ABF TASKFORCE Emergency Department Funding Model ABF Taskforce

ABF TASKFORCE
Emergency Department
Funding Model
ABF Taskforce
Susan Dunn, Manager, ABF Workstreams,
Xiao Cai, Manager, ED and Non admitted Workstreams
ABF Taskforce
Contents
 Review of classification
 2013/14 model changes
 Outstanding issues
 Scenario’s
 URG/UDG Tool
 ABM BIS
Emergency Departments
Classification System
•Urgency Related Groups (URG)
•Urgency Disposition Groups (UDGs)
UDG Components (1 -3a)
–Triage Category
–Disposition (mode of separation)
URG Code and Description:
UDG 1 Admitted Triage 1
URG Components (3B -6)
–Triage Category
–Disposition (mode of separation)
–ED principal diagnosis
27 MDB
URG Code and Description:
URG 3 Admitted Triage 1 - Injury
URG Components:
ED Diagnosis
Diagnosis code maps to Major Diagnostic group
•Acute bronchitis, unspecified
3B Respiratory system illness
•Stroke, not specified as haemorrhage or infarction
3E Neurological illness
Note: Only first entered diagnosis is used
ED ABF MODEL CHANGES
FOR 2013/14
URG/UDG classification
changes in 13/14
 Five additional classes
o Died in ED
o Non Admitted Return Visit Triage cat 1, 2, 3
o Non Admitted Return Visit Triage cat 4, 5
o Admitted Return Visit, any triage category
o Transfer presentations
NEW URG/UDG Price Weights
(NWAU)
NEP Adjustments 2013/14
Price adjustments
 Error URGs/UDGs receive no payment
 Indigenous - A patient based adjustment of 4%
 The rural/remote adjustment does not apply to
ED patients in 2013/14
Calculation of Price
NWAU(13) = URG_PriceWeight * (1+Aindig)
Funding = State Price($4671) x NWAU(13)
Code Domain Description
Current ED Error Results
OUTSTANDING ISSUES
Code Domain Description
Transport
 Cost is accounted for in the costing model
 As an overhead
 At patient level, depending on patient linkage ability
 Costing Standards
 No specific direction in Cost Accounting Guidelines
 Will consider this for next round
Code Domain Description
Homelessness
 In acute,
 Remoteness adjustment uses Postcode
 Statistical Local Area (SLA) of Address
 Hospital SLA
 In ED
 Remoteness adjustment removed from model
Code Domain Description
FAQ – Scenario 1
•Patient in ED, then admitted to EMU before discharge
ED episode
URG 16 Admitted Triage 2
– Circulatory system illness
NWAU – 0.1936
Funding:$904
Acute Admitted Episode
DRG F74Z Chest Pain
NWAU - 0.2693
Funding:$1258
Code Domain Description
FAQ – Scenario 2
•Patient transferred from smaller hospital and expected
to go straight to ward
•Goes to ED first
•Then Admitted to ward
Hosp A
Acute Admitted Episode
DRG F74Z Chest Pain
NWAU - 0.2693
Funding: $1258
Hosp B
ED episode
URG 16 Admitted Triage
2 – Circulatory system
illness
NWAU – 0.1936
Funding: $904
Hosp B
Acute Admitted Episode
DRG F42C CRC DSRD
–AMI +IC IN PR SD
NWAU – 0.6032
Funding: $2,818
Code Domain Description
FAQ Scenario 3
•ED provides telephone support to patient/GP
•Pt transferred to hospital, admitted directly to ward,
bypassing ED
•Activity Based Management (ABM) :
•Appropriate clinical practice, reduced demand on ED
Beds, less waiting time for other patients, meeting
NEAT targets
Telephone
NWAU
ED NWAU
Acute Admitted
DRG NWAU
Code Domain Description
FAQ Scenario 4
•Patient attends ED for a GP related issue
•Returns multiple times
•ABF : Planned Vs Unplanned URG
•ABM Issues: Impact on ED bed capacity, increased
waiting ties, workforce issues, chronic care management
programs, Impact on Emergency representation and
NEAT KPIs
ED NWAU
ED NWAU
ED NWAU
ED CASE STUDIES
INTERESTING PATIENT
Code Domain Description
FAQ Scenario 5
•Compare
•Patient attending ED triaged as cat 4, deteriorates,
requires full resus, admitted to ICU
•Same patient triaged as cat 2 and seen within 10
minutes
ED Cat 4 Admission
Cardiac
URG 33
Admitted Triage 4 –All
other MDB groups
NWAU 0.1470
OR
ED Cat 2 Admission
Cardiac
URG16
Admitted Triage 2 –
Circulatory illness
NWAU 0.1936
Admitted DRG episode
Including ICU hours
or a bundled DRG
IT system will update triage cat.
Example of URG Funding
 ED URG/UDG tool
ABM BIS TOOL
Average Cost of URG 3 per ED
Presentation
2011-12 Emergency URG 3 Admitted Triage 1 - Injury
Average Cost - Peer Groups A1 to C1 - Draft
3,500
3,000
2,500
2,000
1,500
1,000
500
0
LHD Benchmarking – Avg Cost Per NWAU (ED)
Facility Benchmarking – Avg Cost Per NWAU (ED)
Interesting Patient
The following example is an interesting patient:
For 2011-12 the patient had:
-
Total 99 Episodes
-
86 ED presentation (42k)
-
13 Acute admission (14k)
From the presentation and admission history, the patient was in and out of
the hospital frequently sometimes for consecutive days.
INTERESTING PATIENT
INTERESTING PATIENT – Mar 2012
INTERESTING PATIENT – ADMISSION HISTORY
Further ABF Information
 Resource kit available:
http://internal.health.nsw.gov.au/communications/
funding_reform/resources.html
 Email: [email protected]
`