CG 13 Consultation liaison

CG 13.1 Scope

CG 13.1.1 This Costing guideline outlines an approach to patient level costing consultation liaison services.

CG 13.1.2 This Costing guideline also provides practical steps and examples to guide staff on the patient costing process for this activity.

Consultation liaison scope

CG 13.1.3 Consultation liaison applies to any products that require these services, including where these services are provided for patients treated in admitted, an emergency or non-admitted setting. These services may be provided by other departments in the hospital or from/to another organisation.

CG 13.1.4 The nature of these services supports a department in the hospital to deliver patient care. These services are not an overhead and on their own not patient care but are an independent product that supports patient care.

CG 13.1.5 These services are considered intermediate products and as such it is important to understand the value of these services to ensure that:

  • they are matched to the patients or products that they helped to produce; and
  • departments proving consultation liaison service do not assign expense for these service to its own department products.

CG 13.1.6 Consultation liaison may also be provided for purposes that are not related directly related to a patient but do support patient care, such as where infectious diseases staff will be providing advice on the need for ward super washes.

CG 13.2 Objective

CG 13.2.1 The objective of this Costing guideline is to ensure that all consultation liaison expenses which contribute to an organisations day to day production of final products are included in patient costing to determine the full cost of production.

CG 13.2.2 This Costing guideline also aims to provide a resource for costing practitioners to assist them undertaking patient level costing by providing practical examples of consultation or clinical liaison services.

CG 13.3 Costing guideline

Step 1: Stakeholder identification service scale and scope

CG 13.3.1 Costing practitioners should consult relevant stakeholders to obtain an overview of the Consultation Liaison services within the hospital. This type of service may take place across a number of units and specialities within the hospital. However key areas which that these service are generally found is within the mental health and emergency department settings.

CG 13.3.2 Stakeholder from these settings need to be consulted to determine the nature of these service, and how they are or can be measured.

Step 2: Align expense to the Consultation liaison service and define overhead and direct expenses, including overhead allocation methods

CG 13.3.3 Costing practitioners should engage finance stakeholders to ascertain how consultation liaison expenses are recorded within the general ledger. There are two scenarios that need consideration:

  • generally, these expenses are not separately identified, as they would be integrated within a department’s functions. This means that consultation liaison expenses are not recorded against the same cost centre as where the services are provided.
  • in some cases, cost centres may be specifically assigned for Consultation Liaison services such as Aboriginal Liaison, Mental Health Consultation Liaison – Psychiatry.

CG 13.3.4 In consultation with stakeholders, expenses that are integrated within departments need to be moved to a Consultation Liaison final cost centre. The methods used to identify these expenses need to be developed in line with stakeholder insights about how these services are provided and to where in the organisation they are delivered.

CG 13.3.5 Expenses for Clinical liaison services that are provided to third parties, where the associated products are reported by the third party, are not to be included in the clinical costs at the host hospital. These expenses should be made available to the receiving hospital as costed intermediate products and included as third party costs to its production.

CG 13.3.6 Similarly, where consultation liaison services are used by the hospital which are provided by a third party, these expenses need to be identified by the hospital included in the host hospital’s cost of production as a third party cost.

CG 13.3.7 Any insights obtained from stakeholders on the nature of consultation liaison service, the associated expenses and ways to measures theses services need to be clearly documented and reviewed for currency.

Step 3: Identify patient level activity and Consultation liaison feeder data and perform quality assurance checks

CG 13.3.8 Ideally, measurement of these type of service should be supported by appropriate feeder systems and include this data in the costing process. The availability, source and level of activity detail captured will influence the costing methodology for consultation liaison services intermediate products.

CG 13.3.9 Some Consultation Liaison services may not be recorded well and feeder systems may not provide the required detail that demonstrates the use of these services across hospital units. In these cases, the costing practitioner may need to with relevant stakeholders refer to other sources for information (for example, timesheets) to derive feeder data.

CG 13.3.10 Consultation Liaison services may also be provided to advise the hospital on specific areas of interest that may not be directly related to specific patient activity. Feeder data may not be captured and the expenditures will most likely need to be allocated as overhead. For example, an Infectious Diseases Unit may provide advice on infection control (such as the need for isolation units or super washes of wards).

CG 13.3.11 If available. the consultation liaison feeder data will ideally include some or all of the following fields:

  • The patient’s unique identifier;
  • The patient unique episode identifier;
  • The unit where the service was requested and provided (for example, Emergency, Ward B);
  • The date/time of service;
  • The type or category of service provided (for example consultation);
  • Delivery mode (for example: face to face, telephone); and
  • the duration of the service.

CG 13.3.12 Costing practitioners should perform quality assurance checks on the consultation liaison feeder activity file prior to the costing process. For example, checks should be made on the date of service (to test reliability to remove error dates and ensure dates are relevant to the period being costed).

Step 4: Creating and mapping Consultation liaison service costing products or intermediate products

CG 13.3.13 The costing practitioner should consider the following to inform the costing process for Consultation Liaison services:

  • Where traceable Consultation Liaison costs can be identified, these costs should be used to allocate expenses directly to the patients.
  • Where Consultation Liaison time is recorded at patient level, they should be used to allocate expenses directly to the patients. For example, patients in the emergency department may receive consultation liaison services provided by clinical staff from the Consultation Liaison Psychiatry Department. The time staff attend to the emergency department should be used as a basis to allocate expenses.
  • Where Consultation Liaison activity data is missing for feeder purposes, utilisation data or Relative Value Units (RVU) may also be created from demographic or coding information. For example, the costing practitioner may use Indigenous status field (as a measure) to create a feeder or RVU to allocate expenses from Indigenous Liaison cost centre
  • Where feeder data cannot be found, the costing practitioner should consider allocating these expenses as an overhead

CG 13.3.14 If consultation liaison services are treated as an overhead, costing practitioners should assign the most appropriate overhead statistic (see Costing guideline 9 – Mental Health Services) to distribute these expenditures.

CG 13.3.15 If consultation liaison services are treated as direct cost, intermediate products may be created and mapped to respective final cost centres.

Step 5. Apply Relative Value Units

CG 13.3.16 The cost allocation process for consultation liaison services might be further enhanced through the use of RVUs. RVUs are relative values used to assist the costing practitioner allocate costs to better reflect the cost of service provision.

CG 13.3.17 The relative values should be determined and agreed in consultation with the relevant stakeholders.

Step 6: Create intermediate product costs in final cost centres

CG 13.3.18 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 Consultation liaison activity

CG 13.3.19 Consultation liaison services or intermediate products are matched to the appropriate patient episode or encounter using the appropriate matching criteria.

CG 13.3.20 Consultation liaison services may itself be treated as a final cost product. For example, Mental Health Consultation Liaison services provided by specialist mental health clinicians may be counted and costed as a distinct service contact/event in some jurisdiction. In this case, consumption of resources from other hospital department should be matched appropriately to the service contact/event.

Step 8: Report costs

CG 13.3.21 Costing practitioners should perform the required steps to consolidate and report costs at patient or encounter level

Step 9: Cost data review with Consultation liaison services stakeholders

CG 13.3.22 Costing practitioners should meet with their relevant stakeholders to report and review the costs calculated for Consultation Liaison activities.