Comment / The right tools
The HFMA Healthcare Costing for Value Institute has recently published its first patient-level information and costing systems (PLICS) toolkit for acute services.
In the current financial climate, PLICS can play a vital role in improving the efficiency and effectiveness of how patient care is delivered. It brings together information about the resources consumed by individual patients on a daily basis and combines this with the cost of this resource. This type of blended financial information is new for many organisations and is incredibly powerful.
PLICS also allows organisations to identify variation against standardised bundles or pathways of care, between clinical teams, or between different groups of patients. When PLICS is analysed alongside other performance and quality information it becomes even more powerful in understanding the delivery and performance of services.
The toolkit aims to support providers and their costing practitioners to turn the data generated by PLICS systems into powerful intelligence. Examples are provided of how data can be presented in different ways to different audiences including the executive team, clinicians and the wider finance team.
It also provides ‘top tips’ from organisations that have made the most progress with patient costing to date by spending considerable time working with the users of the data (clinicians, operational managers and finance teams in particular) to improve the content, functionality, usefulness and presentation of reports.
Case study
Maximising the value of PLICS data at Nottingham University Hospitals NHS Trust
“Our PLICS system shows us the resources consumed by each patient on a daily basis. This enables users of PLICS to look at the costs incurred after a particular date – for example, we are looking at the costs that are incurred after a patient is flagged as ‘medically safe for discharge’.This is incredibly powerful information as it can be aggregated by consultant/specialty/division/trust-wide level to understand the financial impact of keeping patients in hospital beds rather than in the community. This information also enables PLICS users to identify when patients have contracted hospital acquired infections and identify if any of these were past ‘medically safe dates’ – that is, potentially avoidable.
Our PLICS users also noticed that a lot of money was being spent on radiology tests at the weekends. This was in part due to the shortage of consultants (junior doctors ordering more tests). This is not good for the patients (extra radiation) and not good for the costs!
As a result, this finding was included within a review of staffing on wards at weekends. Our PLICS users in pathology noticed that spending on pathology had reduced and argued that all the focus had been on reducing pathology costs, whilst length of stay had been creeping up.
It was suggested that more money should be spent on pathology and a focus on getting the testing done in day one of a patient’s stay. In theory this should reduce length of stay. This is currently being trialled to assess the impact.” Scott Hodgson, head of costing, Nottingham University Hospitals NHS Trust
The publication of this toolkit by the Institute coincides with NHS Improvement’s publication of the first draft version of the healthcare costing standards and a ‘case for change’ document which reiterates the value of improved costing and the efficiency and service improvements that consistent and robust cost data can support.
If your organisation has already implemented a patient-level information and costing system, the PLICS toolkit will provide a useful checklist of reports and dashboards. The toolkit also sets out a number of areas to consider when rolling out PLICS, to maximise the value and use of the information.
This first toolkit is aimed specifically at acute organisations. Future toolkits are planned to support mental health and community organisations and services, as well as a further ‘beyond the basics’ document for acute services.
The toolkit is one of the many benefits of organisational membership of the Healthcare Costing for Value Institute. More details about the toolkit or membership can be found here.
Related content
The Institute’s annual costing conference provides the NHS with the latest developments and guidance in NHS costing.
The value masterclass shares examples of organisations and systems that have pursued a value-driven approach and the results they have achieved.