Non-Admitted Patient Data and
ABF- Challenges and
Opportunities
Joanne Chicco
Manager, Data Quality
Health System Informat...
Non-Admitted Patient Data - History
 Collected in NSW for more than 20 years using the
Department of Health Reporting Sys...
Change happens...
 Our Health Information Exchange is reaching its end of life
due to obsolete operating systems
 The Mi...
HERO - What is already collected?

 All NSW Health Organisations (e.g. Hospitals, MPS,
Community Health Centres)
 All se...
HERO was adapted to fit the ABF
requirements
 All NAP clinics throughout the state need to be entered into
HERO
 All NAP...
IHPA’sTier 2 Non-Admitted Services
Classification
 “Tier 2 classes provide a consistent framework for grouping
clinics th...
IHPA’sTier 2 Non-Admitted Services
Classification – Group level

1. Procedures

2. Medical Consultation
3. Stand-alone dia...
IHPA’sTier 2 Non-Admitted Services
Classification – Class level – 10 series
10. Procedure classes
10.01 Hyperbaric medicin...
IHPA’sTier 2 Non-Admitted Services
Classification – Class level – 20 series
20. Medical Consultation classes
20.01 Transpl...
IHPA’sTier 2 Non-Admitted Services
Classification – Class level – 30 series
30. Stand-alone diagnostic classes
30.01 Gener...
IHPA’sTier 2 Non-Admitted Services
Classification – Class level – 40 series
40. Allied Health and/or Clinical Nurse Specia...
Tier 2 – how apply it to reality?
 Tier 2 is a list of clinics
 Tier 2 is not really a classification of patient charact...
The significance of getting it right
 This is the first time ever in Australia that Activity Based
Funding reimbursement ...
Is it difficult to classify?
 There are rules in the Tier 2 non-admitted services
definitions manual
 There are rules in...
How would I classify this clinic?
Example 1 - Aboriginal Maternal Mental Health Clinic –

What is the clinical intent, and...
How would I classify this clinic?
Example 2 - Social Work Psychogeriatrics Clinic

 Social Work Clinic? (Tier 2 Class 40....
NAPOOS v NAPSE


A non-admitted patient occasion of service (NAPOOS) is a non-admitted patient service
or a non-admitted ...
NAPOOS v NAPSE
 Very different concepts
 Had been collecting NAPOOS for 20 years

 Counting infrastructure and data col...
Opportunities and further work
 Is there an interest in a national NAP classification special
interest group? IHPA is enc...
Contact details

Joanne Chicco

Manager, Data Quality
NSW Ministry of Health
Email: jchic@doh.health.nsw.gov.au
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Joanne Chicco - NSW Ministry of Health - NSW State Update: Non-Admitted Patient Data and Activity Based Funding - Challenges and Opportunities

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Joanne Chicco, Manager Data Quality, Health System Information and Performance Reporting Branch, NSW Ministry of Health 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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Joanne Chicco - NSW Ministry of Health - NSW State Update: Non-Admitted Patient Data and Activity Based Funding - Challenges and Opportunities

  1. 1. Non-Admitted Patient Data and ABF- Challenges and Opportunities Joanne Chicco Manager, Data Quality Health System Information & Performance Reporting (HSIPR) Branch February 2014
  2. 2. Non-Admitted Patient Data - History  Collected in NSW for more than 20 years using the Department of Health Reporting System (DOHRS)  Data collected via paper format, VAX DOHRS, Web DOHRS, WebNAP  The NAP data is refreshed weekly into the NSW Ministry’s Data Warehouse  Historically we counted Non-Admitted Patient Occasions of Service (NAPOOS)
  3. 3. Change happens...  Our Health Information Exchange is reaching its end of life due to obsolete operating systems  The Ministry is nearing the end of the process of replacing the HIE with its new Enterprise Data Warehouse for Analysis, Reporting and Decisions (EDWARD)  Health Establishments Registration Online (HERO) is rocketed to stardom  HERO is a building block for EDWARD reporting
  4. 4. HERO - What is already collected?  All NSW Health Organisations (e.g. Hospitals, MPS, Community Health Centres)  All service units (e.g. Hospital-based outpatient clinics, CHC-based services) – 17,000 clinics in HERO  All service point locations e.g. Health campuses, operating suites and rooms, wards)  All MOH-related organisations e.g. Private hospitals and DPCs, RACFs, Pathology Labs)
  5. 5. HERO was adapted to fit the ABF requirements  All NAP clinics throughout the state need to be entered into HERO  All NAP clinics had to be classified correctly using HERO’s “Establishment Type” (ET)  As HERO was already in existence and its classes were more granular than the national classes, many clinics needed to have their ETs re-classified.  All of this had to be done within a four month timeframe (March – June 2013)
  6. 6. IHPA’sTier 2 Non-Admitted Services Classification  “Tier 2 classes provide a consistent framework for grouping clinics that provide non-admitted patient service events  At the group level, the classification is based on the nature of the service provided  At the class level, the classification is based on the predominant specialisation of the clinic” From IHPA’s Tier 2 non-admitted services definitions manual
  7. 7. IHPA’sTier 2 Non-Admitted Services Classification – Group level 1. Procedures 2. Medical Consultation 3. Stand-alone diagnostic 4. Allied Health and / or clinical nurse specialist intervention
  8. 8. IHPA’sTier 2 Non-Admitted Services Classification – Class level – 10 series 10. Procedure classes 10.01 Hyperbaric medicine 10.02 Interventional imaging 10.03 Minor surgical 10.04 Dental 10.05 Angioplasty/angiography 10.06 Endoscopy – gastrointestinal 10.07 Endoscopy – urological / gynaecological ... Etc.
  9. 9. IHPA’sTier 2 Non-Admitted Services Classification – Class level – 20 series 20. Medical Consultation classes 20.01 Transplants 20.02 Anaesthetics 20.03 Pain management 20.04 Developmental disabilities 20.05 General medicine 20.06 General practice and primary care 20.07 General surgery ... Etc.
  10. 10. IHPA’sTier 2 Non-Admitted Services Classification – Class level – 30 series 30. Stand-alone diagnostic classes 30.01 General imaging 30.02 Magnetic resonance imaging 30.03 Computerised tomography 30.04 Nuclear medicine 30.05 Pathology (microbiology, haematology, biochemistry) 30.06 Positron emission tomography (PET) 30.07 Mammography screening 30.08 Clinical measurement
  11. 11. IHPA’sTier 2 Non-Admitted Services Classification – Class level – 40 series 40. Allied Health and/or Clinical Nurse Specialist Interventions classes 40.01 Aboriginal and Torres Strait Islander peoples health clinic 40.02 Aged care assessment 40.03 Aids and appliances 40.04 Clinical pharmacy 40.05 Hydrotherapy 40.06 Occupational therapy ... 40.53 General medicine 40.54 General surgery... Etc.
  12. 12. Tier 2 – how apply it to reality?  Tier 2 is a list of clinics  Tier 2 is not really a classification of patient characteristics or a classification of what happens to patients during an outpatient visit  We needed to re-think the way of reporting NAP episodes – we now needed to classify each existing clinic according to whether or not they perform one of the listed therapeutic procedures, whether or not they are considered as standalone diagnostic units or whether the “usual provider” is a doctor, an allied health professional, a nurse practitioner or a clinical nurse consultant
  13. 13. The significance of getting it right  This is the first time ever in Australia that Activity Based Funding reimbursement is based entirely on ONE data element – the Tier 2 class as selected by the service unit’s manager  Diagnosis-Related Grouping (DRG) is based on multiple characteristics (e.g. diagnosis, procedures, age, admission weight, hours of mechanical ventilation etc...)  Urgency-Related Grouping (URG) is based on multiple characteristics (e.g. diagnosis, episode end status, triage etc...)
  14. 14. Is it difficult to classify?  There are rules in the Tier 2 non-admitted services definitions manual  There are rules in the Tier 2 non-admitted services compendium  There are examples to follow in the Tier 2 non-admitted services national index
  15. 15. How would I classify this clinic? Example 1 - Aboriginal Maternal Mental Health Clinic – What is the clinical intent, and who is the usual provider?  Aboriginal and Torres Strait Islander Peoples health clinic? (Tier 2 Class 40.01)  Midwifery and Maternity? (Tier 2 Class 40.28)  Obstetrics Medical Consultation? (Tier 2 Class 20.40)  Specialised Mental Health? (Tier 2 Class 20.34)  Psychiatry? (Tier 2 Class 20.45)
  16. 16. How would I classify this clinic? Example 2 - Social Work Psychogeriatrics Clinic  Social Work Clinic? (Tier 2 Class 40.11)  Psychogeriatric Allied Health / CNS? (Tier 2 Class 40.37)  Psychogeriatric Medical Consultation? (Tier 2 Class 20.50)
  17. 17. NAPOOS v NAPSE  A non-admitted patient occasion of service (NAPOOS) is a non-admitted patient service or a non-admitted patient support activity reported for each provider type and service type combination on each occasion a service is provided to the patient within one nonadmitted patient appointment on one calendar day.  A non-admitted patient (national) service event (NAPSE) is an interaction between one non-admitted patient and one or more healthcare provider(s) who are working within the context of one service unit on one calendar day. The interaction must contain clinical and/or therapeutic content (i.e. an assessment, examination, consultation, treatment and/or education), that results in a dated entry being made in the patient’s medical record.  Non-admitted patient service events (NAPSEs) exclude services provided by stand-alone diagnostic service units, travel by the healthcare provider or patient, services where the patient is not present, or services provided to persons who are admitted patients at the time of service provision.
  18. 18. NAPOOS v NAPSE  Very different concepts  Had been collecting NAPOOS for 20 years  Counting infrastructure and data collection systems were built around NAPOOS  Needed to change the mindset about what we were collecting for Activity Based Funding  Needed to change information systems to collect NAPSE
  19. 19. Opportunities and further work  Is there an interest in a national NAP classification special interest group? IHPA is encouraged to join.  Keep providing advice to IHPA’s NACAWG on how to improve Tier 2  Provide keen input into the development of the new NAP classification
  20. 20. Contact details Joanne Chicco Manager, Data Quality NSW Ministry of Health Email: jchic@doh.health.nsw.gov.au

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