Admitted care cost model General issues Cost unit An of admitted patient care’ is the cost unit for admitted acute patients. It is ‘episode “the period of admitted patient care characterised by only one care type”, and covers the … period of care from admission to discharge. In-scope activity National arrangements for ABF apply to a subset of admitted acute episodes defined by the care type, funding source for the patient and the type of hospital in which the episodes occur. The breakdown for in-scope is illustrated in Table 1. Table 1: Admitted acute episodes in scope for ABF. Variable Episodes that meet the inclusion criteria Care type* 1 Acute care 7 Newborn care and qualified days > 0 11 Mental Health Funding Funding Source (2016-17 codes) Public hospitals Private hospitals source/ 01 Health Service Budget Included Included Election status (Not covered elsewhere) 02 Health Service Budget Included Included (due to eligibility for Reciprocal Health Care Agreement) 08 Other hospital or public authority (contracted Included Included where care) election status is public 09 Private Health Insurance Included Excluded 13 Self-funded Included Excluded Hospital size & As per the Determination. location Error ARDRGs Episodes with an AR-DRG are not assigned an NWAU. These include AR-DRGs v9 ‘error’ 960Z, 961Z, and 963Z. *See data element Care type [METeOR identifier: 584408 See object class Episode of admitted patient care [METeOR identifier: 268956]. All episodes from all funding sources are included in the calculation of the cost weights. This approach is taken to ensure the sample used for the development of NWAU is maximised and reflects the overall costs for the hospital. Only in-scope patients are included in the calculation of the mean cost used in the development of the NEP. All other episodes (e.g. those funded through the Department of Veterans’ Affairs (DVA) and compensable patients) are excluded from the scope of funding.
Admitted care cost model General issues Cost unit An ‘episode of admitted patient care’ is the cost unit for admitted acute patients. It is “the period of admitted patient care … characterised by only one care type”, and covers the period of care from admission to discharge. In-scope activity National arrangements for ABF apply to a subset of admitted acute episodes defined by the care type, funding source for the patient and the type of hospital in which the episodes occur. The breakdown for in-scope is illustrated in Table 1. Table 1: Admitted acute episodes in scope for ABF. Variable Episodes that meet the inclusion criteria Care type* 1 Acute care 7 Newborn care and qualified days > 0 11 Mental Health Funding source/ Election status Funding Source (2016-17 codes) Public hospitals Private hospitals 01 Health Service Budget (Not covered elsewhere) Included Included 02 Health Service Budget (due to eligibility for Reciprocal Health Care Agreement) Included Included 08 Other hospital or public authority (contracted care) Included Included where election status is public 09 Private Health Insurance Included Excluded 13 Self-funded Included Excluded Hospital size & location As per the Determination. Error ARDRGs Episodes with an ‘error’ AR-DRG are not assigned an NWAU. These include AR-DRGs v9 960Z, 961Z, and 963Z. *See data element Care type [METeOR identifier: 584408 See object class Episode of admitted patient care [METeOR identifier: 268956]. All episodes from all funding sources are included in the calculation of the cost weights. This approach is taken to ensure the sample used for the development of NWAU is maximised and reflects the overall costs for the hospital. Only in-scope patients are included in the calculation of the mean cost used in the development of the NEP. All other episodes (e.g. those funded through the Department of Veterans’ Affairs (DVA) and compensable patients) are excluded from the scope of funding.
national_pricing_model_technical_specifications_2018-19.docx