Casemix
information is used as a tool in both financial and clinical management of
health services. The
Australian Refined Diagnosis Related Groups (AR-DRG) is the
Casemix classification currently in use for acute inpatients. As
further patient classification systems are developed and information systems are
improved Casemix will continue to be used to help provide more effective and
efficient health care across the spectrum of health settings.
At
present South East Health has various systems in place to provide Casemix
information for use in management. There
is an integrated network that allows information to flow from the Area to
the hospitals and vice versa. The
Area uses Casemix information to assist in budget allocation and utilises
Casemix information in clinical management and planning.
Use of Casemix in
Reporting
Acute
Casemix Reporting
Casemix
reporting and costing has been undertaken in the Area
for some time using the AR-DRG classification. Examples of Casemix based activities include:
Costing
of acute inpatients by AR-DRG using both cost modelling and clinical
costing approaches
Cost
comparison reports by AR-DRG, using state peer group averages and
benchmarks
Activity
and cost by AR-DRG and Service Related Group which is used in planning and
/ or monitoring service delivery and streamlining existing services
Monitoring
of inflows and outflows to enable cross-Area purchasing arrangements
Development
of clinical pathways in all major acute teaching hospitals to aid in
clinical management and quality monitoring
Monitoring
of service use by Veterans for payment purposes
Focusing
on acute inpatients does not provide the Area or hospitals with all of the
information necessary to manage and cost hospital activity.
In addition to acute inpatients there are other patient types for
which there are no classification systems and for which little or no
patient data is collected or reported.
Sub-Acute
and Non-Acute Casemix Reporting
With
the growing demand for Casemix information and more importantly the
introduction of Casemix funding to replace traditional funding methods,
the need for a system in SEH to capture other types of care is great.
The Australian National Sub-Acute and Non Acute Patient
Classification (AN-SNAP) is such a classification system and is designed
specifically to capture Sub and Non-Acute care provided in both inpatient
and ambulatory settings. It
is intended to be useful for both funding and clinical management purposes
across the Area.
AN-SNAP
is based on five case types: Rehabilitation, Palliative Care,
Psychogeriatric, Geriatric Evaluation and Management and Maintenance Care. In 1997 a national study was undertaken of these types of
care and as a result, the AN-SNAP classification system was developed.
In accordance with the views of various state committees, NSW
resolved that AN-SNAP be progressively implemented over a four year
period. Phase One began on 1 July 1998.
Within the Area four facilities participated in the voluntary
phase, collecting AN-SNAP data relating to designated inpatient settings.
Phase
Two of the implementation began on 1 July 1999. Collection then became compulsory for all designated inpatient settings. It is envisaged that the scope of the collection will
increase over the coming two years until 1 July 2001, at which time all
AN-SNAP settings regardless of inpatient, ambulatory or community
location,
will be required to collect AN-SNAP data and submit this to NSW Health for
analysis.
Trendstar
To
assist in the provision and development of Casemix information the Area
implemented TRENDSTAR, an information system that integrates both the
clinical and financial feeder systems that exist within the hospital, into
one database. This provides a
comprehensive and cohesive Casemix information data base that can be made
available to the widest possible platform of users across a wide range of
disciplines. It is a system
that is designed to assist with management issues.
The
implementation of TRENDSTAR within SEH originated from a decision made by
the NSW Information Systems Steering Committee (ISSC) on the 16th
December, 1993. The
objectives of acquiring such a system were:
to
provide an effective management tool for the Area and hospitals
to
facilitate the effective allocation of resources from Area to hospitals,
enhance the service planning process, and enable accountability of health
professionals for the utilisation of health resources
and
to assist with the development of quality improvement programs
In
June 1994, the
TRENDSTAR Clinical Costing/Decision Support System was selected as the
preferred system for NSW Health.
The
Area commenced the implementation of TRENDSTAR in September 1995 with a 6
month project at St George Hospital. TRENDSTAR was then rolled out to the remaining six acute care
facilities over the next three years, culminating in an Area wide
TRENDSTAR network in June 1998.
Typically,
sites have been able to download data from the following systems:
Financial, Patient Administration System, Pathology, Radiology, Nursing
Dependency and Allied Health. Recent
enhancements to TRENDSTAR also mean that sites are now able to import Casemix
data from other local systems such as Nuclear Medicine, Pharmacy and
Theatres. The combination of
these data elements provides an unprecedented profile of hospital activity
down to the inpatient level. For
clinical and financial managers, understanding the trends and costs of
providing services is made possible through analysing a complete profile
of the procedures delivered to patients and their costs, and through being
able to compare these across given periods of time on a departmental
basis.
Use of
Casemix in
funding
At
present NSW Health utilises a funding allocation process to Areas based on
the population's needs, on recurrent expenditure requirements of new
facilities and developments in Commonwealth funding arrangements. This is known as the Resource
Distribution Formula. The
funding provided to Areas is largely provided as a global allocation and
decisions about funding of individual institutions are made locally by the
Area.
In
order to make these allocation decisions more equitable and standard
across the state, the NSW Health Council recommended the introduction of
episode based funding for acute services from July 2000. The model calculates funding from Areas to Hospitals and is a
prospective payment based model with payment calculated on each
hospital’s projected activity and adjusted for case types such as day
only patients, transferred patients, long stay outliers and the public /
private mix. Payment is
calculated using state hospital peer group benchmark prices.
There
is the intention in future years to expand the model to incorporate
funding for Emergency Services, Intensive Care, Mental Health and
Rehabilitation and Extended Care services. These services are currently funded on an historical basis.
To
further expand on the use of Casemix principles in funding, the Area
decided to implement the Contract Payment Advisor (CPA) module of
TRENDSTAR. The four month
project commenced in March 1999 and now provides the Area with the ability
to simulate funding to individual hospitals using the principles of
episode based funding. CPA
provides hospitals with the ability to report actual cost and activity
against payment and to model new funding contracts and scenarios.
Key Tasks
of the Area Casemix Unit
Managing
the NSW Program and Product Data Collection which incorporates the patient
costing study and the Unaudited Annual Return.
Improving
performance levels for the coding of hospital records.
Extensive
involvement with the implementation of the NSW Health Information Exchange
to ensure changes are well communicated an in line with State, Area and
Hospital requirements.
Participating
in the development of an interface from the NSW HIE to Trendstar, ensuring
that the relevant patient costing and activity data is readily available.
Managing
the implementation of AN-SNAP across the Area.
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