Re-introducing ABF in Ireland - understanding hospital performance

Mark O'Connor ^a

Introduction
After a pause caused by COVID Ireland has re-introduced Activity Based Funding (ABF) in 2024, based on 2022 costs and activity. This presentation will illustrate how this has progressed and the information shared among hospitals to support understanding of hospital performance.

Methods
Begin with information about the structure and environment for the re-introduction of ABF including the different structures nationally, how they are changing, and the broader financial and human resource environment.

Detail

• How ABF works in Ireland
• Significant changes in the structure of the ABF model
• Anonymised results by hospital and group
• Drivers behind ABF performance
• Problems encountered
• Hospital level reports and the information contained
  • Different elements of ABF Revenue
  • Admitted activity profile for each patient type
    • Overnight inpatients
    • Non elective same day cases
    • Elective same day cases
    All of these items shown by
    • Cases
    • Admitted Patient Weighted Units (APWU)
    • Casemix Index (Complexity/Costliness)
• Beds
  • ABF Cost per bed
  • APWUs per bed
• Costs
  • Medical pay cost bucket versus peers
  • Nursing pay cost bucket versus peers
• Average length of stay versus peers by DRG - This is a new piece of analysis showing differences in LOS adjusted for complexity
• Discharges by day of the week and if discharges reduce at weekends
• Coding Complexity or ABCDZ Analysis - This is a new piece of analysis that examines the relative complexity within each Adjacent DRG across peer hospitals to find evidence of hospitals not fully capturing complexity.

Results
I will present the findings of this analysis and how ABF and the supporting information has been received by hospitals. This is a current Work in Progress given the evolving circumstances.

Conclusions
I will reflect on what has worked and what needs to be improved and how they information above has been received and the impact that it has made.


^a Healthcare Pricing Office, HSE, Ireland, Ireland

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