Capturing Coding and Complexity: Evidence for Business Case Approval

Brad Schmitt¹, Kathryn Heath¹,
¹Royal Adelaide Hospital, Adelaide, SA, Australia

Abstract

The hospital environment in which we all function is becoming increasingly monitored for budgeting purposes and revenue generation. This can make it difficult to access funding for new positions and in turn prove the worth of newly created positions.

The Royal Adelaide Hospital (RAH) burns unit recently had a business case approved for a temporary increase in Dietetics and OT hours. A major challenge was to prove the value of this initiative. Utilisation of BRANZ and prospective data effectively demonstrated the provision of a more responsive and comprehensive service, however, this alone might not be enough to for newly created positions to be appointed on a permanent basis.

To assist in our analysis, we accessed coding data to help demonstrate increased revenue generation associated with increased access to a ward dietitian. Criteria for dietitian review was expanded and resulted in more burn inpatients reviewed and subsequently diagnosed with malnutrition. This is important as malnutrition attracts coding “points” and contributes to increased complexity. Therefore, it can affect final DRG complexity grouping and in turn funding for an inpatient episode.

During 2022, 38 patients were diagnosed with malnutrition and this resulted in 30 patients being coded for malnutrition in this period. Improved documentation enabled a higher percentage of malnutrition codes to be captured in the second half of the year. An upward complexity shift was shown for 3 patients, resulting in significant extra revenue generation for the burns service and fiscal evidence to support ongoing funding of the additional allied health positions/hours.

Biography

Brad has been Senior Burns Physiotherapist at the Royal Adelaide Hospital over the last 10 years. More recently he has also been supporting the burns unit as an Allied Health Project Manager. The Project Manager role encompasses multiples activities including research and support, quality improvement initiatives and business case approval and analysis.