Money Follows the
Patient
Maureen Cronin
Healthcare Pricing Office
November 2014
Current Status
 HPO established 1-1-14 on an administrative
basis
 Merger of the HIPE team from the ESRI and
the Case-mix team from the HSE
 Setting prices for all episodes of care so that
care can be ‘purchased’
 Commencing with hospitals
Current Planning Model
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



Number of discharges in HSE service plan
Liver Transplants ?
Toenails ?
Cannot link money with activity
Cannot demonstrate our work to our funder
ABF will show complexity, volume and price
Fair Deal
 Explicit visibility of where the money was
being spent
 2013 we had 22,971 named individuals
spending €974m
 We know the price in every home
 We know how much money we are spending
on each individual
Example
Detail 060Z Vaginal Delivery (Inpatient 2012)
1
2
3
4
5
Total
Total Cost
12,395,198
16,523,272
2,941,438
3,679,823
5,692,770
41,239,240
Total Revenue
13,950,099
13,315,620
2,897,738
3,729,719
5,342,440
39,242,425
Net Surplus/(Loss)
1,554,901
-3,207,652
-43,700
49,896
-350,330
-1,996,815
Activity
6,095
5,808
1,275
1,643
2,342
17,166
Average Cost per Case
2,034
2,845
2,307
2,240
2,431
2,402
Breakdown of Average Cost Per Case by Cost Type from PLC
1
2
3
4
5
1,011
1,594
1,135
1,268
1,393
1,294
Non Clinical Salaries
339
419
375
236
256
348
Medical Salaries
271
225
375
332
222
263
Ward or Med Dept Supplies
164
355
189
187
274
248
Hotel Services
75
163
112
142
142
123
Pathology
99
12
92
50
79
62
Drugs
25
28
10
16
36
26
Theatre
31
0
Allied Health
17
23
8
7
15
11
Imaging
2
14
7
1
2
7
Blood Products
0
10
3
0
11
5
2,034
2,845
2,307
2,240
2,431
2,402
Nursing Salaries
Average Cost per Case
All Hosp Average
17
Maternity Outcome Data
 Surgical wound infections per 1,000
 3rd and 4th degree tears
 One hospital length-of-stay slightly longer
than international recommended best-practice
(48 hours)
 One hospital 24 hour length-of-stay with
similar outcomes for patients
Improving Patient Outcomes
 Stroke care – 3 criteria or we don’t pay for
the case
 Stroke Unit
 Thrombolysis
 Rehabilitation
9
Next Steps
 Investment in ICT infrastructure
 Investment in staffing
 Convert hospitals to ABF budgets for 2015
 2015 ‘conversion year’
Final