PHO Register analysis
This spreadsheet is a summary of the financial information, patient numbers, fee for service (FFS) deductions and demographic analysis of your PHO for a given month. View a sample report (pdf 444kb) A description of each sheet follows.
This page is a brief summary of the register and financial information for the current month. On the right side of the page, there are clickable links to each of the other sheets.
There are two tables on this sheet which detail payment and deduction amounts - all amounts in both tables are GST exclusive.
Payments (excl GST) for the Current Month
This table is a breakdown of funding and deductions for the month by the practices in your PHO.
It includes for all practices:
- First Contact Care (the core payment to practices)
- Health Promotion (the amount of the flexible funding received by the PHO based on the patients in this practice),
- Services to Improve Access (SIA) (the amount of the flexible funding received by the PHO based on the patients in this practice)
For eligible practices or practices that have opted in to various schemes:
- Very Low-Cost Access (VLCA) - this is available to High Need practices and covers Under 14s and CSC as part of the scheme
- Under 6s - for practices who have only opted for Under 6's - this means they have not opted for the Under 14s scheme
- Under 14s - for practices who have opted for Under 14's scheme
- CSC Subsidy - for practices who have opted into the CSC scheme
The Fee For Service Deductions are also shown - these deductions are based on all GMS claims for the practice's enrolled patients that were received and processed by the MoH in the previous month. Deductions will be included here even if the practice was in a different PHO in the previous month.
Note the Management Fee is calculated based on the population of the PHO as a whole so while the enrolled population of a practice will contribute to that amount there is no way to break it down by practice and therefore it is not included in this table. The CarePlus payment is more complex as depending on the number of HUHC patients a practice has the allocation can be negative - refer to the Care Plus Summary sheet for details on CarePlus payments.
PHO Monthly Totals (previous 2 years, excl GST)
This table is is a longitudinal view of the various payment types over the previous 2 years. Variation over those 2 years will include practice movements (e.g. new practices opening, practices closing or practices moving PHO), population changes - generally this is an upward trend but may vary by location and by changes to the payment levels - these are typically implemented on the 1 July each year but may also occur on a one off basis at other times.
Payment Notification Check
This is the checking sheet that we use to check that our calculations match the MoH calculations. It is important for us to do an independent calculation for two reasons; firstly to ensure that neither the MoH or Karo have made any mistakes (this does happen from time to time) and secondly to provide you with evidence for your auditors that the BCTI from the MoH is verifiable. Payment amounts are GST exclusive
There are two tables on this sheet. Together they give an analysis of the total number of patients funded and terminated (including reasons for termination) for the current month.
NES Enrolments over time
This table shows the total number of funded patients for the PHO for a maximum of the previous 2 years post NES implementation. It also shows the number of new patients and the number of terminated patients. This is a good way to get and estimate of the total churn within your PHO. Note there are no new or terminated patients for the current month as this is only known at the end of the month
Enrolments by Practice for the Month
This table shows the total enrolments by practice for the current month, it also shows the number and percentage of patients in the practice that currently hold a Community Service Card or a High User Health Card.
These graphs shows the information Patient Enrolments sheet. Use the graph to track changes in patient numbers over time. Please note the scale of the funded patients over time can make changes look more significant than they actually are - you can use the Format Axis facility in Excel to set the minimum value to 0 for a different view of the changes.
There are two sections on this sheet. Together, they give a full analysis of the age, gender and quintile for the PHO and the high needs ethnicity and gender for the practices in the PHO, you can use this to determine which practices are over 50% high needs.
The first table and graph is gender by funding age group. While we appreciate that there are issues with the recording of gender in the PMS it is recommended that practices update patients with an unknown gender.
The second table is ethnic group by funding age group. We strongly recommend that practices update patients with unknown ethnic group - where those patients are Maori or Pacific it will represent lost revenue to the PHO.
The third table is quintile by funding age group. This gives you an idea of where your PHO sits with regard to quintile. Each quintile in the New Zealand population is around 20%: slightly less in Quintile 1 (18%) increasing to slightly more in Quintile 5 (21%). You should expect a number of patients to have an unknown quintile - an explanation of the reasons for patients have an unknown quintile can be found here.
High Needs Analysis
This first table (Patient Register by Ethnic Group and Deprivation Index) shows the breakdown of patients in the PHO by deprivation index (or quintile) and Maori, Pacific and Other categories. Note that the percentages are a percentage of the total register.
The second table (LCAF Analysis) shows the total patients who qualify as 'high need' patients (Maori, Pacific, Dep 5), giving the total "High Needs" patients for the PHO. If the percentage is over 50%, the PHO is a low-cost access formula PHO.
The third table (High Needs Analysis by Practice) is a breakdown of each practice's 'high need' population. If the percentage in column G is greater than 50%, the practice would be eligible for the VLCA funding scheme.
These two table are 2 different ways of looking at the monthly Fee for Service deductions.
The first table (FFS Deductions by Month of the Deduction) is a view based on the month of the deduction so this represents the amount that was deducted for a given month. The visits that contribute to that deduction have not necessarily taken place in the previous month so this is not a good representation of claims in a given time but will tally with the payment amounts in the previous sheets.
The second table (FFS Deductions by Month of the Visit) won't match the $ amount deducted but is a representation of the number of claims that were made in any given month. Generally these will be lower over summer and higher in winter.
Care Plus Summary
This Patient Numbers Summary gives the details of the Care Plus calculations.
The first row is the number of funded patients for the PHO.
The second row is the calculated total potential Care Plus patients.
The third row is the total HUHC patients for this month.
The fourth row is the Care Plus residual. This is the Care Plus potential minus the HUHC patients. each HUHC patient reduces the number of funded CarePlus patients by one.
The fifth row is the total funded patients enrolled in Care Plus. Note that for a patient to be counted as enrolled in Care Plus, the 'Care Plus end date' must be after the quarter start date.
The Funding Summary is simply the total residual patients multiplied by CarePlus monthly amount to give the total amount (which will match previous sheets). This amount is ex GST.
The Breakdown by Practice shows the number of potential patients for each practice and the number of HUHC patients - the residual is the first number minus the second number. It is possible for a practice to have a negative residual number if they enrol a significant number of patients onto HUHC. Note that the calculation of the Care Plus potential is complex and does not result in a "whole number" as a result it is unlikely that the total of the Care Plus Potential column will add up to the Total Care Plus Potential in Cell B6.