Abstract: Improving radiotherapy inpatient activity based funding at Central Coast Local Health ...

This is an abstract presentation recorded for the Independent Hospital Pricing Authority's (IHPA) Activity Based Funding Conference 2022, which was held virtually from 5 to 6 May 2022.
About this abstract
Clinical documentation auditing of radiation oncology episodes revealed that activities of planning and providing radiotherapy to admitted patients were not routinely recorded in the inpatient Electronic Medical Record (eMR). As a result, Clinical Coders were not able to capture this activity when coding which did not accurately reflect the complexity of the care provided to our patients. Radiotherapy planning and treatments (specific codes) attract a 39% increase in Activity Based Funding (ABF) for these patients (in 2020/21). If it is not coded, the District is missing out on funding. The primary objective of this initiative was to increase coding for these patients from 50 to 100%, resulting in appropriate funding. It was estimated that if these episodes had been coded correctly there would have been an increase in ABF of over $1,000,000 over 2 years (2018/19 - 2019/20).
Benchmarking at the beginning of the initiative indicated that many Local Health Districts in NSW had difficulty consistently coding admitted patient radiotherapy planning and treatments, as these events occur in an outpatient setting, however the funding is attached to the inpatient episode. It was identified that there are a variety of processes in place to address this issue with varying success. A working group was convened to work with key stakeholders from Cancer Services, Clinical Coding and Activity Based Management to identify issues and potential solutions using clinical redesign methodology. Solutions were implemented which included new processes for Nursing and Coding staff.
Presenters
• Ms Emma Watson, Healthcare Improvement Partner and Activity Based Management Specialist, Central Coast Local Health District
Emma Watson is the Healthcare Improvement Partner and Activity Based Management Specialist at Central Coast Local Health District. She has over 11 years’ experience in public health, seven of which have been here in the Central Coast. Emma has held roles in clinical costing, activity based management, health information services and healthcare improvement.
Emma has a Bachelor of Science in Health Information Management, a Masters in Health Service Management and a Graduate Certificate in Clinical Redesign.
• Ms Claire Neilson, Senior Health Planner, Central Coast Local Health District
Claire has more than 20 years' experience as a clinician and manager at Central Coast Local Health District. Originally trained as a Speech Pathologist completing a Bachelor of Applied Science (Speech Pathology), Claire has continued to expand her skills and knowledge with a Masters in Public Health, and a Graduate Certificate in Clinical Redesign. Utilising these diverse skills, Claire has held a variety of roles with the District, including Activity Based Management Officer whilst leading the improvement initiative presented at this conference. Currently Claire is the Senior Health Planner for Central Coast Local Health District.
• Ms Leanne Cowie, Operational Nurse Manager Cancer Services, Central Coast Local Health District
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