Costing Team)
  
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  Cost A/Cost C Final Submission (ABF Costing Team)
  

Final reports are analysed by Queensland Health in conjunction with the HHS for:

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  ABF / Non ABF splits;
  
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  Public Hospital Establishments Collection data;
  
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  Teaching, Training and Research reporting; and
  
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  Activity matching.
  

2.