HFMA 2019: Patient cost data shows its value

Delegates in a Learning Lab session on use of costing data heard about joint work between West Hertfordshire Hospitals NHS Trust and NHS Improvement to explore why they appeared to be an outlier in geriatric medicine.

The trust made a loss on geriatric medicine last year, equating to more than a quarter of the trust’s overall deficit for the year. While its cost per weighted activity unit for geriatric medicine was high, the need to explore the issue was underlined by the trust having the highest costs as a proportion of overall costs across the whole the NHS.

This led to the trust asking NHS Improvement if it could help with further information on comparative performance. Using data from the national voluntary collection of patient-level information and cost system (PLICS) data, which it could link with national hospital episode statistics data, helped to confirm the trust as an outlier.

However, the granularity of the patient-level cost data – accessed through NHS Improvement’s PLICS portal – also enabled the underlying components of cost to be explored. This simply wouldn’t have been possible with the top-down reference costs that predate patient-level costs as these simply provide healthcare resource group (HRG) level costs.

Looking specifically at one sepsis HRG, analysis showed that length of stay was a big driver of the higher costs – with patients staying in about three days longer in many cases than the average among peer hospitals.

Having broadly ruled out a number of causes including coding errors and hospital acquired infections, the trust was able to identify a specific issue with high costs associated with treatment of patients over the age of 80.

With around three billion data points in the patient cost data submitted by just 80 trusts as part of the last voluntary submission by acute trusts, it can be easy to get lost in the data available in NHS Improvement’s PLICS portal. ‘The point of the exercise was to get something actionable and reasonable out of there,’ said Stephen Dunham (pictured), assistant director of finance and commercial development at the trust. ‘This has got us to a place where our sepsis lead is now liaising with other partner trusts and local commissioners and a business case is being put together to strengthen our sepsis work and try to drive down some of the delayed transfers of care.’

‘So actionable things are happening and this is by no means the only department in the trust this could happen with,’ he continued. ‘Nor is this the only trust [where this approach would help].’ And he added the data could be used in a strategic way to redesign pathways or simply to identify areas such as coding that could be improved.