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Alfa D’Amato, Deputy Director, ABF Taskforce Susan Dunn, Manager, ABF Workstreams, ABF Taskforce ABF TASKFORCE Emergency Department Funding Model ABF Taskforce

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  • Alfa D’Amato, Deputy Director, ABF TaskforceSusan Dunn, Manager, ABF Workstreams, ABF Taskforce

    ABF TASKFORCEEmergency Department

    Funding Model

    ABF Taskforce

    http://internal.health.nsw.gov.au/communications/

  • NHRA 2011 ObjectivesObjectives of the National Health Reforms – Broader than ABF

    • Share the future cost of growth in the efficient price and service provision equally between the State and Commonwealth

    • Establish a national consistent approach to activity based funding for public hospitals, with the provision for block funding smaller rural hospitals where required

    • Ensure strong national standards to improve clinical safety and quality in hospitals and health care settings

    • Enhance transparency on the performance of hospital and health care services.

  • National Health Reform Agreement Implementation of a nationally consistent Activity based funding

    system for:

    – admitted acute services, emergency department services and non-admitted patient services from July 2012

    – mental health and sub and non-acute services from July 2013; and

    Teaching Training and Research no later than 30 June 2018

    Commonwealth will fund 45% of efficient growth from July 2014, increasing to 50% from July 2017.

    Block Funded hospitals: Commonwealth will fund 45% of growth in efficient cost from July 2014, increasing to 50% from July 2017.

  • LHDs/SHNs

    Australian Commission on Safety and Quality in

    Health Care

    National Health Performance

    Authority

    Independent Hospital Pricing

    AuthorityNational Funding

    Body

    Ministry of Health

    Data Provision by Health Departments Data Provision by Health Departments

    National Minimum Data Set Reporting

    Performance KPIse.g. Emergency

    e.g. Elective Surgery

    Patient Level Cost & Activity Data

    Activity Targetse.g. Admitted Acute

    e.g. Emergency

    National Health Reform Act (NHRA)

    National Minimum Data Set Reporting

    Performance KPIse.g. Emergencye.g. Elective Surgery

    Patient Level Cost & Activity Data

    Activity Targetse.g. Admitted Acutee.g. Emergency

  • Independent Hospital Pricing Authority - IHPA An independent statutory authority established under

    Commonwealth legislation (Dec 2011) as part of the National Health Reform Agreement (NHRA) reached by the Council of Australian Governments (COAG) in August 2011

    Set in scope services, national efficient price (NEP $4808), set national efficient cost (NEC), set general guidelines

    Guidelines may change in the future

    May do audit in the future – therefore, need to be able to prove the source of data in WebNAP ie 150 Respiratory OOS in WebNAP corresponds to 150 OOS in IPM

  • State Accountability

    System manager for the public hospital system

    Negotiates with LHDs/SHNs about service volumes (targets) and locations to be delivered

    Determines state funding contribution and total funding to each LHD/SHN. State price = $4471

    Bears residual risk and meet costs of service delivery State remains majority funder of health services until 2063

    when Commonwealth share finally reaches 50%BUT Role of the Independent Administrator may effect payments Local decision making - LHDs/SHNs responsible for allocation

    of budgets to hospitals under Service Agreements

  • National Efficient Price (NEP)Interpreting the NEP

    The NEP, as calculated by the IHPA, is based on the average cost of providing acute admitted services across Australia, but also applies to emergency and non-admitted services.

    All cost weights are expressed as a single unit of measure being the National Weighted Activity Unit (NWAU). It provides a scale that identifies the relative measure of resource use of each public hospital service.

  • NEP Adjustments Indigenous - A patient based adjustment of 5%

    LocationA patient based adjustment with three levels:

    Outer regional 8.7%Remote 15.3%Very remote 19.4%

    Calculation of Price$ (2012/13) = NEP x NWAU(12)NWAU(12) = URG_PriceWeight * (1+Aindig + Alocation))

  • Emergency Departments Classification System

  • Emergency Classification(1)Urgency Disposition Groups Classified to UDGs - Urgency Disposition Groups

    – Classification developed by Dr George Jelinek (FACEM) in 1992 using WA hospitals data

    – ED Role delineation 1 – 3A

    – eg Batemans Bay, Sydney/Sydney Eye, Singleton

    Requires correct classification of:

    – Triage Category

    – Disposition (mode of separation)

    9

  • Emergency Classification (2)Urgency Related Groups Groups to URGs -

    – Initially developed by Dr George Jelinek (FACEM) based on UDGs

    – ED Role delineation 3B – 6

    – eg Westmead, Prince Alfred, Liverpool

    Requires correct classification of:

    – Triage Category

    – ED principal diagnosis

    – groups to 27 Major Diagnostic Blocks

    – Disposition (mode of separation)10

  • Urgency Disposition Groups

    admitted non-admitted dead on arrival(URG 38)did not wait

    (URG 73)

    MDB 2A(URG 1)

    MDB 3O(URG 2)

    MDB 2B(URG 3)

    MDB 1A/1B(URG 4)

    MDB 3B(URG 5)

    MDB 3A(URG 6)

    MDB Other(URG 7)

    triage 1 triage 2 triage 3 triage 4 triage 5

    Emergency Department Classification System

    Urgency Related Groups

  • URG Components

    –Triage Category

    –Disposition (mode of separation)

    –ED principal diagnosis

    URG 3 Admitted Triage 1 - Injury

  • URG Components:TriageDefinition:

    Classification according to urgency of need for medical and nursing care, using the Australian Triage Scale.

    Valid Triage Codes

    – 1 Emergency Presentation

    – 2 Emergency

    – 3 Urgent

    – 4 Semi urgent

    – 5 Non urgent

  • URG Components:Disposition

    Disposition Classes

    • The URG classification system consists of 4 disposition classes that include:

    – Non-admitted

    – Admitted

    – Dead on arrival

    – Did not wait

    Assignment to disposition class is dependent on ED Mode of Separation value

    Code Domain Description

  • URG Components:DispositionCode ED Mode of Separation (disposition) Disposition

    01 Admitted: To Ward/inpatient unit, not a Critical Care Ward Admitted

    02 Admitted & discharged as inpatient within ED Non admitted

    03 Admitted: Died in ED Died in ED

    04 Departed: Treatment completed Non admitted

    05 Departed: Transferred to another hospital without first being admitted to the hospital from which transferred

    Transfer presentation

    06 Departed: Did not wait Did not wait

    07 Departed: Left at own risk Non admitted

    08 Dead on Arrival Dead on Arrival

    09 Departed: for other Clinical Service Location Non admitted

    10 Admitted: To Critical Care Admitted

    11 Admitted: Via Operating Suite Admitted

    12 Admitted: Transferred to another hospital Transfer presentation

    13 Admitted: Left at own risk Admitted

    99 Registered in Error

    Code Domain Description

  • URG Components:ED Diagnosis

    •Diagnosis code maps to Major Diagnostic group•Acute bronchitis, unspecified

    3B Respiratory system illness•Stroke, not specified as haemorrhage or infarction

    3E Neurological illness•No diagnosis code = Moves to a UDG code

  • 1A Poisoning, comatose1B Poisoning, conscious1C Drug reaction1D Alcohol/drug abuse and alcohol/drug induced mental disorders2A Injury, multiple sites2B Injury, single site2BA Injury, single site *minor (subset of MDB 2B)3A Circulatory system illness3B Respiratory system illness3C Digestive system illness3D Urological illness3E Neurological illness

    Major Diagnostic Blocks

  • Recording Diagnosis 2012-13

    Non-admitted patient

    ED component

    Time of arrival at ED Time of departure from ED

    Applicable period of reported ED diagnosisED diagnosis assigned

    URG Components:ED Diagnosis

  • Recording Diagnosis – 2012-13

    Admitted to ward patient

    ED component Ward component

    Time of arrival at ED Time of departure from ED to ward

    Applicable period of reported ED diagnosisED diagnosis assigned

    Time of departureFrom hospital

    Applicable period of reported principal diagnosis

    Principal diagnosis assigned

    URG Components:ED Diagnosis

    URG/UDG AR-DRG

  • URG classification: Diagnosis code = SeizureURG classification can be any of these depending on the Triage category and the disposition (ED Separation mode)

    Each of these URG codes will have a separate funding amount attached to it based on the National Weighted Activity Unit value.

  • Example of URG Funding Scenario 1 Major Trauma patient (non-aboriginal from a remote area) is brought in

    via ambulance to a regional emergency department, & triaged as a category 1. Patient is stabilised, and a decision to transfer is made. Patient is subsequently transferred to a major tertiary major trauma centre. On discharge, patient ED principal diagnosis recorded as Traumatic subdural haemorrhage

    Key data items:

    Triage 1ED Mode of separation: Departed: Transferred to another hospital without first

    being admitted to the hospital from which transferred (Non Admitted)Diagnosis –Traumatic subdural haemorrhage (MDB 2A) Injury, multiple

    sitesAssigned -URG Group 39 Non Admitted Triage 1 – All MDB groupsATSI –No

    Very Remote –Yes (19.4%)

  • URG Funding Scenario 1 (cont)Price:

    NWAU(12) = URG_39 PriceWeight * (1+Aindig + Alocation))

    = 0.2203 * (1 + 0 + 0.194)

    = 0.2630382

    $ (2012/13) = State price x NWAU(12)

    = $4,471 x 0.2630382

    = $1,176.04

  • 0

    200

    400

    600

    800

    1000

    1200

    1400

    1600

    2011-12 Emergency URG 39 Non-Admitted Triage 1 - All MDB GroupsAverage Cost - Peer Groups A1 to C1 - Draft

    Average Cost of URG 39 per ED Presentation

  • Example of URG Funding Scenario 2

    Major Trauma patient (non-aboriginal from a remote area) from a regional emergency department is received at a major trauma centre. Patient is brought into the ED, triaged a category 1, assessed , CT scan is ordered, reviewed and a decision is made to transfer the patient to theatre. Patient is subsequently transferred to a ward. On ED discharge, patient ED principal diagnosis recorded as Traumatic subdural haemorrhage (S065).

    Key data items:

    Triage 1

    ED Mode of separation 11 Admitted: Via Operating Suite (admitted)

    Diagnosis Traumatic subdural haemorrhage (MDB 2A) Injury, multiple sites

    Assigned - URG 3 Admitted Triage 1 -Injury

    ATSI – No

    Very Remote – Yes (19.4%)

  • URG Funding Scenario 2 (cont)Price:

    NWAU(12) = URG 3_PriceWeight * (1+Aindig + Alocation))

    = 0.3313 * (1 + 0 + 0.194)

    = 0.3955722

    $ (2012/13) = State price x NWAU(12)

    = $4,471 x 0.3955722

    = $1,768.60

  • Average Cost of URG 3 per ED Presentation

    0

    500

    1,000

    1,500

    2,000

    2,500

    3,000

    3,500

    2011-12 Emergency URG 3 Admitted Triage 1 - InjuryAverage Cost - Peer Groups A1 to C1 - Draft

  • Further ABF Information

    Resource kit available: http://internal.health.nsw.gov.au/communications/funding_reform/resources.html

    Email: [email protected]

    http://internal.health.nsw.gov.au/communications/http://internal.health.nsw.gov.au/communications/http://internal.health.nsw.gov.au/communications/http://internal.health.nsw.gov.au/communications/mailto:[email protected]

  • ABF TASKFORCE�Emergency Department Funding ModelNHRA 2011 ObjectivesNational Health Reform AgreementSlide Number 4Independent Hospital Pricing Authority - IHPAState AccountabilityNational Efficient Price (NEP)NEP AdjustmentsEmergency Departments Classification SystemEmergency Classification(1)� Urgency Disposition GroupsEmergency Classification (2) Urgency Related GroupsSlide Number 12URG ComponentsURG Components:�TriageURG Components:�DispositionURG Components:�DispositionURG Components:�ED DiagnosisSlide Number 19Slide Number 20Slide Number 21�URG classification: �Diagnosis code = Seizure��URG classification can be any of these depending on the Triage category and the disposition (ED Separation mode)Example of URG Funding Scenario 1URG Funding Scenario 1 (cont)Average Cost of URG 39 per ED PresentationExample of URG Funding Scenario 2URG Funding Scenario 2 (cont)Average Cost of URG 3 per ED PresentationFurther ABF InformationSlide Number 30