This document provides an overview and introduction to Swiss Diagnosis Related Groups (SwissDRGs) which were introduced in Switzerland in 2012 as part of a reform of the country's health insurance law. It discusses the impact SwissDRGs have had on hospital profitability based on examples from Germany. It also outlines the broader context of the health insurance law reform, including changes to hospital planning regulations and the establishment of cantonal lists defining which hospitals can treat patients with basic mandatory health insurance. Hospitals can have different statuses depending on whether they are on a cantonal list or have contracts with insurers.

1. This
presentaEon
has
been
adapted.
The
original
was
presented
under
the
name
and
with
the
logo
of
Newtone
Associates
SA.
Paianet
is
the
spin-­‐off
from
Newtone
Associates’
healthcare
team.
The
introduc-on
of
SwissDRGs
in
Switzerland
EMBA
Healthcare
Management
HEC
Lausanne
–
IEMS
Lausanne,
18
August
2012
Thomas
Lu?in
&
Stefan
Stefaniak

2.
A.
Welcome
and
introducEon

3. Today’s
presenta-on
will
be
held
by
two
healthcare
consultants
-­‐ Speakers
Thomas
Lu>in
§ PhD
in
health
economics
at
IEMS
–
University
of
Lausanne
and
CHUV
§ Interest
in
healhcare
financing
and
its
economic
implicaEons
§ thomas.lu?in@paianet.com
Stefan
Stefaniak
§ 8
years
experience
in
hospital
management
under
DRGs
§ Management
consulEng
in
German
hospitals
during
the
introducEon
of
G-­‐DRGs
§ stefan.stefaniak@paianet.com
www.paianet.com
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3

4. We
would
like
to
durably
garantee
the
quality
of
medical
services
by
suppor-ng
the
management
of
hospitals
and
clinics
with
the
right
tools
A
B
Improvement
of
Involvment
of
the
operaEng
results
the
medical
staff
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5. Our
clients
benefit
from
a
strong
exper-se
with
SwissDRGs
and
experience
in
university
hospitals
as
well
as
private
clinics
Reference
projects
and
experEse
Projects
in
the
last
12
months:
• IntroducEon
of
SwissDRGs
• Improvement
of
coding
quality
• Involvement
of
physicians
/
remuneraEon
• AcquisiEon
of
paEents
• Strategic
and
financial
objecEves
• “Groupe
de
réflexion
hospitalière”
Personal
experience
of
the
team:
• IntroducEon
of
G-­‐DRGs
• IntroducEon
of
case
management
• ReorganisaEon
of
processes
• Dashboards
and
management
tools
• Business
planning
• RestructuraEons
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5

6. Now
it
is
-me
to
introduce
yourselves
too
§ What
is
your
background?
§ What
do
you
expect
to
do
ager
the
MBA?
§ What
are
you
expecEng
from
today?
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6

7. The
impact
of
DRGs
on
inpa-ent
medical
facili-es’
profitability
can
be
significant
–
both
for
public
hospitals
and
private
clinics
EvoluEon
of
profitability
(examples
ager
the
introducEon
of
G-­‐DRGs)
2005
2006
2007
2008
2009
2010
2004
2005
2006
2007
2008
2009
Loss
Loss
mulEplied
divided
by
10
by
10
Client
example
from
Germany
EKH
(CHU
Hamburg);
source:
annual
report
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7

8. Canton
Basic
Supplementary
$
$ $
$
B.
The
health
insurance
law
(LAMal/
KVG)
reform
Changes
at
the
cantonal
level

9. Un-l
a
few
months
prior
to
the
introduc-on
of
SwissDRGs,
some
stakeholders
hoped
the
law
would
not
enter
into
force
in
2012
PeEEons
Source:
www.drg-­‐moratorium.ch
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9

10. SwissDRGs
are
only
one
of
the
elements
of
the
health
insurance
law
reform,
which
also
introduces
hospital
planning
Timeline
2009
2010
2011
2012
2013
2014
2015
…
Entry
into
force
of
the
3rd
LAMal
revision
IntroducEon
of
the
fixed
rate
per
case
(SwissDRGs)
At
the
latest,
entry
into
force
of
the
new
hospital
planning
based
on
services
provided
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10

11. The
new
hospital
planning
rules
have
changed
the
framework
in
which
hospitals
and
clinics
work
§ Each
canton
must
define
a
list
of
hospitals
that
receive
a
public
mandate
§ Listed
hospitals
can
be
reimbursed
by
the
mandatory
insurance
and
receive
public
funding
§ Cantons
are
free
to
set
the
criteria,
but
a
model
has
been
proposed
by
the
Canton
of
Zurich
and
recommended
by
the
Swiss
conference
of
cantonal
health
directors
(CDS/
GDK)
§ The
cantonal
lists,
as
well
as
the
planning
model
can
be
found
on
the
CDS’s
website:
hqp://www.gdk-­‐cds.ch/index.php?id=624&L=1
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11

12. The
cantonal
lists
define
which
hospital
is
allowed
to
accept
pa-ents
with
a
mandatory
insurance
for
each
medical
specialty
Example:
Canton
Bern’s
hospital
list
Source:
Canton
Bern,
www.gef.be.ch/gef/fr/index/gesundheit/gesundheit/spitalversorgung/spitaeler/spitalliste.html
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12

13. A
medical
facility
can
be
on
the
cantonal
list
or
have
contracts
with
health
insurance
companies
Cantonal
lists
and
hospital
planning
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13

14. A
hospital
can
be
subject
to
different
regimes,
each
implying
a
different
status
Hospital
planning
–
the
different
regimes
LAMal
(cantonal
list)
LAMal
(convenEon)
Outside
of
LAMal
listed
hospital
contract
hospital
contract
hospital
PaEent
and/
or
PaEent
and/
or
PaEent
and/
or
supplementary
insurance
supplementary
insurance
supplementary
insurance
Basic
insurance
Basic
insurance
(45%
of
LAMal
rate)
(45%
of
LAMal
rate)
Canton
(55%
of
LAMal
rate)
Note:
the
size
of
the
boxes
is
not
proporEonal
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14

15. Pa-ents
are
also
free
to
choose
another
hospital,
as
long
as
it
is
on
a
cantonal
list
and
cheaper
than
in
their
canton
of
residence
Change
of
canton
for
mandatory
insured
paEents
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15

16. On
January
1st
2012,
several
significant
changes
have
been
introduced
–
SwissDRGs
was
one
of
the
key
amendments
Hospital
choice
for
paEent
1 Hospital
planning
2 3 Rate
per
case/
SwissDRGs
Basic
health
Supplementary
Insurance
Insurance
§ Cantonal
parEcipaEon
in
the
§ Possibility
to
aqract
§ Complete
§ Cash
flows
funding
paEents
from
outside
the
change
of
the
between
§ FaciliEes
have
to
respect
canton
to
the
hospital
billing
policy
insurance
cantonal
decisions
and
increase
the
number
§ Financial
companies,
concerning
case
aqribuEon
of
cases
impact
not
physicians
and
§ Possibility
to
collaborate
and
§ Rules
unclear
and
not
predictable,
clinics
need
to
to
acquire
addiEonal
cases
very
detailed
at
launch;
risks
and
be
redefined
§ Context,
budget
and
rules
dependent
on
cantonal
opportuniEes
§ No
significant
sEll
not
enErely
defined
at
hospital
planning
both
exist
and
immediate
launch
changes
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16

17. Canton
Basic
Supplementary
$
$ $
$
C.
The
SwissDRG
system
Changes
concerning
the
billing
rules

18. Switzerland
has
introduced
a
new
hospital
financing
system
to
promote
effec-ve,
adequate
and
economical
care
EvoluEon
of
hospital
costs
payable
by
the
mandatory
health
insurance
(mio
CHF)
10'000
Ambulatoire
OutpaEent
StaEonary
StaEonnaire
+
29%
9'000
Hospital
total
Total
hôpital
8'000
7'000
6'000
5'000
4'000
3'000
2'000
1'000
0
2004
2005
2006
2007
2008
Source:
Santésuisse
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18

19. SwissDRG
is
a
pa-ent
classifica-on
system
used
for
the
financing
of
hospital
stays
by
the
Swiss
mandatory
health
insurance
DefiniEon
and
background
of
Diagnosis-­‐Related
Groups
(DRGs)
§ DRGs
were
developed
in
the
USA
in
the
late
70’s
§ IniEally,
DRG
were
used
in
hospitals
as
an
internal
management
tool
§ Today,
they
are
the
basis
for
reimbursement
of
medical
treatment
or
are
used
for
budget
planning
in
many
countries
§ In
Switzerland,
many
hospitals,
including
HUG
or
CHUV,
already
used
charge
according
to
AP-­‐DRGs
§ Since
1st
January
2012,
SwissDRGs,
based
on
German
G-­‐DRGs,
are
used
in
Swiss
hospitals
for
the
reimbursement
of
somaEc
acute
care
by
the
mandatory
health
insurance
§
RehabilitaEon
and
psychiatry
will
also
be
concerned
in
a
next
step
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19

20. The
objec-ve
of
the
DRG
system
is
to
reduce
costs
by
encouraging
hospitals
to
adopt
best
prac-ces
EvoluEon
of
average
cost
and
cost
deviaEon
between
hospitals
Costs
Costs
of
individual
hospitals
Average
cost
Time
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20

21. More
factors
are
taken
into
account
in
order
to
determine
the
payment
from
the
mandatory
insurance
Comparison
between
financing
using
daily
or
per
case
fixed
rates
(SwissDRGs)
• before
2012
ager
2012
Length
of
Primary
Secondary
OperaEng
Adm.
Data
stay
diagnosis
diagnoses
procedures
Severity
Coding
Grouper
DRG
Payment
Payment
According
to
SwissDRG
SA
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21

22. DRGs
require
medical
data
related
to
the
case
Deciding
factors
of
the
case
fixed
rate
Primary
Secondary
OperaEng
Adm.
data
diagnosis
diagnoses
procedures
Severity
Coded
according
to
the
InternaEonal
Coded
according
to
• AdministraEve
data
ClassificaEon
of
Diseases
(ICD,
CIM
in
French)
Swiss
classificaEon
(age,
sex,
length
of
of
the
World
Health
OrganizaEon,
modified
by
of
surgical
stay)
the
Deutsches
InsEtut
für
Medizinische
intervenEons
• Degree
of
severity,
DokumentaEon
und
InformaEon
(CHOP)
complicaEons
• Birth
weight
• Etc.
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22

23. You
can
find
more
informa-on
on
these
websites
§ Swiss
federal
health
insurance
law
(LAMal/
KVG)
hqp://www.admin.ch/ch/f/rs/c832_10.html
§ SwissDRG
www.swissdrg.org
§ ICD-­‐10
catalogue
www.bfs.admin.ch/bfs/portal/fr/index/infothek/nomenklaturen/blank/blank/
cim10/02/01.html
§ CHOP
catalogue
www.bfs.admin.ch/bfs/portal/fr/index/infothek/nomenklaturen/blank/blank/
chop/02/04.html
www.paianet.com
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23

24. Financing
using
DRGs
induces
a
shortening
of
the
length
of
stay
Comparison
between
financing
using
daily
or
per
case
fixed
rates
before
2012
ager
2012
Payment Payment
Days Days
The
hospital
is
encouraged
to
keep
the
paEent
The
hospital
is
paid
more
for
short
lengths
of
longer
stay
and
less
for
longer
lengths
of
stay
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24

25. Costs
are
more
transparent
and
comparable
with
a
DRG
based
financing
DecomposiEon
of
the
amount
paid
on
the
basis
of
SwissDRGs
NegoEaEons
between
Calculated
by
SwissDRG
AG,
hospitals
and
insurance
valid
throughout
companies,
validated
by
Switzerland
the
cantons
• Fixed
rate
• per
case
= Cost-­‐weight
(points)
x
Baserate
(price
of
1
point)
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25

26. Financing
rules
for
hospitals
have
also
changed
this
year
Financing
of
hospital
stays
for
insured
paEents
before
2012
ager
2012
Canton
Basic
Supplementary
Canton
Basic
Supplementary
$ $ $ $
$
invoice
$ cash
flow
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26

27. The
treatment
of
immobilisa-ons
and
teaching
and
research
change,
on
top
of
ac-vity
based
funding
from
cantons
DecomposiEon
of
costs
Before
2012
Ager
2012
Public
hospitals
Listed
hospitals
Public
interest
missions
Public
interest
missions
Teaching
and
research
(global)
Teaching
and
research
(uni.)
Investment
Remainder
Remainder
Canton
(min
55%)
Canton
(min
50%)
Financed
by
DRGs
Remainder
Financed
on
a
Remainder
Health
insurance
(max
50%)
per
diem
basis
Health
insurance
(max
45%)
Note:
the
relaEve
size
of
boxes
is
not
significant
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27

28. The
change
is
even
bigger
for
private
clinics
and
their
rela-onship
with
independent
physicians
Financing
of
hospital
stays
for
insured
paEents
before
2012
ager
2012
Basic
Supplementary
Canton
Basic
Supplementary
$ $
$ $ $
$
$
$
invoice
cash
flow
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28

29. SwissDRGs
have
modified
the
rela-onship
between
clinics
and
affiliated
independent
physicians
§ Clinics
have
to
obtain
all
the
medical
data
necessary
for
coding,
directly
from
affiliated
physicians
§ Listed
clinics
have
to
accept
paEents
without
supplementary
insurance
§ Clinics
have
to
pay
affiliated
independent
physicians
directly
§ These
topics
had
to
be
negoEated
between
clinics
and
affiliated
physicians
§ The
medical
share
is
a
variable
that
must
be
negoEated
with
affiliated
independent
physicians
§ Different
models
and
strategies
exist
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29

30. SwissDRGs
thus
give
new
incen-ves
to
hospitals
and
clinics
The
impact
of
SwissDRGs
§ The
adopEon
of
SwissDRGs
has
changed
the
logic
of
the
health
care
system:
from
costs
reimbursement
to
fixed
rate
purchases
of
medical
services
by
insurance
companies;
§ SwissDRGs
are
fixed
rates
including
all
costs
related
to
the
stay,
notably:
§ Medical
services
§ Medical
care
§ Laboratory
tests
§ Hospital
accommodaEon
§ Drugs
§ Medical
equipment
§ This
introduces
more
compeEEon
between
medical
faciliEes
and
therefore
puts
pressure
on
them
to
reduce
costs.
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30

31. Canton
Basic
Supplementary
$
$ $
$
D.
ApplicaEon
of
SwissDRGs
Example:
coding
of
a
case

32. Now,
let
us
take
a
look
at
a
real-­‐life
example
Caesarian
delivery
§ PaEent:
35
years
old
woman
§ Diagnosis:
caesarian
delivery
§ Procedure:
caesarean
secEon
§ Length
of
stay:
6
days
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32

33. Administra-ve
data,
diagnosis
and
procedures
are
o`en
obvious
–
all
the
details
have
to
be
entered
§ PaEent:
Primary
Secondary
OperaEng
Adm.
data
diagnosis
diagnoses
procedures
Severity
35
years
old
woman
§ Diagnosis:
caesarian
delivery
Coding
§ Procedure:
caesarean
secEon
§ Length
of
stay:
Grouper
6
days
DRG
Payment
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33

34. Medical
data
is
used
to
iden-fy
the
corresponding
codes
in
the
current
catalogue
Medical
data
Coding
§ 35
year
old
paEent
§ Sex:
female
/
Age:
35
years
§ Primary
diagnosis:
Caesarian
delivery
§ Secondary
diagnoses:
• CIM:
O82
§ Single
birth,
child
alive
§ Length
of
pregnancy:
34th
week
to
36
• CIM:
Z37.0
weeks
CIM:
O09.5
§ Procedure:
caesarean
secEon
§ Length
of
stay:
6
days
• CHOP:
74.1
§ Length
of
stay:
6
days
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34

35. Coding
is
complete
Primary
Secondary
OperaEng
Adm.
data
diagnosis
diagnoses
procedures
Severity
§ ICD:
O82
Coding
Z37.0
O09.5
Grouper
§ CHOP:
74.1
DRG
Payment
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35

36. Administra-ve
data
and
codes
are
entered
into
a
specific
so`ware,
the
grouper
SwissDRG
online
grouper
(screenshot)
Source:
www.swissdrg.org
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36

37. Grouping
is
done
Primary
Secondary
OperaEng
Adm.
data
diagnosis
diagnoses
procedures
Severity
Coding
Grouper
DRG
Payment
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37

38. Following
a
complex
paaern,
the
grouper
determines
the
corresponding
DRG:
in
this
case
O01F,
with
a
cost-­‐weight
of
0.831
Online
grouper’s
results
(screenshot)
Source:
www.swissdrg.org
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38

39. The
medical
data
are
used
to
iden-fy
the
corresponding
codes
in
the
current
catalogues
Secondary
diagnoses
of
our
real-­‐life
example
Medical
data
Coding
§ Secondary
diagnoses:
§ PreexisEng
diabetes
during
pregnancy
O24.0
§ Other
hemorrhage
during
childbirth
O67.8
§ ComplicaEon
of
anesthesia
during
labour
and
O74.9
childbirth,
no
precision
O86.0
§ InfecEon
of
a
surgical
obstetric
wound
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39

40. The
grouper
accepts
a
large
number
of
secondary
diagnoses
to
have
a
comprehensive
understanding
of
the
case
Entering
the
data
in
the
grouper
Source:
www.swissdrg.org
www.paianet.com
www.paianet.com
40

41. With
the
secondary
diagnoses,
the
grouper
determines
a
different
DRG:
the
new
one
is
O01C,
with
a
cost-­‐weight
of
1.631
Grouper’s
results
for
the
more
complex
case
Source:
www.swissdrg.org
www.paianet.com
www.paianet.com
41

42. The
rates
paid
by
the
mandatory
insurance
vary
greatly
according
to
the
complexity
of
the
case
Example
of
incomes
for
a
caesarian
secEon
Primary
diagnosis
Caesarian
Caesarian
Caesarian
MulEple
Secondary
diagnoses
Diabetes
complicaEons
Cost-­‐weight
0.831
0.972
1.631
Clinic’s
income
CHF
8’310
CHF
9’720
CHF
16’310
(baserate:
CHF
10’000)
Change
compared
to
96%
the
baseline
case
+
CHF
8’000
Source:
Result
of
the
SwissDRG
web
grouper
,
version
1.0
Hypothesis:
baserate
=
CHF
10’000,
rounded
results,
100%
of
the
DRG
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42

43. Canton
Basic
Supplementary
$
$ $
$
E.
Impact
of
DRGs
on
hospitals

44. The
rela-onships
will
be
even
more
important
in
the
future
–
All
domains
are
interdependent
and
revolve
around
medicine
Contract
Business
plan
Analy-cal
negocia-ons
3-­‐5
years
with
accoun-ng
simula-ons
KPIs
Monthly
by
project
KPIs
Strategy
and
Projects
Benchmarking
Objec-ves
posi-oning
(Toolbox)
and
references
www.paianet.com
www.paianet.com

45. The
contract
negocia-ons
are
o`en
the
base
on
which
cost-­‐
efficiency
and
new
medial
services
are
developped
Contract
Business
plan
Analy-cal
negocia-ons
3-­‐5
years
with
accoun-ng
simula-ons
KPIs
Monthly
by
project
KPIs
Strategy
and
Projects
Benchmarking
Objec-ves
posi-oning
(Toolbox)
and
references
www.paianet.com
www.paianet.com

46. The
final
baserate
is
nego-ated
with
insurance
companies
(and
validated
by
the
canton)
–
different
bases
of
nego-a-on
are
possible
Individual
value
Na-onal
or
cantonal
value
Costs
Baserate
ager
negoEaEon
Δ
%
NaEonal
benchmark
=
Reference
baserate
as
a
negoEaEon
basis
Time
Δ
%
CHF
±
Δ%:
NegoEaEon
range
Cost
of
individual
hospitals
Average
cost
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46

47. One
of
the
crucial
points
for
hospitals
is
the
determina-on
of
the
price
–
calcula-on
of
the
technical
baserate
Formulas
for
the
technical
baserate
Before
2012
Total
cost
2010
=
cost
per
case
Number
of
cases
2010
Data
cleaning:
§ HospitalizaEon
vs.
ambulant
case
§ Basic
insurance
vs.
private
insurance
§ Infrastructure
costs
Total
cost
2010
Ager
2012
§ Training
costs
§ Other…
(hospitalisaEon)
=
cost
per
case-­‐mix
point
Number
of
case-­‐mix
points:
Number
of
case-­‐mix
§ Complete
coding
of
hospital
cases,
with
points
2010
comorbidiEes
§ Use
of
CHOP
and
ICD-­‐10
catalogues
=
Technical
baserate
(internal)
(from
the
given
year)
§ SwissDRG
1.0
catalogue
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47

48. The
baserate
negocia-on
process
is
complex
Total
expenses
Relevant
Cleaning
from
P&L
2010
operaEng
costs
1
OperaEng
costs
Technical
Benchmarking
Weighted
cases
baserate
Weighted
Coded
cases
Grouping
number
of
cases
2010
(Σ
CMP)
2
Baserate
benchmark:
reference
value
ValidaEon
4
3
Business
Preliminary
Baserate
NegoEaEon
AdaptaEon
planning
2012
Baserate
2012
for
negoEaEons
Complements
à
4
different
baserates
in
the
process!
Source:
Newtone
Associates
2011
Project
peparaEon
for
negociaEons
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48

49. The
amount
obtained
through
the
baserate
has
to
cover
all
the
costs
DRG
matrix
Example
from
German
G-­‐DRG;
in
Switzerland
this
level
of
detail
is
not
published
by
SwissDRG
AG
Source:
InEK:
G-­‐DRG-­‐Browser
2009,
DRG
I24Z
www.paianet.com
www.paianet.com
49

50. The
number
of
different
parameters
make
it
difficult
to
get
a
“feeling”
for
the
important
factors
Contract
Business
plan
Analy-cal
negocia-ons
3-­‐5
years
with
accoun-ng
simula-ons
KPIs
Monthly
by
project
KPIs
Strategy
and
Projects
Benchmarking
Objec-ves
posi-oning
(Toolbox)
and
references
www.paianet.com
www.paianet.com

51. From
2012
on,
new
variables
have
an
impact
on
the
financial
results
of
a
hospital
or
clinic
List
of
new
elements
linked
with
a
public
mandate
• Variable
Impact
on
the
results
1
Rate
of
cannibalisaEon
of
supplementary
Number
of
new
cases
insured
paEents
in
the
mandate
2
Baserate
Income
from
each
new
case
without
supplementary
insurance
3
Medical
share
Income
from
cases
with
a
4
Share
of
55%
of
the
DRG
not
paid
by
the
supplementary
insurance
supplementary
insurance
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51

52. The
decision
makers
should
be
able
to
“play“
with
the
data,
in
order
to
internalize
them
SimulaEon
of
the
Business
Plan
over
3
to
5
years
Profit
and
loss
accounEng
Hypotheses
and
parameters
2011
-­‐-­‐-­‐
2015
Hypothèses 2012
Hypothèses principales
Résultat final (pos = profit; nég = perte) 5'000 10'000 10'000 9'533 9'033
CLINIQUE XYZ
Budget 2012-2014 (en m illiers de Francs)
2011 Budget 2012 Sim ulé 2012 Sim ulé 2013 Sim ulé 2014
Fr. Fr. Fr. Fr. Fr.
Baserate (KCHF) 10.000
PRODUITS
Clinique
Pensions et taxes soins infirmiers 25'000 35'000 35'000 35'300 35'603
CMI 1
Part médicale 20%
Pensions hospitalisés 15'000 18'000 18'000 18'180 18'362
Pensions ambulatoires 1'000 1'000 1'000 1'010 1'020
Soins inf. hospitalisés 5'000 7'000 7'000 7'070 7'141
Soins inf. ambulatoires 1'000 1'000 1'000 1'010 1'020
Forfait SUVA et divers
Forfait DRG (mandats) (AOS pur)
Taxes opératoires, salle de réveil, soins intensifs
3'000
20'000
3'000
5'000
25'000
3'000
5'000
25'000
3'030
5'000
25'240
3'060
5'000
25'482
Part des factures LCA hors mandat pour lesquelles la
Taxes opératoires hospitalisés
Taxes opératoires ambulatoires
Salle de réveil hospitalisés
15'000
1'000
3'000
20'000
1'000
3'000
20'000
1'000
3'000
20'200
1'010
3'030
20'402
1'020
3'060
complémentaire ne paie pas les 55% du DRG (ex: Surpa) 0%
Soins intensifs 1'000 1'000 1'000 1'000 1'000
Pharmacie, matériel de soins, centre laser, divers (médical) 15'000 20'000 20'000 20'200 20'402
Cafétéria, téléphones, parking, divers (non-médical) 1'000 2'000 2'000 2'000 2'000
Total Clinique 61'000 82'000 82'000 82'740 83'487
Radiologie
Médecine nucléaire
Laboratoire
10'000
2'000
1'000
15'000
5'000
2'000
15'000
5'000
2'000
15'150
5'050
2'020
15'302
5'101
2'040
Nombre de patients AOS pur dans le mandat 500
Nombre de patients LCA dans le mandat: 0
Produits financiers (int. sur c/c et divers) 1'000 1'000 1'000 1'000 1'000
Total radiologie et autres produits 14'000 23'000 23'000 23'220 23'442
TOTAL PRODUITS 75'000 105'000 105'000 105'960 106'930
_ dont nouveaux cas 0
CHARGES
Salaires et charges sociales
Personnel
Salaires secteur médical 20'000 25'000 25'000 25'250 25'503
_ dont anciens cas LCA hors mandat 0
_ dont anciens cas LCA dans le mandat 0
Salaires secteur hôtelier 5'000 10'000 10'000 10'100 10'201
Salaires administration 5'000 5'000 5'000 5'050 5'101
Total salaires brut 30'000 40'000 40'000 40'400 40'804
Charges sociales (AVS LPP LAA APG) 5'000 5'000 5'000 5'000 5'000
Autres charges de personnel 1'000 2'000 2'000 2'020 2'040
Total charges sociales et divers 6'000 7'000 7'000 7'020 7'040
Total salaires et charges sociales 36'000 47'000 47'000 47'420 47'844
Radiologues
Médecins / gardes
Rétrocession DRG chirurgiens & anesthésistes
3'000
1'000
5'000
2'000
1'000
5'000
2'000
1'000
5'050
2'020
1'000
5'101
2'040
1'000
Variation nombre de cas LCA hors mandat: 0
_ dont nouveaux cas 0
Total radiologues & m édecins garde 4'000 8'000 8'000 8'070 8'141
Total salaires & honoraires & charges sociales 40'000 55'000 55'000 55'490 55'985
Autres charges d'exploitation
Matériel et fournitures médicales 10'000 15'000 15'000 15'750 16'537
Laboratoire
Aliments et boissons
Energie et eau
2'000
2'000
1'000
2'000
2'000
2'000
2'000
2'000
2'000
2'100
2'020
2'020
2'205
2'040
2'040
_ dont cas entrés dans le mandat (<0) 0
Matériel exploitation, entretien, renouvellements 4'000 5'000 5'000 5'050 5'101
Amortissements acquisitions 1'000 2'000 2'000 2'020 2'040
Leasing 2'000 3'000 3'000 3'000 3'000
DRG
Frais généraux d'administration 2'000 3'000 3'000 3'030 3'060
Loyer 3'000 3'000 3'000 3'030 3'060
Autres frais financiers 1'000 1'000 1'000 1'010 1'020
Impôts 2'000 2'000 2'000 1'907 1'807
Total autres charges d'exploitation
TOTAL DES CHARGES
30'000
70'000
40'000
95'000
40'000
95'000
40'937
96'427
41'911
97'896
Montant tot par Sw issDRG 38'750
Résultat final (pos = profit; nég = perte) 5'000 10'000 10'000 9'533 9'033 Part assurance AOS 45%
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52

53. It
is
possible
to
es-mate
the
impact
of
these
different
factors
HypotheEcal
example
Impact
on
earnings
• Scenarios
Baserate
10’000
CHF
9’000
CHF
1
1%
of
“old”
supplementary
insurance
−
25’000
CHF
−
20’000
CHF
cases
in
the
mandate
The
baserate
changes
from
10’000
to
−
35’000
CHF
2
−
25’000
CHF
9’900
CHF
3
The
medical
share
goes
from
20%
to
21%
−
40’000
CHF
−
30’000
CHF
−
200’000
CHF
−
150’000
CHF
4
The
supplementary
insurance
does
not
pay
for
the
canton’s
55%
share
of
DRG
for
paEents
outside
the
mandate
Hypotheses
:
Medical
share:
20%,
supplementary
insurances
cover
100%
for
paEents
outside
of
mandate,
hypotheEcal
values
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53

54. The
introduc-on
of
a
performing
analy-cal
accoun-ng
system
is
important
–
but
its
main
goal
is
tho
feed
monthly
indicators
Contract
Business
plan
Analy-cal
negocia-ons
3-­‐5
years
with
accoun-ng
simula-ons
KPIs
Monthly
by
project
KPIs
Strategy
and
Projects
Benchmarking
Objec-ves
posi-oning
(Toolbox)
and
references
www.paianet.com
www.paianet.com

55. To
start
with,
financial
resrults
are
the
most
important
outcome
Structure
of
an
economic
enEty
(such
as
a
hospital)
Hospital
Service
X
Service
X
Y
Z
P&L1)
Income
PP
PP
PP
...........
P&L1)
• Produits
...........
.....
• Produits
...........
.....
Costs
.....
• ...........
Income
...........
• Charges
...........
.....
• Charges
...........
.....
Income
...........
Result
.....
..........
• ±
.
• .....
Résultat
±
...........
Résultat
±
...........
Ins-tute
X
Y
• .....
PP
PP
Z
Income
PP
...........
• Produits
...........
.....
• Produits
...........
.....
Costs
...........
•
Cost
.....
...........
• Charges
...........
.....
Cost
...........
• Charges
...........
• .....
Non-­‐medical
.....
Result
.....
..........
• ±
.
Résultat
±
...........
• .....
service
X
Résultat
±
...........
PP
Y
PP Z
Income
PP
...........
Result
±
...........
• Produits
...........
.....
• Produits
...........
.....
Costs
.....
• ...........
Result
±
...........
• Charges
...........
.....
• Charges
...........
.....
Result
.....
..........
• ±
.
Résultat
±
...........
Résultat
±
...........
P&L:
profits
and
losses
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56. Analy-cal
accoun-ng
has
become
a
strategic
tool
for
hospital
managers
–
no
longer
just
a
legal
requirement
§ AnalyEcal
accounEng
is
a
legal
requirement
for
hospitals
and
clinics
§ The
aim
is
to
compute
the
cost
of
hospital
stays
for
each
paEent
§ The
data
are
also
used
by
SwissDRG
AG
to
generate
the
DRG
structure
and
to
compute
the
cost-­‐weights
§ For
a
hospital,
it
is
essenEal
to
know
its
cost
structure
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56

57. The
goal
is
to
aaribute
its
full
cost
to
each
pa-ent
‒
direct
costs
Source:
P.
Besson,
REKOLE
‒
Comptabilité
de
gesEon
à
l’hôpital,
2008,
p.
268
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57

58. …
as
well
as
indirect
costs,
though
imputa-on
mechanisms
Source:
P.
Besson,
REKOLE
‒
Comptabilité
de
gesEon
à
l’hôpital,
2008,
p.
269
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58

59. The
monthly
key
performance
data
serve
as
a
base
for
sevng
concrete
objec-ves
for
each
unit
Contract
Business
plan
Analy-cal
negocia-ons
3-­‐5
years
with
accoun-ng
simula-ons
KPIs
Monthly
by
project
KPIs
Strategy
and
Projects
Benchmarking
Objec-ves
posi-oning
(Toolbox)
and
references
www.paianet.com
www.paianet.com

60. The
structure
of
DRGs
and
improved
data
collec-on
allow
to
compute
important
indicators
‒
but
rarely
in
line
with
objec-ves
Examples
of
monthly
dashboards
and
indicators
Profitability
of
DRGs
Entry
and
exit
days/
Length
of
stay
Occupancy
rates
(beds,
ICU,
OP)
Coding
and
length
of
stay
5.0
4.5
4.0
Nombre
de
code
3.5
3.0
Nombre
code
2.5 100.0%
CIM
moyen
2.0 90.0%
80.0%
1.5
Nombre
code
1.0 70.0%
CHOP
moyen
0.5 60.0%
0.0 50.0%
F39B
I20E
I23A
I32E
I24Z
I53Z
I30Z
I47Z
I29Z
J10B
C20B
I76B
B05Z
I43B
I74C
I75B
I27C
I12C
I08D
40.0%
30.0%
20.0% DRG
10.0%
0.0%
I24Z I47Z I76B I43B C20B I53Z I20E I23A I29Z I74C F39B I75B I27C I32E I12C I30Z B05Z I08D J10B
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60

61. In
a
changing
situa-on,
per-nent
KPIs
become
an
essen-al
management
tool
• QuesEons
and
challenges
for
the
management
EvoluEon
of
indicators
of
number
of
cases
to
§ How
to
transform
historic
data
into
concrete
§ Quality,
exhaus-veness
and
speed
of
coding
objecEves?
§ Time
between
paEent
exit,
codable
file,
and
expediEon
of
bill
§ Which
KPIs
to
choose
and
how
to
define
them?
§ Number
of
informaEon
requests
by
§ What
correcEve
measures
to
set-­‐up
for
the
insurance
companies
already
chosen
KPIs?
§ Number
of
changes
of
DRGs
§ Number
of
“trash
DRGs”
§ How
to
involve
unit
heads
and
physicians
in
the
objecEves?
§ Medical
ac-vity
and
use
of
resources
§ Which
dashboards
to
develop
and
how
to
share
§ Average
length
of
stay
them?
§ Number
of
cases
§ Number
of
outliers
§ Which
objecEves
to
set
and
how
to
explain
and
§ CMI
divide
them?
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61

62. The
medical
staff
o`en
expects
more
concrete
and
understandable
indicators
Example:
monthly
dashboard
of
a
surgery
unit
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62