Add something maybe about disclosing information to third parties no

Kathleen Alloway – Senior Policy Officer
Activity Ba...
43,000 staff
Metro
5 teaching & 6 secondary
2 private/public
Community Health
Child & Adolescent Health
Country
13 health ...
New Hospitals
Fiona Stanley
Albany
Midland
Childrens Hospital

Slide 3
WA coding update
 ABF has stimulated re-alignment of coding , now
under Finance at both NMAHS and SMAHS.
 ABF offered sc...
Slide 5
Challenges for WA Health
 Spending on Health is approximately 25%
of State total general expenditure
 Cost increases in ...
What is the focus of the work?
Understand our business (Revenue,
Cost and Performance)

Develop/enhance
processes, people ...
Clinical Casemix Handbook 2012-2014
 The Clinical Casemix handbook is a
structured practical guide for clinicians.
 The ...
The Handbook outlines:


The clinical coding process, from its use of
diagnoses and complications or comorbidities to det...
The Handbook outlines:


The clinical coding process, from its use of
diagnoses and complications or comorbidities to det...
The Handbook:


Highlights the importance of documenting
clinical information in the patient‟s medical
record and produci...
Vision for WA ABF/ABM
Activity Based Funding is the management tool that supports ABM to enhance

public accountability an...
Change Management

“ Structured approach to transitioning individuals, teams
and organisations from a current state to a d...
WA health services have an obligation to count and label activity
in an accurate and consistent fashion
 Consistent clas...
Activity Based Funding and Management as the principal resource
allocation and funding mechanism means that correct label...
The ARDT policy had been developed through research into other
jurisdictions and in collaboration with staff across WA Hea...
Why is it so important ?

Activity
Data

Activity

+

Costing
Data

Classification

WAU &
Price

WAU

ED

URG: 6
Admitted,...
Policy Management Utopia
DoH
Consultation
Development
Distribution
Education
Operational Directive
Issues
Revision

Health...
Patients

NON ADMITTED
1.
2.
3.
4.
5.
6.
7.
8.
9.

ED ATTENDANCE
OUTPATIENT SERVICES
COMMUNITY AND
OUTREACH SERVICES
BOARD...
Slide 20
Policy research – DoH policy documents
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










Admission Policy for WA Hospitals (Technical Bulletin 17/...
Some Myths







Policy distributed = Implemented
Operation Directive = Law
Admission = Admitted Care
Consultation ...
Admitted Care
 An admitted patient is defined as a person who
meets the criteria for admission and additional
criteria sp...
Non-admitted care
 patients attending for a procedure on the non-admitted
procedures (Type C) list, without other justifi...
Outpatient clinic while an inpatient.
 Outpatient (non- admitted) care provided to an inpatient
is included as part of th...
Policy : Not should but could admit
 The patient‟s condition and planned treatment may
meet admission criteria. This make...
Admission Criteria
 the person‟s condition requires clinical management
and/or facilities only available in an admitted c...
Admission Same Day
Same day admission categories are:
 same day extended medical treatment (Type E)
 same day admitted p...
Admission criteria for ED admissions
 When an ED patient is admitted for short stay/same day,
admission to they must meet...
Emergency Department– Guide to Short Stay Admission Criteria
The decision to admit can ONLY be made by an authorised medic...
ED Admission Exclusions
 A patient should not be admitted because they are or will
be in the ED for longer than 4 hours.
...
ED admission exclusions
 A patient should not be admitted if the reason is they are
resting prior to discharge, but do no...
Key policy changes – effective 1 July 2013

Patients who receive their entire episode of
care within an Emergency Departme...
Key policy changes – effective 1 July 2013
 Admission Time is the time the patient physically
leaves the clinical area of...
Criteria for same day extended medical
treatment (Type E)
 Same day medical patients receive a minimum of four hours of
c...
Type c
 These are procedures that would normally be undertaken
on a non-admitted basis and therefore not accepted as a
re...
Overnight Admission
 Overnight admission occurs when the patient is
expected to require admission for a minimum of one
ni...
Admitted Care types

Slide 38
Slide 39
What are the care types?
 Acute (includes involuntary mental health admitted care)
 Subacute
Patients must meet the crit...
Acute Care
 manage labour (obstetric)
 cure illness or provide definitive treatment of injury
 perform surgery, diagnos...
Subacute care
 Evidence of a care type change (including the date of
handover, if applicable) must be clearly documented ...
Subacute care
 Care delivered under the management of or
informed by a clinician with specialised expertise in
the subacu...
Episode of care changes are not valid:
 On the day of formal admission or discharge

(new

policy inclusion)

 For a tem...
Episode of care changes invalid
 For the waiting period between acute care and
transfer to a subacute care facility
 For...
Transfer
 Patients who are being transferred to another
hospital with no plan for return are to be discharged.
 If the i...
Outpatient clinic while an inpatient.
 Outpatient (non- admitted) care provided to an inpatient
is included as part of th...
Policy compliance evaluation
 Corporate Governance Audit 2012:
 70% of ED admissions, no valid clinical reason for admis...
NEAT impact ?
 Desire to meet the NEAT = Routinely admitting
patients to the virtual ward?
 Admissions where entire stay...
Audit issues
 In summary, health services are
non-compliant with the ARDT
policy
 Invalid admissions are generating
addi...
Causal Factors and Actions
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






Awareness
Implementation
Conflict with NEAT
WHADILT
Documentation
Don‟t mean us?...
Currently
 ED Continue with admitting practice and
cancel the invalid admissions later.
 New service delivery models spl...
Change Management
 The new environment of ABF/ABM
impacts on all aspects of health
service delivery
 Purpose of existing...
Lessons learnt







Impact on current business practices
Conflict with other policy/reforms
Culture ready for chan...
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Kathy Alloway - Dept of Health WA - WA State Update

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Kathy Alloway, Senior Policy Officer, Activity Based Funding and Management (ABF/ABM) Team, Performance Activity and Quality, Department of Health Western Australia 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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Kathy Alloway - Dept of Health WA - WA State Update

  1. 1. Add something maybe about disclosing information to third parties no Kathleen Alloway – Senior Policy Officer Activity Based Funding and Management Department of Health Counting Activity Correctly and Consistently Counts : The application and evaluation of Admission, Readmission , Discharge and Transfer Policy
  2. 2. 43,000 staff Metro 5 teaching & 6 secondary 2 private/public Community Health Child & Adolescent Health Country 13 health campuses 15 secondary, 51 small hosp numerous nursing posts, health centres Slide 2
  3. 3. New Hospitals Fiona Stanley Albany Midland Childrens Hospital Slide 3
  4. 4. WA coding update  ABF has stimulated re-alignment of coding , now under Finance at both NMAHS and SMAHS.  ABF offered scholarships for further study which many took up (not funded this year)  WA has no shortfall in coder workforce at the moment.  Clinical Advisory Group keen to address clinical documentation and coding education  Coding standards V ABF Slide 4
  5. 5. Slide 5
  6. 6. Challenges for WA Health  Spending on Health is approximately 25% of State total general expenditure  Cost increases in Health exceed “standard” cost growth – IHPA indexation = 4.7% for 2013-2014  Pressure from State Treasury to close the gap between national price and state price  Reliability of ABF measures in explanation of Health System performance  Managing resources and reconfiguration of Health Services Slide 6
  7. 7. What is the focus of the work? Understand our business (Revenue, Cost and Performance) Develop/enhance processes, people or tools so we: Collect Code Classify Cost Count Improve Accountability and Performance Management Benchmark Services Improve service efficiency ACTIVITY Enables us to Improve safety and quality Make more informed decisions Negotiate for Commonwealth Funds Fund services appropriately Slide 7
  8. 8. Clinical Casemix Handbook 2012-2014  The Clinical Casemix handbook is a structured practical guide for clinicians.  The handbook has been developed in collaboration with staff across WA Health, to support clinicians to understand the importance of timely and accurate information about their patients and their care. Clinical documentation requirements for timely, accurate, and accountable information are a key element in successful implementation of Activity Based Funding and Management Slide 8
  9. 9. The Handbook outlines:  The clinical coding process, from its use of diagnoses and complications or comorbidities to determine care and complexity levels, to the final assignment of DRGs.  How the DRG is then used to drive the Activity Based Funding and Management approach. Improving clinical documentation is about making the patient‟s journey through the health care system safer and smoother Slide 9
  10. 10. The Handbook outlines:  The clinical coding process, from its use of diagnoses and complications or comorbidities to determine care and complexity levels, to the final assignment of DRGs.  How the DRG is then used to drive the Activity Based Funding and Management approach. Improving clinical documentation is about making the patient‟s journey through the health care system safer and smoother Slide 10
  11. 11. The Handbook:  Highlights the importance of documenting clinical information in the patient‟s medical record and producing an accurate and timely discharge summary.  Incorporates case studies from within WA health demonstrating the impact of documentation on patient safety, quality of care, cost and revenue. Incomplete, delayed or inaccurate documentation impairs both the data available for safe and quality patient care, and that used for reporting, coding, costing and subsequent funding to the health service Slide 11
  12. 12. Vision for WA ABF/ABM Activity Based Funding is the management tool that supports ABM to enhance public accountability and drive technical efficiency in the delivery of health services by:  Capturing consistent information on activity and the costs of delivery;  Creating an explicit relationship between funds allocated and services provided;  Strengthening management‟s focus on outputs, outcomes, quality and safety;  Managing variation in costs and practices to improve efficiency and effectiveness; and  Providing mechanisms to reward good practice and support quality and safety initiatives. Slide 12
  13. 13. Change Management “ Structured approach to transitioning individuals, teams and organisations from a current state to a desired future state” Supporting people to be: Ready Willing Able Dimensions: Culture Commitment Capability Slide 13
  14. 14. WA health services have an obligation to count and label activity in an accurate and consistent fashion  Consistent classification and tracking of activity provides access to reliable data so that we may understand and manage our business better  National activity based funding program requires a standardised approach  High quality robust data is an integral part of the practical application of ABF/ABM  We need rules on how we count and classify activity  Activity data is used for a range of applications Slide 14
  15. 15. Activity Based Funding and Management as the principal resource allocation and funding mechanism means that correct labelling and counting of activity is now especially important An admitted patient must meet the criteria for admission related to the admission category and care type. These include :      Expected levels of care Documentation requirements Same day specific criteria for emergency admissions Procedure exclusions set by the Commonwealth Assessment and Care planning The ARDT policy provides a framework, containing detailed rules and criteria to enable this to occur Slide 15
  16. 16. The ARDT policy had been developed through research into other jurisdictions and in collaboration with staff across WA Health The ARDT policy has range of benefits:  Ensuring health services are correctly funded  Accurate activity for use in clinical costing  Inform and position the state to align with national hospital funding reforms  Provide a reliable care delivery profile to inform clinical services planning Key information from a range of related documents provides a “one stop policy document” to support staff as they record and classify this information Slide 16
  17. 17. Why is it so important ? Activity Data Activity + Costing Data Classification WAU & Price WAU ED URG: 6 Admitted, Triage 1, Circulatory 0.2528 Acute Admitted DRG: F10A Interventional Coronary Procedures with AMI without Catastrophic CC 2.1616 Non Admitted Tier 2 Clinic: 20.22 Cardiology Clinic For 2014-2015 health activity data will directly inform the amount of Commonwealth funding to WA 0.0610 Slide 17
  18. 18. Policy Management Utopia DoH Consultation Development Distribution Education Operational Directive Issues Revision Health Services Implementation Impact Communication Access Audit compliance Action non-compliance Feedback issues Slide 18
  19. 19. Patients NON ADMITTED 1. 2. 3. 4. 5. 6. 7. 8. 9. ED ATTENDANCE OUTPATIENT SERVICES COMMUNITY AND OUTREACH SERVICES BOARDERS CANCELLED PROCEDURES REFUSED PROCEDURES DEAD ON ARRIVAL POSTHUMOUS ORGAN DONATION STILLBORN Emergency ED Presentation Elective Direct Admission Wait list Non-wait list 1. 2. ADMISSION Rehabilitation Geriatric evaluation and management Psychogeriatric Palliative Care 3. 4. Ambulatory Surgery Sub-Acute Non-Acute Acute 5. 6. Maintenance care Nursing Home Type care Aged / ‘Flexible’ care 7. Contracted Care Same Day Overnight Organ donation Non-Admitted Procedures (Type C) Commonwealth Legislation Automatically qualified for admission (Type B) Special circumstances Clinical decision to admit becoming…certified Band 1 Admitted Procedures (Type B) Band 2 Band 3 Band 4 Non-Admitted Procedures (Type C) when certified Same-day extended medical treatment (SDE) Overnight Adult (OA) 16 Admission criteria Overnight Paediatric (PA) 20 Admission criteria Overnight Mental Health (MH) Additional legal and social factors Newborns <9 days old 8 criteria to distinguish b/w QN and UQN Qualified (QN) Unqualified (UQN) Slide 19
  20. 20. Slide 20
  21. 21. Policy research – DoH policy documents             Admission Policy for WA Hospitals (Technical Bulletin 17/3, 2002). Transferred Patients (Technical Bulletin 50/0, 2002). Neonatal care information reporting (Technical Bulletin 14/5, 2004). Renal Dialysis (Technical Bulletin 4/5, 2002). Reporting different episodes of care (Technical Bulletin 26/5, 2004). Hospital Morbidity Information (Technical Bulletin 10/6, 2005). Rehabilitation program – definitions and reporting requirements (Operational Directive 0025/06, 2006). Hospital in the Home care (Technical Bulletin 78/0, 2006). Subacute and non-acute care (Technical bulletin: 20/6, 2004). Discharge Policy in WA Hospitals (Technical bulletin: 40/1, 2001). Geriatric Evaluation and Management (GEM) – Definitions and Reporting Requirements (Technical Bulletin 79/0, 2006) Palliative Care Program (Technical Bulletin 42/3, 2002) Slide 21
  22. 22. Some Myths       Policy distributed = Implemented Operation Directive = Law Admission = Admitted Care Consultation = Compliance Communication = Consultation Change management = Just do what the policy says Slide 22
  23. 23. Admitted Care  An admitted patient is defined as a person who meets the criteria for admission and additional criteria specific to the applicable admission category and care type, and undergoes a hospital‟s admission process (documented) to receive treatment and/or care for a period of time Slide 23
  24. 24. Non-admitted care  patients attending for a procedure on the non-admitted procedures (Type C) list, without other justification for admission documented by the treating medical practitioner in the medical record  patients who receive their entire care within the Emergency Department (excluding admissions to short stay units).  dead on arrival (no active resuscitation)  babies who are stillborn, or show no sign of life at birth  patients attending an outpatient clinic/service Slide 24
  25. 25. Outpatient clinic while an inpatient.  Outpatient (non- admitted) care provided to an inpatient is included as part of the admitted care episode and is not to be reported as separate activity, for example:  Inpatients receiving non-admitted care during an admission, when attending an outpatient clinic or allied health service.  Patients receiving non-admitted outpatient care on the same day as admission, for example where the patient has a procedure/treatment in an outpatient clinic requiring, or followed by, subsequent same day or overnight admission. Slide 25
  26. 26. Policy : Not should but could admit  The patient‟s condition and planned treatment may meet admission criteria. This makes the patient eligible to be considered for admission; it does not in itself constitute admission. Care which technically meets admission criteria may be provided as nonadmitted care. The policy is not directing that patients should be admitted if they meet admission criteria. Slide 26
  27. 27. Admission Criteria  the person‟s condition requires clinical management and/or facilities only available in an admitted care setting  the person requires regular and periodic observation in order to be assessed or diagnosed  the person requires at least daily assessment of their medication needs  the person requires a procedure(s) that cannot be performed in a stand-alone facility, such as a doctor‟s room, without specialised support facilities and/or expertise available  there is a legal requirement for admission Slide 27
  28. 28. Admission Same Day Same day admission categories are:  same day extended medical treatment (Type E)  same day admitted procedures (Type B)  same day non-admitted procedures (Type C) when certified Same Day Rule Only 1 admission per patient, per hospital, per day Slide 28
  29. 29. Admission criteria for ED admissions  When an ED patient is admitted for short stay/same day, admission to they must meet admission criteria:  Receive a minimum of four hours of continuous active management; or  Are admitted to receive a procedure on the Type B admitted procedures list  Exceptional cases which do not meet the admission criteria, but which the treating medical officer decides require admission Slide 29
  30. 30. Emergency Department– Guide to Short Stay Admission Criteria The decision to admit can ONLY be made by an authorised medical officer or nursing practitioner. The decision to admit must be documented in the medical record. NO Does the patient require a procedure? YES Does the patient require 4 or more hours of continuous active management? YES DO NOT ADMIT Identify which of the following the patient will require and complete the associated documentation: Reason for admission Patient is to receive an admitted Type B procedure. Examples: • Sedation/Anaesthesia • Infusion/transfusion of blood/blood products • Closed reduction of fracture or dislocations • Infusion/transfusion of pharmacological agent. • Incision & drainage of abscess • Arrest nasal haemorrhage • Exc debridement skin & subc tissue Reason for admission Patient is to receive a non-admitted Type C procedure AND has a condition or special circumstance that justifies admission. MANAGEMENT DOCUMENTATION REQUIRED Admission (Type B) Admission (Type C) NB. IV therapy is the administration by intravenous infusion of a pharmacological/therapeutic agent. Ancillary, preparatory and line maintenance procedures are NOT included as „therapy‟. NB. Reason for admission & special circumstances must be documented in the medical record Reference: Admission, Readmission, Discharge and Transfer (ARDT) Policy for WA Health Services and Operational Directive http://www.health.wa.gov.au/circularsnew  Tests Required & intervals  Results and actions documented  Regular periodic observations Examples: • where general/regional anaesthesia is required • Where intravenous or inhalational sedation is required • Where the patient‟s co-morbidities place the patient under high dependency  Serial tests/investigations  Required observations, intervals and duration  4 hours of observation must be documented Excludes: BP / pulse / temp monitoring only  Continuous monitoring  Type of monitoring  Active treatment (and  Nature Admission (Type E) of treatment review)  Time of planned review NB. Admission time commences when the patient physically leaves the clinical area of ED for transfer to a ward, including ED short stay unit, or operating theatre/procedure room PLEASE NOTE that a patient is not eligible for admission just because/if: o They are/will be in the Emergency Department for longer than 4 hours o They are transferred to a short stay unit but do not meet admission criteria o They are only waiting for: • review by an admitting team • diagnostic tests or results • transport home or transfer to another health care facility • equipment or medications o They receive their entire care within the Emergency Department 30 Slide
  31. 31. ED Admission Exclusions  A patient should not be admitted because they are or will be in the ED for longer than 4 hours.  A patient should not be admitted if the reason for the admission is they are waiting for:     review by an admitting team diagnostic tests or results transport home or to another health care facility equipment or medications Slide 31
  32. 32. ED admission exclusions  A patient should not be admitted if the reason is they are resting prior to discharge, but do not require any ongoing monitoring or care  Patients who require transfer to another hospital should only be admitted  If they meet admission criteria and:  their condition requires stabilisation, which is not possible in a non-admitted patient setting; or  their condition requires extensive active monitoring or investigation prior to transfer Slide 32
  33. 33. Key policy changes – effective 1 July 2013 Patients who receive their entire episode of care within an Emergency Department (ED) are not eligible for admission, even if they meet the criteria for admission. Admissions to a virtual ward within an Emergency Department are invalid Slide 33
  34. 34. Key policy changes – effective 1 July 2013  Admission Time is the time the patient physically leaves the clinical area of the Emergency Department for immediate transfer to a ward or operating theatre/procedure room at the same hospital. Non-admitted services provided to a patient who is subsequently classified as an admitted patient shall not be regarded as part of the admitted episode . Treatment in ED not coded Slide 34
  35. 35. Criteria for same day extended medical treatment (Type E)  Same day medical patients receive a minimum of four hours of continuous active management consisting of:  regular observations (which may include diagnostic or investigative procedures)  continuous monitoring  mental health patients requiring a period of safe observation/assessment and discharge planning, including complex evaluation of medical and ongoing psychosocial needs  Note: Continuous blood pressure and/or pulse monitoring alone is not considered a sufficient level of continuous monitoring or regular observations for this purpose. Slide 35
  36. 36. Type c  These are procedures that would normally be undertaken on a non-admitted basis and therefore not accepted as a reason for admission in their own right.  Examples that would justify admitting a patient to perform a Type C procedure include:  where general/regional anaesthesia is required  where intravenous or inhalational sedation is required  where the patient‟s co-morbidities place the patient under high dependency Slide 36
  37. 37. Overnight Admission  Overnight admission occurs when the patient is expected to require admission for a minimum of one night. Overnight admission includes:  Patients for whom a clinical decision is made to commence treatment for a mental health diagnosis. Treatment is anticipated to be for a minimum of one night. Overnight admission excludes patients whose treatment is expected to be concluded on the same day. Slide 37
  38. 38. Admitted Care types Slide 38
  39. 39. Slide 39
  40. 40. What are the care types?  Acute (includes involuntary mental health admitted care)  Subacute Patients must meet the criteria -Rehab for admission for the care type -GEM for a legitimate change to be made and only one care type at -Psych Geri a time -Palliative  Non-acute- maintenance, nursing home type, respite, care awaiting placement Slide 40
  41. 41. Acute Care  manage labour (obstetric)  cure illness or provide definitive treatment of injury  perform surgery, diagnostic or therapeutic procedures  relieve symptoms of illness or injury (excluding palliative care)  protect against exacerbation and/or complication of an illness and/or injury which could threaten life or normal function, including involuntary psychiatric admissions. Slide 41
  42. 42. Subacute care  Evidence of a care type change (including the date of handover, if applicable) must be clearly documented in the patient‟s medical record.  A multidisciplinary management plan comprising a series of documented and agreed initiatives or treatments which are established through multidisciplinary consultation and consultation with the patient and/or carer(s).  It must contain specific program goals, actions and timeframes. Slide 42
  43. 43. Subacute care  Care delivered under the management of or informed by a clinician with specialised expertise in the subacute care type  The patient is expected to require admission for a minimum of one night  2014 policy must be in a deisgnated program/unit classified AN-SNAP. (30% not groupable)  GEM v Rehabilitation – one not both Slide 43
  44. 44. Episode of care changes are not valid:  On the day of formal admission or discharge (new policy inclusion)  For a temporary interruption/suspension due to a change in patient condition  For a day procedure/treatment with planned return  For a non-admitted care attendance e.g. emergency department, outpatients.  For the recovery period of an acute episode prior to separation Slide 44
  45. 45. Episode of care changes invalid  For the waiting period between acute care and transfer to a subacute care facility  For a temporary change in ward or funding source  By the ward receiving the patient  To correct the care type due to a clerical error or change of mind Only one care type change per day Only one admission per hospital per day Slide 45
  46. 46. Transfer  Patients who are being transferred to another hospital with no plan for return are to be discharged.  If the intention is for the patient to return within seven days then the patient is placed on leave, not discharged.  Internal transfers for same day procedure/treatment are not to be statistically discharged Slide 46
  47. 47. Outpatient clinic while an inpatient.  Outpatient (non- admitted) care provided to an inpatient is included as part of the admitted care episode and is not to be reported as separate activity, for example:  Inpatients receiving non-admitted care during an admission, when attending an outpatient clinic or allied health service.  Patients receiving non-admitted outpatient care on the same day as admission, for example where the patient has a procedure/treatment in an outpatient clinic requiring, or followed by, subsequent same day or overnight admission. Slide 47
  48. 48. Policy compliance evaluation  Corporate Governance Audit 2012:  70% of ED admissions, no valid clinical reason for admission  Up to 65% less than 4 hours in duration  Focus audit for < 4hr admissions from ED  59% no valid clinical reason for admission  50% did not leave ED (virtual ward)  Subacute Rehabilitation  Compliance with all admission criteria was 9%  23% of admissions >25 days should be non-acute maintenance  38% of admissions <8 days were not valid rehabilitation episodes Slide 48
  49. 49. NEAT impact ?  Desire to meet the NEAT = Routinely admitting patients to the virtual ward?  Admissions where entire stay from Triage to Discharge < 4 hours  The clock does not stop until the patient is discharged from ED admitted to a ward  Impact to NEAT performance after adjustment for ED admissions < 4hours is minimal, ranging from 0 7 %, with an average 2% decrease across all metropolitan hospitals. Slide 49
  50. 50. Audit issues  In summary, health services are non-compliant with the ARDT policy  Invalid admissions are generating additional activity and revenue  National alignment risk  Fraudulent claim of funding risk It is a sad story Piglet and it does not improve with the telling  Activity is not being counted and costed in the correct classification system  Incorrect activity data for use in costing, funding, planning and other applications Slide 50
  51. 51. Causal Factors and Actions        Awareness Implementation Conflict with NEAT WHADILT Documentation Don‟t mean us? Information Systems inadequate         Governance of policy Education & Training Change Management Communication Activity 2013-14 adjusted NEAT risks Improve documentation Information Systems alignment Slide 51
  52. 52. Currently  ED Continue with admitting practice and cancel the invalid admissions later.  New service delivery models splitting the acute episode across sites.  New hospital opening = large patient transfers – activity counting and classification challenge  HITH not HITH  Assessment Units – mixed nonadmitted/admitted Slide 52
  53. 53. Change Management  The new environment of ABF/ABM impacts on all aspects of health service delivery  Purpose of existing data collections  Every admission is an invoice requesting payment for product/service delivered  Clinical practice alignment  Policy required to ensure appropriate and legitimate funding of activity  Rules required to guide health services Slide 53
  54. 54. Lessons learnt       Impact on current business practices Conflict with other policy/reforms Culture ready for change Humans will avoid/work around it A ward is not always a ward Policy ain‟t policy without good policy management.  Policy alone is not going to cut it Slide 54

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