Transcript CASEMIX CONFERENCE OCTOBER 2011 SOUTH AUSTRALIAN …

ACTIVITY BASED FUNDING
CONFERENCE CONFERNCE 2013
SOUTH AUSTRALIAN CASEMIX
FUNDING MODEL – RECOGNITION OF
DIFFERENCES IN PATIENT SEVERITY
ACROSS HOSPITALS
Mr. Phillip Battista
Senior Manager, Funding Models
SA Health
South Australian Casemix
Funding Model
> Casemix funding was implemented in
South Australia in 1994-95.
> From the beginning it was recognised that
the SA funding model needed to account
for differential patient severity, based on
the premise that:
• “patient severity correlates with the intensity of
patient care and therefore the volume of
resources consumed.”
SA Health
Recognising Patient Severity
> Using the most current available
Diagnostic Related Groups (DRG's).
> Costliness Index - applied in 1994-95 in
lieu of severity index.
> Discrete Intensive Care Unit funding
introduced in 1995-96.
> Severity Index introduced 1997-98.
> Paediatric cost weights introduced 200001.
SA Health
Costliness Index
> Costliness Index 1994-95, in lieu of
severity index
• was applied based on the type of hospital i.e.
teaching, large non-teaching and other.
• Metropolitan teaching hospitals 10% loading
on inpatient funding
• All other metropolitan and country hospitals
5% loading
SA Health
Costliness Index Profile
1.12
1.10
1.08
1.06
1.04
1.02
1.00
H1
H2
H3
H4
H5
H6
H7
H8
Costliness Index
H9
H 10
H 11
H 12
H 13
H 14
H 15
Severity Index 1997-98
> Introduced to address concerns that:
• DRG’s did not adequately account for variation
in the severity in patient illness (Horn,1985)
leading to a potential inequity in the funding
allocation
SA Health
Severity Index 1997-98
> The Severity Index calculation is largely
based on:
•
the number of diagnosis and procedure codes
per patient record regressed against length of
stay (Hindle, Degeling, and van der Wel, 1997)
• length of stay is used as proxy for cost
• derives the additional days due to the number
of diagnosis and procedures
SA Health
Severity Index –
Counting Diagnosis & Procedures
> Diagnoses listed as co-morbidities and
complications (CC’s) are used in the
assignment of DRGs.
> Weighted score, based on the Patient
Clinical Complexity Level (PCCL) is
computed in the DRG assignment.
> CC’s weighted on a severity scale of
1 (minor) to 4 (catastrophic)
> Procedure codes used in the assignment
of a DRG
SA Health
Severity Index –
Adjusted Length of Stay
> Patient length of stay varies and
between hospitals for identical DRGs.
> Variation in length of stay can be due to
variations in clinical practices.
• ABF can assist in removing inefficiencies
due to inappropriate length of stay by
promoting good clinical practices.
SA Health
Severity Index –
Adjusted Length of Stay
> Variation in length of stay to non clinical
practices
• variation in hospitals’ length of stay can
reflect activity differences not
accommodated in the DRG classification
• e.g. discharge practices
> The focus of the SI is on the clinical
aspects of an episode
SA Health
Severity Index –
Adjusted Length of Stay
> The SI calculation excludes:
•
•
•
•
Short stay outliers
Long stay outliers
Intensive care days
Same day and Day only DRGs
> The calculation:
• Eliminates the difference in mean length of
stay between hospitals
• Maintains the variation in length of stay
between patients in the same hospital
SA Health
Severity Index –
Adjusted Length of Stay
>
SA Health
Prediction of Length of Stay for
Weighted Complexities and
Procedure
SA Health
Severity Index For Each Hospital
Predicted days of stay
Number of days predicted
by the regression model
Base DRG days of stay
Number of days expected
on the basis of the DRG
data alone
Crude Index
Predicted/Base
Rebased Index Value
Crude index of each individual
hospital divided by the lowest
hospital crude index from the 25
hospitals where an SI was
deemed appropriate
SA Health
Severity Index v Costliness Index
1.12
1.10
1.08
1.06
1.04
1.02
1.00
H1
H2
H3
H4
H5
H6
H7
Costliness Index
H8
H9
Severity Index
H 10
H 11
H 12
H 13
H 14
H 15
Severity Index – Possible
Revision
> Use diagnosis and procedures NOT used
in the assignment of a DRG
• Flagged by the Grouper
• Only weight and count what has not been
used in the DRG grouping process
> Reflects the complexity not picked up in
the DRG grouping process
SA Health
Severity Index
1.12
1.10
1.08
1.06
1.04
1.02
1.00
H1
H2
H3
H4
H5
H6
H7
Costliness Index
H8
H9
Severity Index
H 10
Revision
H 11
H 12
H 13
H 14
H 15
Severity Index
Comments/Questions
> In the SA Casemix Funding the Severity
Index redistributes funding between
hospitals
• For two of the largest tertiary hospitals, one
gets an additional $6m (2.3% of inpatient
funding) and the other gets $18m (4.8%)
> Length of stay is being used as a proxy
for cost. Is this a reasonable approach?
> What is going to be the impact of the new
AR-DRG v7.0?
SA Health
Severity Index
Comments/Questions
> There is a proposed review of the Patient
Clinical Complexity Level Scores
• Are the current PCCL scores appropriate?
• Does the SI have more meaning with updated
PCCL scores?
SA Health
Application of Severity Index in
National Model
> Is there need for a Severity Index in a
National ABF model?
• It could be argued that the new DRG version
and the review of the PCCL scores will better
explain the variations in complexity therefore
costs.
• However in a recent review by KPMG is was
reported that there:
 “appears to be a systemic difference in
costliness between the tertiary referral hospitals
and other major city hospitals after adjusting for
patient attributes (casemix, remoteness
indigenous status (KPMG November 2012).”
SA Health
Questions ?
SA Health