Irish Medical Times Oz wizards to shake up costs 

13 November 2009

Story published in the Irish Medical Times: The Health Service Executive has chosen PowerHealth Solutions UK to advise it on how best to introduce patient level costing (PLC) into the Irish health service.

The HSE has chosen an Australian-based company with offices in the UK to advise it on how best to introduce patient level costings (PLC) into the Irish health service. The consultants have been hired by St James's Hospital - acting on behalf of the HSE - to carry out studies in up to 15 hospitals on a new PLC system, which can measure resource used by individual patients. The move would constitute a sweeping change from the current predominantly 'top down' allocation approach, based on averages and apportionments, to a more direct and sophisticated one determined by the actual interactions and events related to individual patients. With its headquarters in Adelaide, South Australia, Power Health Solutions has worked in a number of countries including New Zealand, the US and UK. It is understood the HSE pilots will be carried out by its UK office in Bristol. The HSE currently employs a Casemix programme that was implemented in the early 1990's and uses the Australian Refined Diagnosis Related Group (DRG) classification, which provides a clinically meaningful way of relating the types of patients treated in hospital to the resources required. To date, costing exercise in Ireland have mostly been at the specialty level. However, the executive now believes that patient level cost data is necessary to 'drive efficiencies throughout the health sector and better inform the allocation of income'. Subject to the final budget approval, the PLC system would be capable of reporting on the individual diagnoses and procedures associated with each patient in the entire health service. Cost and resource consumption data - for example, the pathology or imaging test name, drug name, ward name, consultant or code - would all be recorded on a daily basis. Along with such patient details the HSE also wants to require aggregation at different levels, including division, specialty, DRG, procedure, point of delivery, consultant and hospital site. The process in already underway in the NHS, where it is belived that by tracing the resources used by a patient, the economic and financial drivers can be analysed. The HSE similarly recognises the potential of PLC. This new project has been deemed a 'priority' by the Executive, which has set December 2009 as the ambitious target date for producing the first data.

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