1. The Challenge of Public Hospital
Funding from the perspective of
the COO
Margaret Swords
Chief Operating Officer
RCSI Hospitals Group

2. CFO's and COO's – How we do business
• Roles
• Interdependencies
• Conflicts
• How can we help each other
• Lessons from our start up
• Peaceful co-existence

3. Roles
• Keeper of the Treasury
• Keeper of Operations

4. Interdependencies – CFO & COO
• HIPE – Deposit of rich epidemiology data and basis for funding
Basis for all Service planning
Performance management of Hospital / Individual Consultants / Teams
Research and Education
Activity Based Funding
Until we get first three right ABF won't be meaningful

5. Conflicts
• Crisis response vs Cost containment
• ED overcrowding
• HIQA recommendations
• Infection Outbreaks
• Technological advances
• New Treatment modalities
• New Drugs
• Rationing

6. How can we help each other?
• Communications
• Safety Walks
• Finance involvement in operational committees
• Early alerts in crisis events
• Coding
• Enhance use of HIPE data for research purposes
• Enhance use of HIPE for performance management within directorates/within
specialties
• Share ownership of coding?
• Examples of monetary value of improved coding

7. Principal Diagnosis
K8020 Calculus of gallbladder without cholecystitis, without mention of
obstruction
Procedures 3044500 [0965] Laparoscopic cholecystectomy
9251499 [1910] General anaesthesia, ASA 99
DRG H08B
Casemix Value €5,191
Diagnosis
K8020 Calculus of gallbladder without cholecystitis, without mention of
obstruction
Additional Diagnosis I730 Raynaud's syndrome
Procedures 3044500 [0965] Laparoscopic cholecystectomy
9251499 [1910] General anaesthesia, ASA 99
DRG H08A
Casemix Value €8,396
46yr old - Elective admission for Laparoscopic Cholecystectomy

8. 75 yr old - Emergency admission following a heart attack - LOS 16 days
Principal Diagnosis I214 Acute subendocardial myocardial infarction
Additional Diagnosis I249 Acute ischaemic heart disease, unspecified
I48 Atrial fibrillation and flutter
I10 Essential (primary) hypertension
J22 Unspecified acute lower respiratory infection
Principal Procedure 5600100 [1952] Computerised tomography of brain
DRG F60B
CMU cost €4,025
Principal Diagnosis I214 Acute subendocardial myocardial infarction
Additional Diagnosis I249 Acute ischaemic heart disease, unspecified
I48 Atrial fibrillation and flutter
I10 Essential (primary) hypertension
J22 Unspecified acute lower respiratory infection
E1172 Type 2 diabetes mellitus with features of insulin resistance
Principal Procedure 5600100 [1952] Computerised tomography of brain
DRG F60A
CMUCOST €9,044

9. 70yrs old - Elective admission for a hip replacement – LOS 4 days
Principal diagnosis M161 other Primary coathrosis
additional diagnosis D649 Anaemia
E11.72 Type 2 Diabetes mellitus
i10 Essential Hypertension
Procedure 49318- 00 Total Arthroplasty of hip, unilateral
DRG i03b
Casemix value €10,931
Principal diagnosis M161 other Primary coathrosis
additional diagnosis D649 Anaemia
E11.72 Type 2 Diabetes mellitus
i10 Essential Hypertension
k921 Malena
Procedure 49318-00 Total Arthroplasty of hip, unilateral
13706-02 administration of packed cells
DRG i03A
Casemix value €20,096

10. 82 yr old admitted following a Stroke - LOS 51 days
Principal Diagnosis i639 Cerebral infraction unspecified ( stroke)
Additional Diagnosis i48 Atrial Fibrillation and Flutter
i10 Essential hypertension
DRG B70C
Casemix Value €4,883
Principal Diagnosis i639 Cerebral infraction unspecified ( stroke)
Additional Diagnosis i48 Atrial Fibrillation and Flutter
i10 Essential hypertension
G819 Hemiplegia unspecified
DRG B70B
Casemix Value €9,973
Principal Diagnosis i639 Cerebral infraction unspecified ( stroke)
Additional Diagnosis i48 Atrial Fibrillation and Flutter
i10 Essential hypertension
G819 Hemiplegia unspecified
L891 Decubitus ulcer and pressure
DRG B70A
Casemix Value €23,643

11. Lessons from our Start-up
• Disconnect – eg. cost containment – IP/DC targets
• Services must be planned using HIPE data
• Services must be funded based on activity
• ELS – doesn’t work!
• It takes time to achieve efficiencies
• Right procedure in right hospital closest to patients
• CSSD
• Operational back office

12. Peaceful Co-existence
• Communicate about everything
• We have adjacent offices with little sound proofing!
• The patient is at the centre of everything
• Involve yourselves in each others worries
• Vocalise your concerns
• Both learn how to code

13. A parting piece of Wisdom - !

15. • Thank You