ACCT3011 The Accountant as a Consultant- Accounting Assignment Help

Scope of financial assessment

Undertake an activity and financial analysis for enhancing Neurology services for Hospital A which reduces the weekend transfer of patients to Hospital B taking into account projected population growth over the next five years.

Background

The ABC Local Government Area has a lower socioeconomic status than the NSW average which is more pronounced in the northern parts of the region. The community has higher rates of health risk factors, lower life expectancy, and higher rates of melanoma, lung and colorectal cancers than the NSW average.

Over the next 20 years, the population of the region is projected to grow by 22% to 415,060, an increase of 75,510 persons. Growth will be stronger in Town A (location of Hospital A) (30%) than in Town B (location of Hospital B) (15%), and it is likely that Town A will overtake Town B in terms of total population by 2026.

The greatest numerical growth is projected to occur in the ABC Local Government Area for people in the fertile years of 15 to 44 and in the older years of 70 to 84. Between 2026 and 2036, the population in the oldest age group of 85 and over will increase by an estimated 57%. The proportion of the population aged 70 and over will increase from 14.5% in 2016 to 21% by 2036. The lowest growth will be in Town B for people aged 45 to 69. There is a rapidly growing Aboriginal population making up 3.8 % (or 12,485 people) of the population.

There are two major hospitals in the ABC Local Health District. Hospital B is a Tertiary Referral A1 514 bed hospital providing a range of specialities. Hospital A is B2 delineated facility with 357 beds in the northern part of the District. It is not unusual in the health system for smaller hospitals to network with larger facilities, escalating more complex levels of patient care for access to specialised medical expertise, equipment and resourcing and effective management of costs.

A recent review identified that there are significant numbers of inter-hospital transfers from Hospital A to Hospital B (n=2,178 2020-21), an average of six patients per day, due to the non-availability of a range of speciality services. As a smaller facility, many specialty services only operate during business hours making it difficult to access 24 hours per day/seven days a week care and many services are not able to be covered after-hours due to staff rostering arrangements, staff shortages/difficulty with recruitment, lack of a well-developed District-wide roster and cost.

One such service is Neurology. Neurology is the medical treatment and diagnosis of conditions of the brain, spinal cord and nerves. This can include muscle diseases and disorders that affect thinking and behaviour. Patient care includes management of: Parkinson’s disease, multiple sclerosis, epilepsy, motor neurone disease, neuromuscular disease, dementia and headaches, and stroke. Neurology patients are transferred from Hospital A to Hospital B every Friday due to the lack of weekend medical coverage. This practice is disruptive for the patient and their family and places additional pressure on Hospital B over the weekend when discharges are lower.

Current Service Delivery

Neurology offers an inpatient admitting and consult service Monday to Friday at Hospital A. A Neurologist is on-call (takes calls remotely) to admit patients via the Emergency Department to the Hospital A inpatient units from Monday until Friday up until 1pm, outside of these hours the patients are required to be transferred to Hospital B. A stroke team exists as a Hospital B only service with current arrangements in place for NSW Ambulance Service to bypass Hospital B for any patients with an onset of stroke symptoms.

Neurophysiology provides a 2.5 day a week service at Hospital A conducting inpatient and outpatient Electroencephalograms (EEGs). Current coverage is Monday and Thursday 8am - 4.30pm and Wednesday 8am-12 midday. All nerve conduction studies are undertaken at Hospital B. There is one Staff Specialist outpatient clinic per month undertaken at Hospital A which is a specialised movement disorder clinic. All other neurology related clinics are undertaken at Hospital B including general neurology, Stroke/TIA and MS clinics.

Current Transfer and Cost Activity

For 2020-21 there were 220 Neurology patients’ transferred from Hospital A to Hospital B. Of these 220 Neurology patients, 83% were transferred from Hospital A ED, 9% from a Hospital A ward, 7% from Hospital A ED SSU and 1% from Hospital A ICU. Most patients went directly to a Hospital B ward (97%) and 3% went through a Hospital B critical care area ED or ICU. Hospital B wards that received most of the patients were C4 (69%) and H3 (22%).

Of the 220 patient transferred, 30 were classified as “Diagnostic Related Group (DRG) B70A Stroke and other cerebrovascular disorders– Major Complexity” and as such would be deemed as still requiring transfer to Hospital B for specialist stroke management. This would leave 190 patients that could potentially be retained at Hospital A.

The current cost of transfer by Patient Transport Service includes a booking fee of $254 and $2.54 per km or approximately $343 in total per trip of around 35 km. A reduction of 190 transfers would reduce transport costs by $65,170. It is understood around 15% of patients are transferred back to Hospital A on Monday incurring an additional transport charge.

To obtain a sense of the cost of a neurology patients hospital stay by DRG, table 1 shows the cost of a neurology admissions at Hospital A compared to Hospital B for the same patients. In nearly all cases, for these DRGs it was less expensive to undertake the care at Hospital A.

Table 1. Acute Activity (DRG) Hospital A compared to Hospital B

Current Staffing and Resources

The Neurology Consultant roster is managed centrally for the District. The roster pattern is usually over a 10-12 weeks period with two Consultants allocated to Hospital A. One of which will be allocated on a rotational period to cover Hospital A from Monday to Friday. The roster consists of mainly Visiting Medical Officers (VMOs) who are paid under a fee for service model for their time at Hospital A. The pay rates for VMOs and other Award employees are available from NSW Ministry of

Health web site: https://www.health.nsw.gov.au/. The Consultant onsite presence is limited to ward/consult rounds and the one clinic per month, with no administration/office time at Hospital A. Hospital A has one junior medical team associated with the service consisting of one Basic Physician Trainee (BPT) and two Resident Medical Officers (RMO) – one of which is rostered to start later in the day to assist with workload issues that was resulting in frequent overtime. The team accepts patients each weekday and undertakes all neurology consults for the site.

There is a District-wide Neurology Clinical Nurse Consultant (CNC) that provides cover to both Hospital A and Hospital B. There is also a 1 FTE CNS2 Parkinson’s Liaison Nurse, which provides a consultancy service to both inpatients and outpatients with movement disorders at both Hospital A and Hospital B.

Future Service Proposal

There are a number of options that could be considered and costed. Option 1 is Do Nothing. Alternative options involve expansion of the service to a 7 day a week service. Option 2 recommended by the Neurology Department involves staffing a seven-day medical roster rather than a five-day medical roster. To ensure adequate access to EEGs the Neurophysiology Department would require an increase from 2.5 days to a 4 day a week service at Hospital A. Nerve Conductions studies would remain a Hospital B only service – an expansion to Hospital A would require investment in equipment and increased clinic space and is deemed to be a more future than current need.

To support this model an additional 1 FTE Staff Specialist Neurologist would be required which would enable the re-establishment of Neurology Clinics at Hospital A and improve the onsite supervision of the junior medical teams. Supporting this position, two junior medical teams would also be required. Estimated Costs are outlined on Table 2:

Table 2. Estimated Service Costs

Students are asked to conduct analysis on Options 1 and 2 including affordability and suggested phasing over a five-year period. Students are also encouraged to research or consider at least 1 alternative option or service delivery modification such as the use of technology.

Assessment criteria:

1. Project progression in mee/ng the project deliverables and client expectations: Cri/cal reflection and analysis
2. The outstanding memo, is appropriate for the audience, including the expression of complex ideas and e?ec/ve critique of the themes and issues arising in the course of mee/ng the deliverables set by the client.
3. Evaluate your professional standing: Lessons learned from client interaction, project management and what skills (technical and non-technical) do you need to strengthen?
4. Outstanding discussion of an understanding of professional standing is provided in the context of the project, dealings with clients, and appropriate self-reflections are given about skills that one lacked and could get better at. Reference is made to project management skills and how one's weaknesses can become strengths (technical and non-technical skills) to further develop as a consultant.
5. Wri/ng Style Articulates information in a logical, flowing, integrated manner making it easy to read
6. HD Presents work of a high professional standard using discipline-specific language, written work is logical, integrated, easy to read
7. Presenta/on of informa/on Present work in a professional way about organisation, content, formatting and appropriateness to audience and context
   1. HD Professionally presented with no spelling, grammar, or punctuation errors and accurate choice of words
8. Persuasiveness Communicates the ideas and conclusions convincingly with original content and ideas
   1. HD Articulates an argument in a clear, competent way, and presents substantial and convincing ideas using discipline-specific theory/evidence
9. The prose style, grammar, syntax, and spelling.
10. The writing style is outstanding and is clear and error-free demonstrating superior written communication skills.

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