James Downie - Independent Hospital Pricing Authority (IHPA) - Developing the New Australian...

Independent Hospital Pricing Authority

ACTIVITY

BASED FUNDING

James Downie

Acting CEO

CONTENTS

• IHPA Overview

• Role of IHPA

• Pricing Guidelines

• Use of IHPA Products

• National Weighted Activity Unit

• Significant slowdown in costs

• Creating the National Efficient Price

• What does the future hold?

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IHPA OVERVIEW

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2008 2011

Activity based funding has been a

requirement of Commonwealth funding

for hospitals

National Health Reform Agreement is

signed by all First Ministers. This

agreement outlines the establishment

of IHPA

IHPA OVERVIEW

20162012 20152013

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7 www.ihpa.gov.au

2008 2011

Activity based funding has been a

requirement of Commonwealth funding

for hospitals

National Health Reform Agreement is

signed by all First Ministers. This

agreement outlines the establishment

of IHPA

IHPA OVERVIEW

20162012

First National Efficient Price (NEP) was

established for NEP12 at $4,808

Fifth NEP was established for NEP16

at $4,883

20152013

First National Efficient Cost (NEC) was

established for NEC13 at $4.738 M

Third NEC was established for NEC16

at $5.020 M

PRICING

GUIDELINES

www.ihpa.gov.au9

PRICING GUIDELINES

Timely & Quality of Care

Promote Efficiency

Promote Fairness

Maintain agreed roles and responsibilities as determined in the

NHRA

NATIONAL

WEIGHTED

ACTIVITY UNIT

www.ihpa.gov.au11

NATIONAL WEIGHTED ACTIVITY UNIT

National Weighted Activity Unit (NWAU)

Admitted Acute

Hip Replacement

5.7991 NWAU

$28,827

Admitted

subacute and

non-acute

Spinal Cord

Dysfunction

5.6959 NWAU

$28,314

Emergency

Non-Admitted Triage 1

0.3001 NWAU

$1,492

Non - Admitted

General medicine

0.0356 NWAU

$177

SIGNIFICANT

SLOWDOWN IN

COSTS

www.ihpa.gov.au13

SIGNIFICANT SLOWDOWN IN COSTS

3664

3809

4023

4312

4400

4548 45494588

2006-7 2007-8 2008-9 2009-10 2010-11 2011-12 2012-13 2013-14

Cost per NWAU

Growth Rate: 4.2%

Growth Rate: 1.1%

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SIGNIFICANT SLOWDOWN IN COSTS

5.10%4.70%

3.90%

3.00%

2.10%

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

NEP12 NEP13 NEP14 NEP15 NEP16

Ind

ex

ati

on

Rate

NEP Indexation Rate

www.ihpa.gov.au15

SIGNIFICANT SLOWDOWN IN COSTS

4808

4993 50074956

4883

NEP12 NEP13 NEP14 NEP15 NEP16

Cost per NWAUGrowth Rate: 1.1%

DEVELOPING

THE NEW ED

CLASSIFICATION

CURRENT

CLASSIFICATIONS

• Current classification used for ABF:

‒ Urgency Related Groups (URG): based on type of visit, triage, episode

end status and diagnosis.

‒ Urgency Disposition Groups (UDG): based on type of visit, triage and

episode end status .

‒ Both considered interim classifications.

• Limitations:

‒ Both rely on triage (good indicator of urgency, but not complexity/

resource use).

‒ Limited clinical meaning.

www.ihpa.gov.au17

REVIEW OF CLASSIFICATION

SYSTEMS

• Commenced mid 2013, completed early 2014.

• Reviewed classifications developed/ used in Australia and other countries:

‒ Extensive clinical consultation.

‒ Analysis of existing cost data.

• Conclusions:

‒ New classification needed to replace URGs and UDGs.

‒ Should be based on a high quality costing study.

‒ Triage given less importance.

‒ New classification system should better account for patient complexity.

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PROPOSED NEW

CLASSIFICATION

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STUDY SAMPLE

• There are 10 sites participating in the study from NSW, SA, WA and NT.

• There is a good representation of emergency departments from the various

groups of emergency care services.

• Although emergency services were also in scope, no sites were nominated

to participate and as such are not included in the study.

www.ihpa.gov.au20

Type No. of sites

Specialist paediatric 1

Large ED – major cities 3

Large ED – regional 2

Other ED – major cities 1

Other ED – regional 2

Other ED – remote 1

Emergency services 0

Total sites 10

DATA COLLECTION

OVERVIEW

• The costing study is collecting the following types of

data:

‒ Clinician time

‒ Patient and stay characteristics

• The data collection was undertaken for one month at

each site (between April and June 2016), involving:

‒ 2 weeks of the clinician time collection.

‒ Additional patient and stay characteristics collected

for the whole month.

• All sites used barcode scanning technology to record

clinician time spent with patients and the activity/

procedure undertaken.

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EXAMPLE

BARCODE

SCAN CARD:

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CONSENSUS STUDY

OF CLINICIAN TIME

• Undertaken in addition to the costing study data collection

• Aims to estimate times for procedures and other patient-related activities

undertaken by the different categories of emergency department clinicians.

• Key objectives:

‒ Validate the data collected by clinicians through the costing study data

collection (i.e. scanning and observational data recorded).

‒ Potentially to supplement data that might be missing for specific

procedures/ activities for any hospital.

• The consensus study is being undertaken in two rounds:

‒ Survey 1 – Initial time estimates by clinicians (completed).

‒ Survey 2 – Present the results back to clinicians and request confirmation

or changed estimate (in progress).

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CLASSIFICATION

DEVELOPMENT TIMELINE

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J F M A M J J A S O N D

2017

Initial data analysis

Feb – Apr

Stakeholder consultation

and classification

refinement

Apr – JulDevelopment of

classification supporting

components

Jul – Sept

Project

finalisation

Oct – Dec

FURTHER INFORMATION

• IHPA website: https://www.ihpa.gov.au/what-we-do/emergency-care

• Study website: http://www.edclassificationstudy.com/

• Email: enquiries.ihpa@health.gov.au

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