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Finance and Administration
In July 2020, we commenced the year having just come out of elective surgery restrictions in the state and facing uncertainties about our planned activity and performance for 2021/22. Product supply lines continued to be disrupted by shipping catastrophes, stevedore disputes and raw material shortages on plastic consumables, all of which threatened the supply of medical and surgical consumables needed to run the hospital, particularly personal protective equipment such as masks and gloves. Prices of essential items became increasingly costly. The year ahead was to be challenging, and we planned accordingly. However, throughout this di cult time, we have maintained a solid financial performance, allowing us to keep our long-term commitments to programs such as our Engineering Services Masterplan and our regular capital spending program.
Engineering Services Master Plan
This year $1.3 million was spent on refurbishments to hospital facilities and services including: • patient room upgrades • sewer stack replacements • water softener • water back-flow prevention • patient elevators upgrade
Regular Capital Equipment Program
The hospital spent $3.9 million this year on its regular capital program to ensure availability of good quality medical and surgical equipment, to improve facilities, and to develop our IT systems. The main capital purchases were: • theatre camera systems • duodenoscopes, colonoscopes, cystoscopes and ureteroscopes • infusion pumps • Caviwave steriliser • STERRAD steriliser • Paediatric Clinical Area • Day of Surgery Admission (DOSA) Upgrade • orthopaedic power tools • IT systems data integration • replacement of front foyer and hallway carpets After COVID-19 interruptions during the first quarter of the year, with support from the ANZ Bank, we finished 2020/21 as planned, fully repaying the debt that facilitated the building of the Eastern Clinical Development. Our finance team continues to work closely with all other sta at the hospital, providing key support services such as billing, payroll, accounts payable, accounting and financial reporting. These sta members take on the responsibility for generating and spending our money and ensuring that our financial commitments to employees, contractors and suppliers are met on time in a national economy that is becoming increasingly precarious. This year, Rebecca Keong, our Patient Funding team leader, has taken on a greater role in coordinating workload, training and improving the e ectiveness of the team. Significant improvements have been made in billing processes for emergency department presentations. Expertise provided by Patient Funding sta and particularly by Angela Bayldon, our Senior Claims Assessment O cer, is essential in managing changes in health fund contract terms and conditions, and the complex landscape of changing government regulations. This year has seen significant change in the Private Health Insurance (Prostheses) Rules and chargeable items included on the prostheses list. The hospital received an increased number of self-insured patient inquiries. In response to this, we have developed our TrakCare patient admission system to provide automated and detailed cost estimates. This has improved our capacity to provide informed financial consent to patients, and ensure that they are fully advised of their financial commitments before admission to the hospital.
Patient Services
Throughout a time of such uncertainty, we have proven that we can be flexible and adaptable while still caring for our patients with a helpful and professional attitude. Our screening team at the main entrance has kept the hospital safe by welcoming all patients and visitors with masks, hand sanitiser and screening questions about their travel history, hotspots and other potential risks. The number of visitors allowed for each patient is regularly impacted by changes to density requirements, but we continue to negotiate compassionate solutions in di cult situations. As always, we value all patient feedback to identify areas where we can make improvements. We continue to make advancements with our online pre-admission forms, and with the provision of online financial consent. Communication with our patients and their families continues to be our focus and the Patient Services team brings a friendly and caring face to welcome everyone who comes to the hospital.
Clinical Costing
Our Clinical Costing Analyst continues to work with management and sta throughout the hospital to strengthen our understanding and management of clinical costs. The Revenue and Clinical Costing Working Group has been established and meets monthly to discuss and address areas of interest, work being undertaken and issues raised that impact revenue and clinical costing data at St Andrew’s Hospital. The Power Performance Manager (PPM2) costing system has been extensively reviewed and continues to be refined with updated methodologies, and new data feeding in from various systems and clinical costing reports are now delivered on a quarterly cycle. The costing data plays a major role in supporting the Angiography co-ownership through regular and ad-hoc reporting. Reports have been introduced at Finance and Audit Committee meetings and the costing data has become key to assisting with business analysis. Participation in the annual Private Hospital National Hospital Cost Data Collection has been confirmed for the next three reporting cycles. We have commenced focussing on significant expenditure areas such as medical and surgical supplies to better understand and manage these costs. Linking of the PPM2 and CGov patient incident systems is underway and will identify and quantify the financial impact of incidents during a patient’s hospital stay. The addition of the Revenue Module within PPM2 enables health fund contract rules and rates to be modelled across the same episodic dataset used for clinical costing. This module provides functionality that enables us to model the financial impacts of significant health fund contract changes, such as moving to new Diagnosis Related Group (DRG) versions. It is also used to audit actual billing against expected billing, and has proven very useful to identify discrepancies and potential revenue leakage. These audits have been undertaken numerous times for BUPA and Medibank, and other major health funds are currently being added to the module.
Health Information Management
Over the last twelve months, the Health Information Management Service has continued to achieve key performance indicators whilst further developing and streamlining services, along with the adoption of a number of new initiatives. The hospital’s medical record storage strategy has matured, supported by updated policies and o site storage agreements. Revised sentencing and destruction business rules have been implemented with ongoing savings in annual o site storage costs now being realised. The clinical coding unit has been able to retain stable qualified sta ng levels supported by a robust training and auditing program. All sta have successfully completed an external online further education course in classification of orthopaedic surgery and are participating in regular professional coding related continuing education webinars relevant to the hospital’s case mix. An exciting new initiative for St Andrew’s Hospital is the commencement of a clinical documentation improvement program in partnership with the nationally recognised leader in this field, CDIA. The aim of this program is to improve the quality of our clinical documentation to better support our patients from a safety, quality and communication perspective. The program will also ensure our hospital funding better reflects our patient complexity. Workforce planning in the clinical coding area is an ongoing initiative to ensure the hospital continues to be able to maintain a qualified workforce in a national skills shortage area. The unit is currently supporting two new graduates within our mentored framework, building their competency levels to achieve our hospital’s coding performance standards. The hospital continues to be represented on a number of state and national committees in the health information and coding fields. Health Information Manager, Lorraine Van Gemert, has continued to represent the Australian Private Hospitals Association on the national DRG Technical Group (DTG). She also chairs the SA Branch of the Health Information Management Association of Australia (HIMAA), the peak professional body for health information managers and clinical coders in Australia.
Supply
The hospital continues to develop our Epicor ERP system, improving our stock management in the perioperative area. With their excellent product knowledge, our stock controller and theatre team of clinical nurse managers have optimised stock levels and available space around our theatres. We are constantly upgrading our SurgiBin storage to improve e ciency and use of limited space. About 2,500 product lines are stored in the hospital and, in addition to $1.6 million worth of stock in the main warehouse, $2.1 million of stock is held in the perioperative area. Best management of this resource is essential, particularly in the current COVID-19 a ected era where damaged supply chains continue to limit stock availability and force price increases. A key factor throughout the pandemic is the relationships with our suppliers with whom we have worked closely as they have dealt with supply chain restrictions and high demand from hospitals across South Australia. Our solid relationships supported our ability to source product through allocation systems giving existing customers consistent and continual supply of goods. However, our diligence with
back-order management has remained a key control, ensuring supplies are delivered as needed. South Australia’s Detmold Medical notably stepped up with local manufacture of level 3 surgical masks, guaranteeing a good supply of protective masks for hospital sta , patients and visitors. St Andrew’s remains a keen customer of local manufacturers who support public health needs across our state. Throughout the pandemic, the hospital has had supplies available to meet the needs of our surgical specialists, and has not cancelled any theatre cases. This is a testament to the supply team led by John Ioannou, and is his pièce de resistance as he heads o to a well-earned retirement this year.
Although COVID continues to challenge us, it has enabled us to further embrace and accentuate the day-to-day practice of our values.
We Care, We Create, We Deliver.
