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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?
2 www.ihpa.gov.au
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
5 www.ihpa.gov.au
6 www.ihpa.gov.au
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%
www.ihpa.gov.au14
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.
www.ihpa.gov.au18
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: [email protected]
www.ihpa.gov.au25
WWW.IHPA.GOV.AU
