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.
Block funded services IHPA-defined size and Australian Statistical Geography Standards (ASGS) location categorisation on total NWAU for hospital Expenditure data from the National Public Hospital Establishments Data base (2015-16) NHCDC Round 20 (2015-16) APC NMDS, NAPEDC NMDS, ABF ES DSS, NPHED and aggregate DSS.
Appendix B: Application of NWAU variables Table 23: Acute admitted patients: variable definitions. Variable Name Description Definition A00 _pat_radiotherapy_flag Radiotherapy eligible separation. Either supplied in the input dataset or derived from the list of supplied procedure codes. 1 if patient had radiotherapy treatment or planning procedure; else 0. A01 _pat_dialysis_flag Dialysis eligible separation. Either supplied in the input dataset or derived from the list of supplied procedure codes. 1 if patient had a dialysis procedure and is not in ARDRG L61Z or L68Z; else 0. A02 est_eligible_paed_flag Paediatric adjustment eligible establishment, derived from ICU paediatric eligibility table 1 if establishment is designated as eligible for paediatric adjustment; else 0. A03 est_eligible_icu_flag ICU rate adjustment eligible establishment, derived from ICU and paediatric eligibility table 1 if establishment is designated as eligible for ICU rate adjustment; else 0. A04 _pat_remoteness Patient Residential Remoteness Area 2011 ASGS Remoteness Area category of the patient location taken from the episode's SA2, postcode or SLA value, where: 0 = Major City; 1 = Inner Regional; 2 = Outer Regional; 3 = Remote; and 4 = Very Remote. A05 _treat_remoteness Patient Treatment Remoteness Area 2011 ASGS Remoteness Area category of the patient treatment location taken from the hospitals geographic location information, where: 0 = Major City; 1 = Inner Regional; 2 = Outer Regional; 3 = Remote; and 4 = Very Remote. A06 _pat_acute_flag Acute patient flag 1 if ( Care Type = 1 ) or ( Care Type = 7 and Number of Qualified Days for Newborns > 0 ); else 0. A07 _pat_los Length of stay Max( 1, ( Date of Separation ) - ( Date of Admission ) - ( Leave Days ) ) if Care Type = 1; else Total Qualified Days if Care Type = 7. A08 _pat_sameday_flag Same-day flag 1 if Date of Admission = Date of Separation; else 0. A09 _pat_age_years Age at admission (in years) Total whole years from Date of Birth to Date of Admission.