Innosuisse project at HSLU creates basis for more cost transparency in outpatient care

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As part of an Innosuisse project, the Lucerne University of Applied Sciences and Arts has developed two applications with its business partners Heyde and Polynomics that are intended to help Spitex organizations obtain standardized cost and performance data throughout Switzerland. Such standardization is necessary for the successful integration of care into the "EFAS" healthcare reform.

After fourteen years of wrangling, the national parliament has agreed on the key parameters of the ’EFAS’ project (uniform financing of outpatient and inpatient care). From 2028, all healthcare services are to be financed uniformly in order to eliminate false incentives in the system. At the request of the cantons, it was decided to also integrate nursing care into EFAS from 2032. In concrete terms, this means Regardless of whether the treatment or care takes place in hospital, in a practice, in a nursing home or at home by Spitex, the cost sharing between health insurers and the public sector will always work the same in future.

For the reform to succeed and be aligned with the goals of the care initiative, a common data basis is needed for all service providers. While this is available for medical services, there is currently no comprehensive, transparent cost and data basis for Spitex services. A research project funded by Innosuisse aims to change this. The Lucerne University of Applied Sciences and Arts (HSLU) has developed a cost accounting solution and a benchmarking platform with its business partners Heyde and Polynomics, which enable standardized, high-resolution cost accounting throughout Switzerland as well as meaningful cost/performance comparisons within Spitex. They are aligned with the Spitex Switzerland financial manual.

Comparability despite different starting situations

The project was launched in 2020 in close collaboration with eleven Spitex organizations and Spitex Switzerland. ’For political work at national level, we need standardized, reliable and comparable cost accounting,’ says Cornelis Kooijman, Co-Managing Director of Spitex Switzerland, ’and with the introduction of EFAS, standardized cost accounting and corresponding benchmarking will even become mandatory for Spitex.

The heterogeneous starting positions of the Spitex organizations are challenging - for example in terms of their size, their services and care mandate, their sponsorship or regulatory requirements. ’We deliberately wanted to take this into account,’ emphasizes Matthias Wächter, co-project manager at Lucerne University of Applied Sciences and Arts. The applications developed are a novelty in this respect: unlike other systems, they process raw data from the primary systems instead of aggregated data, which is why they can break down the costs of Spitex services in detail for the first time. If they become the standard, it will be possible to show, explain and compare the exact composition of cost and income structures for each Spitex organization throughout Switzerland.

Contribution to a high-quality healthcare system

’The project lays the foundation for the tariff systems in the Swiss healthcare system to develop further, for the personnel goals of the care initiative to be implemented and for Spitex to be able to assume its role in integrated care,’ Matthias Wächter is convinced. Currently, around 130 Spitex organizations are already using the cost accounting solution developed in the project and 50 organizations are using the benchmark. For Daniel Boller, CFO of Spitex Zurich, one thing is certain: ’The high-quality data processing and the new cost accounting model mark a quantum leap. This development is fundamental for Spitex organizations, as today’s residual financing and new financing models are largely dependent on reliable figures. The organizations can also see how they compare in terms of costs and services and can take appropriate optimization measures.