In a demo earlier this month, one of the prospect's executives asked us whether the PPD budget on the screen could flex daily with the census feed. The same question comes up in the last week of a slow month, when a dietary manager is under her dollar budget and the administrator tells her the department is over.
The budget is a rate
A per patient day budget is a target per resident per day, by department. The dollars a department may spend in a month are that rate multiplied by the patient days the building serves that month. Set the dietary rate and count the days, and the month's dollars follow.
A flat monthly budget is a fixed dollar figure. It looks fine at 92 percent occupancy and fails at 78, because at 78 the department shows under budget in dollars while it spends more per resident than the plan allowed. A PPD budget holds the rate and lets the dollars move with the days.
What happens when the census drops
Take a 120-bed building at 90 percent occupancy. That is 108 residents and 3,240 patient days in a 30-day month. Say the next month, also 30 days, runs at 80 percent. That is 96 residents and 2,880 patient days, 360 fewer, so a dietary budget set per patient day is about 11 percent fewer dollars, and nobody touched the rate.
If the dietary manager keeps ordering at the old pace, her actual PPD rises 12.5 percent on the same grocery bills. The spend stayed where it was and the patient days under it fell. So a department can be at or under a flat dollar budget and over its PPD target in the same month.
Run the same building the other way. Twelve admissions in a week push the census up, and a PPD budget gives the department room to feed and supply those residents without a budget exception. A flat budget would show the extra orders as an overrun as soon as they post.
Where the census number comes from
The dollars available and the actual PPD are only as current as the patient-day count under them. When the count is re-keyed from the EHR into a spreadsheet once a month, every PPD figure a department head sees is built on an occupancy that is already old. On a count like that, a building whose census dropped two weeks ago looks under budget until the month closes.
We pull the daily census from PointClickCare or MatrixCare, so the budgets are per patient day and move with the census without anyone re-keying. The Budget Report shows each department's census, PPD budget, and actual side by side with the amount still available for the period, and it is the same screen for every building on the feed. When a department's spend crosses its threshold, the department head and the administrator hear about it before close.
The feed does not set the rate. That still comes from your own actuals, building by building, because there is no published supply benchmark we would set a dietary rate from.
It does not adjust for case mix either. A wing that turned over to heavier care will run a higher PPD on the same rate, and someone has to decide whether the rate or the wing is the problem. The alert only tells the dietary manager where the department stands; what to hold or substitute is still her call.
Questions controllers ask
Does a PPD budget change when census drops?
The dollar amount does. The rate per patient day stays where you set it, and the dollars available for the period fall with the patient-day count. A department ordering at last month's pace will show over its PPD target even though its dollar spend did not move.
How is a PPD budget calculated?
Multiply the department's per patient day rate by the patient days in the period to get the dollars available, then divide actual spend by the same patient days to get actual PPD. Use the actual midnight census, not licensed beds or a monthly occupancy assumption. Budget by department, because a house-wide figure hides which one is over.
Why is my department over its PPD budget when spending went down?
The census fell faster than the spending did. PPD is spend divided by patient days, so a smaller denominator raises the rate even when the numerator shrinks. Check the patient-day count for the period before you question the orders.
How often should a PPD budget update with the census?
Daily, from the EHR that holds the census. A nightly sync keeps the figures within a day of the actual count. A weekly re-key into a spreadsheet leaves every PPD figure a department head sees up to a week stale.