Kathleen Alloway – Senior Policy Officer Activity Based Funding and Management Department of Health Counting Activity Correctly and Consistently Counts : The application and evaluation of Admission, Readmission , Discharge and Transfer Policy Add something maybe about disclosing information to thir d parties no Add something maybe about disclosing information to thir d parties no
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Kathy Alloway - Dept of Health WA - WA State Update
Kathy Alloway, Senior Policy Officer, Activity Based Funding and Management (ABF/ABM) Team, Performance Activity and Quality, Department of Health Western Australia presented this at the 5th Annual Clinical Documentation, Coding and Analysis Conference. This event is the only case study led conference in Australia looking solely at clinical documentation, coding and analysis.
For more information, please visit http://www.healthcareconferences.com.au/clinicaldocs
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Kathleen Alloway – Senior Policy Officer
Activity Based Funding and Management
Department of Health
Counting Activity Correctly and Consistently
Counts : The application and evaluation of
Admission, Readmission , Discharge and
Transfer Policy
Add something maybe about disclosing information to third parties no Add something maybe about disclosing information to third parties no
Slide 2
43,000 staff
Metro
5 teaching & 6 secondary
2 private/public
Community Health
Child & Adolescent Health
Country
13 health campuses
15 secondary, 51 small hosp
numerous nursing posts,
health centres
Slide 3
New Hospitals
Fiona Stanley
Albany
Midland
Childrens Hospital
Slide 4
WA coding update
ABF has stimulated re-alignment of coding , now
under Finance at both NMAHS and SMAHS.
ABF offered scholarships for further study which
many took up (not funded this year)
WA has no shortfall in coder workforce at the
moment.
Clinical Advisory Group keen to address clinical
documentation and coding education
Coding standards V ABF
Slide 5
Slide 6
Spending on Health is approximately 25%
of State total general expenditure
Cost increases in Health exceed
“standard” cost growth – IHPA indexation
= 4.7% for 2013-2014
Pressure from State Treasury to close the
gap between national price and state price
Reliability of ABF measures in explanation
of Health System performance
Managing resources and reconfiguration
of Health Services
Challenges for WA Health
Slide 7
What is the focus of the work?
Develop/enhance
processes, people or
tools so we:
Collect
Code
Classify
Cost
Count
Enables
us to
Understand our business (Revenue,
Cost and Performance)
Improve Accountability and
Performance Management
Improve service efficiency
Improve safety and quality
Make more informed decisions
Negotiate for Commonwealth Funds
Fund services appropriately
Benchmark Services
ACTIVITY
Slide 8
Clinical Casemix Handbook 2012-2014
The Clinical Casemix handbook is a
structured practical guide for clinicians.
The handbook has been developed in
collaboration with staff across WA Health, to
support clinicians to understand the
importance of timely and accurate
information about their patients and their
care.
Clinical documentation requirements for timely, accurate, and accountable
information are a key element in successful implementation of
Activity Based Funding and Management
Slide 9
The Handbook outlines:
The clinical coding process, from its use of
diagnoses and complications or co-
morbidities to determine care and complexity
levels, to the final assignment of DRGs.
How the DRG is then used to drive the
Activity Based Funding and Management
approach.
Improving clinical documentation is about making the patient‟s journey
through the health care system safer and smoother
Slide 10
The Handbook outlines:
The clinical coding process, from its use of
diagnoses and complications or co-
morbidities to determine care and complexity
levels, to the final assignment of DRGs.
How the DRG is then used to drive the
Activity Based Funding and Management
approach.
Improving clinical documentation is about making the patient‟s journey
through the health care system safer and smoother
Slide 11
The Handbook:
Highlights the importance of documenting
clinical information in the patient‟s medical
record and producing an accurate and
timely discharge summary.
Incorporates case studies from within WA
health demonstrating the impact of
documentation on patient safety, quality of
care, cost and revenue.
Incomplete, delayed or inaccurate documentation impairs both the data
available for safe and quality patient care, and that used for reporting,
coding, costing and subsequent funding to the health service
Slide 12
Vision for WA ABF/ABM
Activity Based Funding is the management tool that supports ABM to enhance
public accountability and drive technical efficiency in the delivery of health
services by:
Capturing consistent information on activity and the costs of delivery;
Creating an explicit relationship between funds allocated and services
provided;
Strengthening management‟s focus on outputs, outcomes, quality and
safety;
Managing variation in costs and practices to improve efficiency and
effectiveness; and
Providing mechanisms to reward good practice and support quality and
safety initiatives.
Slide 13
Change Management
“ Structured approach to transitioning individuals, teams
and organisations from a current state to a desired future
state”
Supporting people to be:
Ready Willing Able
Dimensions:
Culture Commitment Capability
Slide 14
Consistent classification and tracking of activity
provides access to reliable data so that we may
understand and manage our business better
National activity based funding program requires a
standardised approach
High quality robust data is an integral part of the
practical application of ABF/ABM
We need rules on how we count and classify
activity
Activity data is used for a range of applications
WA health services have an obligation to count and label activity in an accurate and consistent fashion
Slide 15
An admitted patient must meet the criteria for admission
related to the admission category and care type. These
include :
Expected levels of care
Documentation requirements
Same day specific criteria for emergency admissions
Procedure exclusions set by the Commonwealth
Assessment and Care planning
Activity Based Funding and Management as the principal resource allocation and funding mechanism means that correct labelling and
counting of activity is now especially important
The ARDT policy provides a framework, containing detailed rules and criteria to enable this to occur
Slide 16
The ARDT policy has range of benefits:
Ensuring health services are correctly funded
Accurate activity for use in clinical costing
Inform and position the state to align with national
hospital funding reforms
Provide a reliable care delivery profile to inform
clinical services planning
Key information from a range of related documents provides a
“one stop policy document” to support staff as they record and
classify this information
The ARDT policy had been developed through research into other
jurisdictions and in collaboration with staff across WA Health
Slide 17
Why is it so important ?
Activity Data
+ Costing Data
WAU & Price
Activity Classification WAU
ED URG: 6
Admitted, Triage 1, Circulatory 0.2528
Acute
Admitted
DRG: F10A Interventional
Coronary Procedures with AMI
without Catastrophic CC
2.1616
Non
Admitted
Tier 2 Clinic: 20.22
Cardiology Clinic 0.0610
For 2014-2015
health activity data
will directly inform
the amount of
Commonwealth
funding to WA
Slide 18
Policy Management Utopia
DoH
Consultation
Development
Distribution
Education
Operational Directive
Issues
Revision
Health Services
Implementation
Impact
Communication
Access
Audit compliance
Action non-compliance
Feedback issues
Slide 19
NON ADMITTED
1. ED ATTENDANCE
2. OUTPATIENT SERVICES
3. COMMUNITY AND
OUTREACH SERVICES
4. BOARDERS
5. CANCELLED PROCEDURES
6. REFUSED PROCEDURES
7. DEAD ON ARRIVAL
8. POSTHUMOUS ORGAN
DONATION
9. STILLBORN
Patients
ElectiveEmergency
Acute
ED Presentation Direct Admission Non-wait listWait list
ADMISSION
Sub-Acute
Non-Acute
Same Day Overnight
Non-Admitted
Procedures
(Type C)
Automatically
qualified for
admission (Type B)
Commonwealth
Legislation
Admitted
Procedures (Type B)
Non-Admitted
Procedures (Type C)
when certified
Same-day extended
medical treatment (SDE)
Band 1
Band 2
Band 3
Band 4
Special circumstances Clinical decision to
admit becoming…certified
Contracted CareOrgan donation
Overnight Adult (OA)
16 Admission criteria
Overnight Paediatric
(PA)
20 Admission criteria
Overnight Mental
Health (MH)
Additional legal and
social factors
Newborns
<9 days old
8 criteria to distinguish
b/w QN and UQN
Unqualified
(UQN)
Qualified
(QN)
1. Rehabilitation
2. Geriatric evaluation and management
3. Psychogeriatric
4. Palliative Care
5. Maintenance care
6. Nursing Home Type care
7. Aged / ‘Flexible’ care
Ambulatory Surgery
Slide 20
Slide 21
Policy research – DoH policy documents
Admission Policy for WA Hospitals (Technical Bulletin 17/3, 2002).