Data Collection Tool for Hospital Utilization and Cost Patterns
Lynn Hill Spragens, MBA, The Bard Group, LLC
To assist in the collection of relevant data
about hospital utilization and cost patterns, that will help ensure that the
Palliative Care program is designed to maximize its positive impact, and is
realistic about volume, revenue, and cost assumptions.
- Requests for information should be approved by the Medical
Director, VP of Medical Affairs, or
other individual with oversight responsibilities for patient and physician
information access and use. This will make it easier to get information from
support staff who must be cautious about data dissemination.
- The Approved Request should be in writing, and should be
supported by a face-to-face meeting with the staff member who will be
responsible for running reports or releasing information; this allows for
request clarification and compromise, to balance the ideal data and the data
that may be available in a timely and non-disruptive fashion from existing
- It is usually advisable to review samples of existing
reports to clarify the request, the available data field definitions, and assess
depth of initial reporting. Depending on the systems used, analysts may prefer to run summary and
detailed reports (case by case data for selected DRGs) at the same time, or to
wait for summary data review and then respond to a more targeted detailed data
request. Analysts may have suggestions for reliable time ranges, data that needs
to be excluded, etc.
- After initial review of data, it is advisable for the
requester (Palliative Care leader) to schedule a follow-up meeting with the
staff member/data source, and possibly with a manager who has used the data in
the past (Medical Director, UM manager) to assist in interpretation of the
- Always remember and repeat that you are looking
for representative data that will allow you to do some basic modeling, or
early stage interventions; it does not have to be perfect, although it is always
helpful to UNDERSTAND the data's imperfections.
- When reviewing sample reports, always clarify how you might
get it in the future, whether it is a customized report or a canned report,
and how hard it was to get, so that you can use this information when deciding
what data to use for ongoing measures of program impact.
(Ask BOTH the Utilization
Management Director (or equivalent role) AND a manager from Finance or Inpatient
- Palliative Care programs often contain the following features:
- Focus on coordination of patient care needs across departments
- Inclusion of other healthcare professionals in the care planning, care delivery, and family
- Emphasis on patient and family involvement in making care decisions
- Strong advocacy for consistent, well-documented care processes
- A focus on symptom management and a conservative approach to interventions and
daily orders that may discomfort the patient and not improve outcomes
Can you identify other initiatives
currently underway, under discussion, or recently completed that have
overlapping or complementary objectives? If so, whom might we talk to for more information?
- What reports can be generated based upon DRG classification? Are there samples that you can review, to focus your data requests on easily available information?
- Who are the users of this data now? What are some examples of
other hospital projects that have used data about case type, LOS, and practice
- What data fields are available? Is there a list available for easy review? In particular, are the following fields available for analysis:
- DRG description field
- Admitting MD
- Attending MD
- Admissions (perDRG)
- Mean and/or Median LOS by DRG
- Payer breakdown/classification (focused on Medicare, Medicaid, Commercial, other)
- Billed Charges per case
- Net revenue (paid charges) per case
- Bed type (ICU, Medicine, Pediatrics, etc)
- Patient AGE (and other demographics)
- Other fields we should have asked about!?
- Is there a Cost Accounting system?
Any methodology for approximating the cost of different bed types or the
utilization of resources? If so,
what types of reports are available?
In particular, we are interested in the impact of
expediting transfer of appropriate patients from the ICU to Medicine beds, and
our care plans may use less ancillary resources such as daily lab tests,
radiology, and administered drugs, so we are interested in any information
available that might assist in estimating impact, or serve as a baseline for
- Are there any reports that report either billed charges or costs by major cost center category, by admission? For
example, some hospitals can report the breakdown of lab, radiology, pharmacy,
OR, and "room and board" for each admission. Thus they can generate reports that
can profile resource use by MD or by DRG, or by both. Then it is possible to extract
information about the average cost of pharmacy for DRG xxx, by attending
physician. This is really helpful when looking for variation that can be
impacted by more consistent practices.
- How are transfers between bed types
handled in the data systems? For instance, if a patient had a total length of
stay of 10 days, and 2 were in the ICU, when looking at admissions by bed type
and ALOS by bed type and total days by bed type, what would we expect to see?
[This will help clarify what we ask for and how we use it.]
- Does the institution have any data on inpatient DRG utilization benchmarks, such as Milliman and Robertson LOS targets? If so, what is available and how is it currently being used?
- A Palliative Care program can contribute significantly to cost avoidance through reducing resource waste that drives cost/day, and reducing LOS for Medicare patients. Are there other programs that have been funded based upon estimated cost avoidance, rather than income production? For example, Utilization management, or Formulary initiatives? If so, who
could I talk with to learn more about their methodology for tracking
contribution vs cost?
Applicable to Finance Interviews Only
Specific DATA requests for DRG information
- What is the BUDGET CYCLE of the institution? Of the faculty practice (if applicable)? [ie is it calendar year or fiscal year, and when does fiscal year begin?]
- What is the budget process and timetable applicable to new programs? In our institution,
what are the options for budget consideration? Are there
required formats? Can I get a copy?
- If our program generates some revenue through consults (professional billings), who will be the billing agent or department? What other
professional billing do they currently do? Can you give me a contact
- If our program is implemented, we may have some staff (RNs, Social Worker, etc.); who
could we talk to about HR issues, estimated salary rates, etc?
- Can you describe the hospital payer mix, and contract types and how this
configuration impacts the financial priorities of the hospital? [ie FFS vs Case Rate vs Risk Sharing or Cap]?
- What percentage of net revenue is from Medicare? From Medicare Risk?
- What is the average occupancy rate in the hospital? How does this differ by bed type? Are there any services with serious capacity constraints, which may be reducing the hospitals ability to attract referrals? [For example, ICU].
In all cases, be prepared to amend your request if you discover more pertinent, easy-to-use information availability. Most hospital systems CAN report admissions, days, billed charges and net revenues. Some cannot report any reliable cost
information. Depending on analyst advice, you may want to request only one
version (possibly #6) and examine it closely, to identify any modifications
needed before the versions are run.
Can the following information be reported as follows?
- Based upon ALL hospital cases?
- Can it also be reported excluding OB, Peds, and Psychiatry? (Consider other
exclusions that may be appropriate to your setting.)
- Use a representative time period that is complete (most bills have been paid and
patients discharged); usually this is prior year.
- Top 20 DRGs, based upon number of admissions
- Top 20 DRGs, based upon total annual inpatient days
- Top 20 DRGs, based upon amount of billed charges
- Top 20 DRGs, based upon amount of net revenue or paid charges
- Top 20 DRGs, based upon total costs incurred, if available
- Top 20 DRGs, for Medicare patients
For each version (1 through 6) of Top 20 DRGs , please include any of the following information that may be available:
- Number of admissions (per DRG)
- Number of total days (per DRG)
- ALOS per DRG
- Total or average billed charges per DRG
- Total or average net revenue or paid charges per DRG
What is the hospital's Base Conversion Factor for Medicare DRG reimbursements? ________ [This should be a dollar
amount between $3000 and $10,000.]
If we provide you with a list of the most frequently used CPT codes for our
program, can you provide us with the local Medicare reimbursement rates, and the
median commercial reimbursement rates or representative
Financial Planning -Grand Rounds
Lynn Hill Spragens, MBA, offers sound advice on developing the financial plan for your palliative care program in an hour audio presentation.
Creating a Compelling Business Case for Palliative Care: Financial Models
A CAPC Management Training Seminar
July 2001, Oakland, CA
Other Resources By
Lynn Hill Spragens, MBA
The Bard Group, LLC