Pwc report

Sunshine Coast HHS

Site overview

Nambour Hospital is the primary facility within the Sunshine Coast HHS offering around 350 beds. Caloundra and Gympie are the other main facilities of the HHS offering between 50 and 60 beds at these sites. The Sunshine Coast HHS services mostly an ageing and weekend / holiday maker population, with close to 400,000 people in southeast QLD. The ATSI population is small, representing approximately 1.5% of this population. The Sunshine Coast HHS also has contract arrangements in place for full services with the Noosa Hospital and the Sunshine Coast University Hospital, both owned by a private provider.

The construction of new clinics has introduced challenges for the costing team. New products in the costing system relating to outpatient data have made defining costs difficult. Input into these decisions is made with the department head. Another challenge for the costing team is to correctly allocate costs between facilities when medical staff visit patients outside their native hospital. While the costing team are able to allocate costs to be spread across these facilities, they are only able to allocate costs accurately if they have sufficient information.

Table below outlines the flow of costs from the GL through to submission to IHPA. We note that the $9.8 million variance is due to WIP patient costs being brought forward from prior years that were included in the breakdown of costs by product in item D.

Table : Financial overview of Sunshine Coast HHS, FY 2012/13

Financial data

General Ledger (Item A)

Financial statements are published at the HHS level. The total expenses per the financial statements for FY 2012/13 were $650.7 million. $649.9 million of this was in the GL for costing. The difference of approximately $821,000 was made up of the following reconciling items:

• 
  Losses on inventories and price differences (recorded as negative revenue when these should have been recorded as an expense) amount to a negative adjustment of approximately $472,000.
  
• 
  Capital works cost centres included in the audited financial statements, but were not included in Transition II for costing. These amount to a positive adjustment of approximately $720.000.
  
• 
  Removal of $579,214 to align the trial balance expenses with audited financial statements.
  

The GL structure and treatment of costs are consistent throughout QLD. As part of this review, specific cost items were examined to understand how they were treated in the GL and in costing. Please see Section for more information on what costs were examined and their treatment.

Inclusions and exclusions (Item B)

No inclusions to the GL are made at the site level. The total dead-ended costs for this round were $3.1 million. Dead-ended costs may include various administrative functions and commercial services which are out of scope in the AHPCS.

Allocation of overheads (Item C)

Overheads that are included in the hospital GL are allocated to patients based on total expenses. However, not all overheads are included in the hospital GL, and additional costs are added by the jurisdiction upon submission. These overheads were added to comply with the AHPCS and are allocated to costed patient records based on total expenses.

Distribution of costs between hospital products (Item D)

Distribution of costs was performed using activity data in line with the state wide methodology. See Section for more information.

Activity information and costing methodology

Overview

The costing methodology and activity information used in Round 17 at Sunshine Coast did not deviate from the state wide methodology. Section explains the allocation methodology by product that was used by Bundaberg and Sunshine Coast for Round 17.

Feeder data for sample areas

Overview

As part of the costing process different methodologies will be utilised to allocate costs to a patient level. The recommended methodology in the AHPCS is using a feeder system, which uses patient activity data to allocate costs. However, if this is not available then service weights or RVUs could be used. Sunshine Coast used a range of feeder systems in Round 17 in order allocate costs to patients, include pharmacy, imaging, prosthetics, theatre, critical care, bloods, ED, ward nursing and ward medical. Three sample feeder systems are discussed in more detail below.

Pharmacy

Sunshine Coast HHS uses the feeder systems iPharmacy and Stocker, which records consumption of pharmacy products by patients. Imprest drugs are allocated to wards, and allocated to patients using the ward’s allocation methodology. Dispensed drugs are linked to patients based on the date of service. The linking of these records was performed in accordance with the state wide process, as described in Section . For Round 17 the linking rules resulted in 66% of records being linked in inpatients and 12% being unmatched as shown in Table . Unmatched pharmacy records were linked to the Tier 2 40.04 Clinical Pharmacology clinic and submitted to IHPA as occasions of service.

Table : Outcome of pharmacy feeder linking



Theatre

Sunshine Coast HHS uses ORMIS, which records various data points of the patient operation. The use of the feeder data and linking rules used was consistent with the approach taken at Bundaberg, which can be found in Section . For Round 17, all but 6 records were matched to inpatients, as displayed in Table below.

Table : Outcome of theatre feeder linking



Ward Nursing

Sunshine Coast HHS uses FAMMIS, which includes data on the patient’s encounter in hospital, such as the admission and discharge date and time, and transfers between wards. The use of the transfer records and RVUs to allocate costs, along with the linking methodology, is consistent with the approach taken at Bundaberg, which can be found in Section . In Round 17, all records were linked to inpatients as shown in Table .

Table : Outcome of ward nursing feeder linking

The costed dataset

QA process

The Patient Costing & Reporting Officer of the Funding, Information and Costing Service team is primarily responsible for performing the costing, and this is reviewed by a Senior Business Support Officer. The costing team run weekly reports on volumes and patient activity looking for missing data and signs of integrity issues. Comparisons between data used in costing and data extracted from source systems are made. Current staffing constraints have limited the level of reporting able to be performed.

More detailed QA checks are performed by the jurisdiction and reported back to the HHS. These are described in more detail in Section . The jurisdiction provides the CFO summarised cost reports to approve by sign off. After the jurisdiction has completed their validity testing and made the required adjustments, the CFO of the Townsville HHS signs off the finalised costed output.

Adjustments

No adjustments to activity or costs are made by the site costing team. All adjustments to the costed dataset are made by the jurisdiction once costed output has been submitted, which can be found in Section .

Work in progress (Item E)

Adjustments are made for patients whose stay at the hospital crosses the financial year in accordance with the state wide policy described. This is consistent with the approach taken by Bundaberg, which is described in Section .

Sample patients

A sample of five patients was requested to verify that the total cost attributed to the jurisdiction’s submitted patient records reconciles with what IHPA has recorded as being received. As Table below demonstrates, no differences in costs were noted.

Table : Sample patient reconciliation with IHPA