Jurisdictional overview Overview of process
QLD Health plays a central role in finalising the costed dataset submitted by the various Hospital and Health Services. They also provide guidance to each of the HHSs in the form of QLD Costing Implementation Guidelines. Once data is received by QLD Health, a data transformation and QA process is performed over the data. This occurs in October each year and is performed over each of the costing databases within the HHSs.
The data transformation and QA process performed by the jurisdiction is summarised in the following steps:
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Pre-extract audit – the underlying cost data is assessed using a number of crystal reports which identify data quality issues that may have an adverse effect on costing outcomes. If the costed data fails to pass an 80% confidence level, then the costing teams are informed that the data is of insufficient quality to be progressed to the next step of transformation. The costing teams will then re-cost and the audit will take place again.
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Source data extraction – once the data has been validated, three data extractions are done:
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Patient level costing data is extracted from Transition II
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Patient information is extracted from a system called pAWS, which contains information on admitted, ED and outpatients
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GL data is extracted from the Decision Support System for reconciliation to costed outputs.
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Data mapping and review – A mapping is required between the state’s required data elements and the NHCDC data requirements. A review at this point allows for the management of changes or new cost centres that require mapping.
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Facility specific data transformation – some facilities require additional transformation procedures to prepare patient level data.
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Build HHS level NHCDC database – new database is constructed for IHPA submission purposes using this source cost information. The original data is maintained for reconciliation purposes.
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Create cost reports – cost reports are created to ensure there are no significant costing issues that will require a re-extraction of data.
Once the final audit has completed, a spreadsheet is returned to the HHSs, where the outcomes of validation reports, costs by facilities, negative cost encounters and high and low cost encounters are reported. An end-to-end reconciliation is performed to identify variances in cost between the initial GL loaded for costing, and the finalised data in the Decision Support System (DSS).
Adjustments to costed dataset
General adjustments were made to the costed datasets of all HSS by the jurisdiction as part of their finalisation procedures. These included:
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Excluded services – These include trust management costs, community care and other dead-ended costs in order to comply with the AHPCS. They are allocated to a virtual patient and subsequently excluded.
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Data quality–related issues – Records that do not meet the validation requirements are excluded from the costed dataset. These may include records where the date of birth is earlier than 1 Jan 1900, an unqualified baby that does not have a corresponding episode for the mother, and patients who have been admitted based on ED records, but do not have an inpatient record. Unlinked records may exist where a record with full patient demographic data does not have a corresponding cost record.
Wide Bay HHS (Bundaberg)
Below is a list of specific adjustments made to the Bundaberg data by the jurisdiction:
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WIP adjustments – $14.3 million was added which related to carried forward costs from prior years. $6.7 million was removed which related to patients who were admitted during the financial year but were not yet discharged.
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Costs removed due to QA checks – $9.2 million was removed due to patient records not passing all the state and IHPA quality assurance checks.
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Corporate overheads – $5.4 million of corporate overheads added by the jurisdiction. Corporate overheads are allocated based on total cost of the encounter for inpatient, emergency and outpatients.
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Out of scope activities – $9.4 million related to non-ABF activities, including services provided to other entities and patient transport schemes.
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Negative cost encounters – $18,000 relating to encounters with a negative cost have been excluded in accordance with IHPA guidelines, increasing overall total costs.
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Mismatched cost records – $8.2 million was excluded, relating to patient and cost records unable to be linked or matched correctly. This is primarily due to data quality issues.
The impact of these adjustments on activity across the hospital products is listed below:
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Acute – 184 encounters excluded
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Outpatient – 12,293 encounters excluded
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Emergency – 11,222 encounters included (due to product type matching errors during processing)
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Sub-acute – 17 encounters excluded
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Other – 535 encounters excluded.
Townsville HHS
Below is a list of specific adjustments made to the Townsville data by the jurisdiction:
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WIP adjustments – $52.3 million was added which related to carried forward costs from prior years. $32.4 million was removed which related to patients who were admitted during the financial year but were not yet discharged.
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Costs removed due to QA checks – $139.2 million was removed due to patient records not passing all the state and IHPA quality assurance checks.
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Corporate overheads – $11.8 million in corporate overheads added by the jurisdiction. Corporate overheads are allocated based on total cost of the encounter for inpatient, emergency and outpatients.
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Out of scope activities – $4.5 million related to non-ABF activities, including nursing homes and services provided to other entities.
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Negative cost encounters – $101,000 relating to encounters with a negative cost have been excluded in accordance with IHPA guidelines, increasing overall total costs.
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Mismatched cost records – $20.9 million was excluded, relating to patient and cost records unable to be linked or matched correctly. This is primarily due to data quality issues.
The impact of these adjustments on activity across the hospital products is listed below:
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Acute – 423 encounters excluded
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Outpatient – excluded 22,540 encounters
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Emergency – included 15,213 encounters (due to product type matching error during processing)
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Sub-acute – excluded 57 encounters and
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Other – excluded 1,715 encounters
Sunshine Coast HHS
Below is a list of adjustments made to the Sunshine Coast data by the jurisdiction:
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WIP adjustments – $9.9 million was removed which related to patients who were admitted during the financial year but were not yet discharged.
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Costs removed due to QA checks – $95.4 million was removed due to patient records not passing all the state and IHPA quality assurance checks.
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Corporate overheads – $9.3 million of corporate overheads added by the jurisdiction. Corporate overheads are allocated based on total cost of the encounter for inpatient, emergency and outpatients.
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Out of scope activities – $99.6 million related to non-ABF activities, including services provided to other entities, nursing homes and the patient transport scheme.
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Negative cost encounters – $18,000 relating to encounters with a negative cost have been excluded in accordance with IHPA guidelines, increasing overall total costs.
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Mismatched cost records – $2.82 million was excluded, relating to patient and cost records unable to be linked or matched correctly. This is primarily due to data quality issues.
The impact of these adjustments on activity across the hospital products is listed below:
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Acute – 444 encounters excluded
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Outpatient – 11,877 encounters excluded
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Emergency – 3,299 encounters included (due to product type matching error during processing)
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Sub-acute – 57 encounters excluded
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Other – 352 encounters excluded.
Reconciliation with IHPA
Table below compares the total costs and activity records submitted by the jurisdiction with the total costs and activity records that were received by IHPA. No variances were identified from the reconciliation.
Table : Reconciliation of total costs and activity submitted
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