CG 10 Outreach and specialist services

CG 10.1 Scope

CG 10.1.1 This Costing guideline outlines an approach to cost community outreach and specialist services activity.

CG 10.1.2 This Costing guideline also provides practical steps and examples to guide staff on the costing process for this activity.

CG 10.2 Objective

CG 10.2.1 The objective of this Costing guideline is to guide costing practitioners of the end to end steps required to identify and allocate expense associated with the provision of community outreach and specialist services to related products.

CG 10.3 Costing guideline

CG 10.3.1 Outreach services involve travel by the service provider, or services provided by a service provider via ICT (including but not limited to telephone and telehealth consultations). Such services may also be provided in the home, place of work or other non-hospital site. Generally, outreach and specialist services provided by a hospital may include:

  • District and home nursing;
  • Needle and Syringe programs;
  • Community based palliative care;
  • Post-acute care programs;
  • Early childhood intervention programs;
  • Home, personal, or respite care;
  • Meals on wheels;
  • Community social work/counselling;
  • Maternal and child health programs; and
  • Genetic counselling services.

CG 10.3.2 It is important to note that for the purpose of national reporting, some services excluded from scope of Outpatient care (METeOR: 584108). To ensure correct alignment between expenses and products, these rules should be understood and reflected in how expenses are matched with different products. Specifically, non-admitted products exclude service events which deliver non-clinical care, e.g. activities such as home cleaning, meals on wheels or home maintenance.

Step 1: Identify scope of activities and stakeholders

CG 10.3.3 Costing practitioners should meet with the appropriate stakeholders within the hospital to identify both the expense and activity related to the provision of Community Outreach and Specialist Services.

CG 10.3.4 The general ledger will provide a useful guide to establish if discreet cost centres exist for community outreach and specialist services. Costing practitioners will need to establish which programs are provided, and the staff member responsible for managing the budgets or cost centres of these programs. This information will be available from the Finance Department.

CG 10.3.5 Stakeholders that should be consulted include the Directors of Nursing and Allied Health. The agenda of this meeting should include a request for information of the various Outreach and Specialist Services provided; the availability of data (e.g., patient contact or occasion of services) for the services; and the expense associated with these services.

CG 10.3.6 Costing practitioners must be aware that expenses associated with these services may not reside within discrete Outreach and Specialist Services cost centres. For example, a social worker may be paid from the social work cost centre, but rostered to provide community based counselling services one day per week. The costing practitioner will need to seek this information from the stakeholders.

CG 10.3.7 Where staff are based in a particular hospital/establishment and provide outreach across a number of locations, their expenses should be reported against the location where the activity is provided. This ensures compliance with the fundamental principal of matching expense with activity.

Step 2: Align expense to the outreach and specialist service department, and define overhead and direct expenses, including overhead allocation methods

CG 10.3.8 Costing practitioners should work with stakeholders to identify the expense within the Outreach and Specialist Services Departments. This includes obtaining agreement on the cost centre/s to map to the Outreach and Specialist Services Departments for costing purposes in the costing software.

CG 10.3.9 Usually, these expenses will eventually map in the costing system to Community Outreach or Other Non-Admitted products. Care should be taken to ensure expense for outreach service that that are also excluded for non-admitted products are correctly matched to community outreach or as appropriate.

CG 10.3.10 Where the general ledger has consolidated expenses for Outreach and Specialist Services within other cost centres (for example, Social Work), costing practitioners should work with the stakeholders to develop an appropriate method to transfer expenses to the Outreach and Specialist Services related products.

CG 10.3.11 Using stakeholder insights, expenses need to be appropriately moved to the Outreach and Specialist Services final cost centre.

CG 10.3.12 Any stakeholder insights and decision made to movement of expenses to the Outreach and Specialist Services final cost centre need to be documented, including the:

  • classification of Outreach and Specialist Services expenses into the Outreach and Specialist Services final cost centres;
  • stakeholder/s who were consulted;
  • date of the meeting/s; and
  • date for future review of Outreach and Specialist Services expenses alignment.

Step 3: Identify outreach and specialist service activity and feeder data and perform quality assurance checks

CG 10.3.13 The maturity of information systems that collect outreach and specialist services are generally not as developed when compared to other hospital information systems.

CG 10.3.14 It is important that where patient level data is captured, such as that provided in the national non-admitted care data collection, that this should also be incorporated into the costing system.

CG 10.3.15 Ideally, information systems should provide patient details such as the number of patient/client contacts or occasions of service to assist with costing.

Step 4: Creating and mapping outreach and specialist services service costing products or intermediate products

CG 10.3.16 Intermediate products are created for services listed in the feeder. The number and type of intermediate products created will depend upon the level of data capture within relevant outreach systems. Once the intermediate products are created, costing practitioners will be required to ensure these are mapped in the costing system to the appropriate final cost centre.

CG 10.3.17 Aggregated (dummy) episode records and intermediate product codes may be created for cost centre or outreach and specialist service program with no feeder system or patient-level activities.

CG 10.3.18 Alternatively, depending on the requirements of the jurisdiction, costing practitioners may be required map the relevant intermediate products to the non-admitted product or products within the costing system.

Step 5: Apply Relative Value Units

CG 10.3.19 Costing practitioners will need to assess based upon the level of data available if RVU’s can be derived and applied.

Step 6: Create intermediate product costs in final cost centres

CG 10.3.20  Two allocation processes are performed:

  • When overhead costs are allocated to the Production Cost Centre (using an appropriate allocation statistic)
  • When the Production Cost Centre costs (overhead and direct) are allocated to the intermediate products.

Step 7: Match intermediate products and their costs to outreach and specialist services data

CG 10.3.21 Outreach and specialist activity will consume intermediate products from other hospital departments, such as imaging, pathology, pharmacy, and allied health. Costing practitioners must ensure that the intermediate products from these departments are matched to the appropriate outreach activity.

CG 10.3.22 Where patient level activity data is available, costing practitioners should ensure that intermediate products are mapped to the appropriate activity. Where the dummy patient is used (as there is only aggregate activity data) these intermediate products and their costs should be mapped to the dummy patient.

Step 8: Report costs

CG 10.3.23 Costing practitioners should then perform the required steps to consolidate and report costs of outreach and specialist service activity.

Step 9: Cost data review with relevant stakeholders

CG 10.3.24 Costing practitioners should meet with their relevant Outreach and Specialist Services stakeholders to report on the costs calculated.

CG 10.3.25 Cost data should be reviewed for amongst other checks, the average cost per product and completeness to decipher if the cost data captures resources that have been provided at product level.