The Victorian ABF direction for Non-Admitted Services

1. The Victorian ABFdirection forNon-Admitted Services

2. Southern Health Fast Facts

3. Steven Damiani Summary 25+ years in Health 21 + years in an Executive Finance role Large Specialist Metro Health Service, known for its State wide Services such as: heart and lung replacement and transplantation, cystic fibrosis, burns, HIV/AIDS, haemophilia, sexual health, hyperbaric medicine and elective surgery $795 Million Largest Health Service in Victoria Revenue in excess of $1.2 billion, Six Public Hospitals and One Private Hospital, Five Aged Care Facilities, Eight Community health Centres, Six community Rehab Centres, Mental Health Facilities Business Support Services Director Operations and Clinical Costing 27/1/2005 to Current 6 years and 6 months Director of Finance Alfred Hospital 15/04/2002 to 7/1/2005 2yrs 9mths State-wide teaching, training and research health service. Specialising in eye, ear, nose and throat (ENT) medicine. Renown for the world’s first cochlear implant, which was done at the Eye & Ear Hospital 25 years ago. $80 million Only dedicated Cancer Centre in Southern Hemisphere, combining a large Research Division and Hospital. $250 million, Director of Finance December 1997 to April 2002 4 years 4 months Director of Finance and Strategy June 1994 to April 2002 7 years 10 months

4. Victoria’s response to Non-Admitted ABF readiness • The Victorian Department of Health recently introduced the Non‐Admitted Patient minimum Data Set (NAP  MDS) as an initiative that will support the future development of Activity‐Based Funding for non‐admitted services.   • For Outpatient Specialist clinics VINAH is change to patient level reporting for non-inpatient services from aggregate count of episodes within our current Agency Information Management System (AIMS). • The aim is to provide an evidence   base  for health services to support health planning, clinic based performance and quality improvement, and contribute  to  government  policy development  and  funding.  

6. 21 Contact fields

7. 7 Episode Fields

8. 5 Patient Registration fields • 5 Referral in Fields • 2 Referral out fields

9. Victorian Non-Admitted Health Services Victorian Integrated Non-Admitted Health Minimum Dataset The following programs must transmit data to the VINAH minimum dataset: • Specialist clinic (outpatient) services • Sub- Acute Ambulatory Care Services (SACS) • Hospital Admission Risk Program (HARP) • Post Acute Care (PAC) • Victorian paediatric rehabilitation services non-admitted • Community-based palliative care • Family Choice Program • Victorian HIV Service • Victorian Respiratory Support Service • Medi-hotel (optional) • Transition Care Program (TCP) • Residential in-reach service • Hospital-based palliative care consultancy teams.

10. Counting Non- Admitted Services Clinical Costing VICTORIAN  INTEGRATED  NON  ADMITTED  HEALTH  MINIMUM  DATA  SET  (VINAH  MDS) Agency Information Management System (AIMS) Patient Level Data Clinic Submit Activity data Aggregate Data ID Register Clinics Service Events Tier 2 Class

12. Encounter Client Service Event Client Contact = Service Event

13. Key Counting rules Service Event An interaction between one non-admitted Patient with one or more clinicians providing clinical/therapeutic content resulting in a dated entry in patient’s medical record Groups – each member of the group = 1 service event Multi-disciplinary clinics = 1 service event regardless Sequential bookings / attendances are multiple service events

14. VACS Weights 35 Medical Clinics 11 Allied Health Clinics Nurse Led Clinics counted and funded same as Allied Health

15. Funding of Radiotherapy Services in Victoria • A Variable Payment per Weighted Activity Unit (WAU) up to set targets for Public, DVA and Private patient categories. Costs for Associated Department services are included in this payment and must be provided to all patients as required. Associated Department services include: • allied health • patient accommodation • patient transport • patient education • staff transport • staff education • staff accommodation • Pharmacy • Radiology Funding = Target non-DVA WAUs x price per WAU$266) plus (Target DVA WAUs x price per WAU x 1.21) less the Private Revenue Target.

16. TIER 2 Clinics 20.25 Gastroenterology 20.2 Hepatobiliary 20.27 Craniofacial 20.28 Metabolic Bone 20.29 Orthopaedics 20.30 Rheumatology 20.31 Spinal 20.32 Breast 20.33 Dermatology 20.34 Endocrinology 20.35 Nephrology 20.36 Urology 20.37 Assisted Reproductive Technology 20.38 Gynaecology 20.39 Gynaecology Oncology 20.40 Obstetrics 20.41 Immunology 20.42 Medical Oncology (Consultation) 20.43 Radiation Oncology (Consultation) 20.44 Infectious Diseases 20.45 Psychiatry 20.46 Plastic and Reconstructive Surgery 20.47 Rehabilitation 20.48 Multidisciplinary Burns Clinic 20.49 Geriatric Evaluation and Management (GEM) 20.50 Psychogeriatric 20.51 Sleep Disorders Medical Consultation clinics 20.01 Transplants 20.02 Anaesthetics 20.03 Pain Management 20.04 Developmental Disabilities 20.05 General Medicine 20.06 General Practice and Primary Care 20.07 General Surgery 20.08 Genetics 20.09 Geriatric Medicine 20.10 Haematology 20.11 Paediatric Medicine 20.12 Paediatric Surgery 20.13 Palliative Care 20.14 Epilepsy 20.15 Neurology 20.16 Neurosurgery 20.17 Ophthalmology 20.18 Ear, Nose and Throat (ENT) 20.19 Respiratory 20.20 Respiratory – Cystic Fibrosis 20.21 Anti-coagulant Screening and Management Cardiology 20.23 Cardiothoracic 20.24 Vascular Surgery 50

17. TIER 2 Clinics continued 10. Procedures clinics 10.01 Hyperbaric Medicine 10.02 Interventional Imaging 10.03 Minor Surgical 10.04 Dental 10.05 Angioplasty/Angiography 10.06 Endoscopy – Gastrointestinal 10.07 Endoscopy- Urological/Gynaecological 10.08 Endoscopy- Orthopaedic 10.09 Endoscopy – Respiratory/ENT 10.10 Renal Dialysis 10.11 Medical Oncology (Treatment) 10.12 Radiation Oncology (Treatment) 10.13 Minor Medical Procedures 10.14 Pain Management Interventions 30. Stand-alone Diagnostic clinics 30.01 General Imaging 30.02 Medical Resonance Imaging (MRI) 30.03 Computerised Tomography (CT) 30.04 Nuclear Medicine 30.05 Pathology (Microbiology, Haematology, Biochemistry) 30.06 Positron Emission Tomography (PET) 30.07 Mammography Screening 30.08 Clinical Measurement 8 14

18. Victorian Acute Health Data Collections • VAED for admitted patient activity • VEMD for designated emergency department activity • ESIS for monitoring elective surgery waiting lists • VINAH Minimum Dataset (MDS) for non-admitted patient activity • Victorian Perinatal Data Collection (VPDC) for all birth episodes • Victorian Cost Data Collection (VCDC) for patient-level costs • Financial data (F1)/Common Chart of Accounts (CCOA), VACS and other non-admitted and financial • Minimum Employee dataset for payroll data • Agency Information Management System (AIMS) primarily used to collect summary level financial and statistical information.

19. Consultative mechanisms Consultative mechanisms on data collection • Victorian Advisory Committee on Casemix Data Integrity (VACCDI) • Victorian ICD Coding Committee (VICC) • VEMD Reference Group • ESIS Reference Group

20. Data collection for the future Smart cards for healthcare sector are widely well accepted in Europe, compared to the rest of the world. The smart cards have been proved to provide great value to the healthcare service. It provides authentication and identification for the users and the healthcare provider, besides increasing patient safety and speed of service. Spain and Scandinavia are one of the fastest adopters of smart card technology into their healthcare sector.

22. Evolution of the Casemix formula in Victoria $ = Price x Coded Activity $ = Price x Coded Activity + Copayments + Specified Grants Limitations of a basic casemix model One cost weight is used to fund each and every patient in a DRG Not every patient in a DRG needs exactly the same level of care A flat rate of funding does not adequately track cost variation with time and across levels of severity within a DRG . Some groups of patients tend to be sicker than others, even within the same DRG. Some hospitals treat more complex patients because of their role. This approach creates financial risk to providers and purchasers of health care

23. Industry bodies that may be of assistance AHSFMA The Australian Health Services Financial Management Association http://www.ahsfma.org.au CCSAA Clinical Costing Standards Association of Australia http://www.ccsaa.com/ Recently established discussion forum

24. Examples of Specified Grants over the years Specified Grants Teaching and Research New technology e.g. Drug eluting Stents Patient complexity e.g. Heart and Liver Transplants Spinal Injuries Cystic Fibrosis Availability of services e.g. Neonatal Intensive Care Unit (NICU) Emergency Department Availability Ambulance Incentive schemes .e.g. Access KPI bonus pool Compensation grants

25. Recently removed Specified Grants List of block grants incorporated into the relevant price within each peer group EBAs AMA 2008–2012 Conditions & Translations AMA EBA 2008–2012 Clinical Support Time (80/20) AMA EBA CME AMA Rural Enhancement Package AMA 2008–2012 Feb11 Translations Australian Nursing Federation EBA 2007–2011 – Ratios and Workload EFT Nurses EBA – Funding of Additional EFT HSUA 5 Reclassification Translation Funding Distribution HSUA 1 & 5 Apprentice HSUA No 1 – Reserved Funding Item – 100 Additional EFT AMA Mental 2008–2012 Conditions & Translations Roster Implementation 8-8-10 HSUA No 4: Additional Pharmacists

26. Recently removed Specified Grants Other Specified Historical Superannuation Adjustment HealthSuper DBS – Funding for all Output Groups 2006/07 Rural Compensation Pricing Review Non Wage EBA Compensation Target A Major Provider HDMS – Supplementary Grant HDMS – Supplementary Grant - Rural Elective ESAC Rural Patient Initiative – HDM Access Co-ord ICU Nurse Liaison ICU Workforce Initiatives Emergency Access Emergency Flexible Emergency GPLO Emergency Mental Health Observation Medicine Co-payment Efficiency and Productivity grants (various)

27. Examples of Co-Payments Current In-patient Copayments Aboriginal and Torres Strait Islander Patients (30% Loading) Mechanical Ventilation Co-Payment Thalassaemia Aortic Abdominal Aneurism (AAA) Stent Atrial Septal Defect (ASD) Closure Devices

28. 23 % of Metro Acute funded by Specified Grants

29. 53% of the Non-Inpatient Emergency Services Grant is an availability Grant.

30. Clincal costing feeder systems Mental Health Allied Health Patient Management Prosthesis Ambulatory Services Outpatients Cost of Care to a PATIENT Aged Residential Services Pathology Teaching \ Research Diagnostic Imaging Data Warehouse Theatre Emergency Pharmacy Finance Payroll / HR

31. Possible issues The definition of clinics.  what is done in a particular clinic in terms of complexity (price may not cover some work in a particular clinic) that will work itself over time- more clinics will be created.  Software and capturing all data feeds etc