Download presentation name - Activity Based Funding Conference 2016

Classification Workshop
Classification and Coding
Standards
#ABF15
27 May 2015
Learning Objectives
The purpose of this workshop is to:
• learn about the Activity Based Funding (ABF) classifications and the
classification work program through interactive activities
• enhance understanding of some of the variances which exist within the
classification data, what impact these have and quality improvement
strategies
• enhance understanding of the use of classification data and systems
beyond ABF purposes
Session Outline
• Welcome and introduction to the Independent Hospital Pricing Authority
(IHPA)
• Three workshops/tables to discuss different topics
‒ care types and classifications
‒ diagnosis and classifications
‒ use of classification systems beyond ABF
• IHPA representative to sit on each table to facilitate discussion
• 40 minute for each workshop before rotating topics
• 30 minute question and answer session at the conclusion of the
workshop
IHPA and ABF
• IHPA was established in December 2011 as part of the implementation of
the National Health Reform Agreement (NHRA)
• IHPA’s primary role is to determine the national efficient price (NEP) and
national efficient cost (NEC) for public hospital services
• NEP is a major determinant of the level of Commonwealth Government
funding for public hospital services
• Provides a price signal or benchmark for the efficient cost of providing
public hospital services
• NEC is for services that are not suitable for ABF, such as small rural
hospitals which are block funded
IHPA and ABF
• IHPA has a number of other
functions specified in legislation,
for example:
‒ determining adjustments to the
NEP to reflect legitimate and
unavoidable variations in the
cost of delivering health
services
‒ determining data requirements
‒ developing and specifying the
classifications for services
provided by public hospitals
The current ABF classifications
• Admitted acute care – ICD-10-AM / ACHI / ACS with Australian Refined
Diagnosis Related Groups (AR-DRGs)
• Emergency care – Urgency Related Groups (URGs) and Urgency
Disposition Groups (UDGs) – new classification in development
• Non-admitted care – Tier 2 Non-Admitted Services – new classification in
development
• Admitted subacute and non-acute care – Australian National Subacute
and Non-acute patient (AN-SNAP) classification
• Mental health care – ICD-10-AM / ACHI / ACS with AR-DRG and
URGs/UDGs – new classification in development
• Teaching, training and research – new classification in development
Care Types and
Classifications
Classification and Coding
Standards
#ABF15
27 May 2015
What is a care type
• Care type refers to the nature of treatment provided to a patient during an episode of care
• The overall nature of a clinical service provided to an admitted patient during an episode of
care (admitted care), or the type of service provided by the hospital for boarders or
posthumous organ retrieval (care other than admitted care) (Hospital service—care type,
code N[N]. METeOR ID: 584408)
•
Care types for admitted care:
– Acute care
– Rehabilitation care
– Palliative care
– Geriatric evaluation and management
– Psychogeriatric care
– Maintenance care (non-acute)
– Newborn care
– Mental Health care
Why are care types important?
• Care types allow the identification of different types of care and services
provided within a hospital or health service
• The allocation of a care type in turn determines which casemix classification is
used to classify the episode of care
• The care type and associated casemix classification determines the amount of
funding for an episode in an Activity Based Funding environment
• Each care type has an associated data collection requirement
Business rules for assigning care types
• The care type is assigned by the clinician responsible for the management of the
care, based on clinical judgement as to the primary clinical purpose of the care to
be provided
• For some care types there is a requirement for care to be managed by a clinician
with specialised expertise
• For some care types, there is a requirement that care is evidenced in the medical
record via documentation such as multidisciplinary management plans or patient
assessments
• Evidence of care type change (including the date of handover, if applicable)
should be clearly documented in the patient’s medical record
• Other rules
‒ Retrospective care type changes
‒ Multiple care type changes within a 24 hour period
‒ Care type changes for same day interventions
Difference in care type assignment across the country
Jurisdiction A
Jurisdiction B
Jurisdiction C
Jurisdiction D
Jurisdiction E
Jurisdiction F
Jurisdiction G
Jurisdiction H
93%
94%
95%
96%
97%
98%
99%
Acute Care
Rehabilitation Care
Palliative Care
Geriatric evaluation and management
Psychogeriatric Care
Maintenance Care
100%
Acute care
Acute care is care in which the primary clinical purpose or treatment goal is to:
• manage labour (obstetric)
• cure illness or provide definitive treatment of injury
• perform surgery
• relieve symptoms of illness or injury (excluding palliative care)
• reduce severity of an illness or injury
• protect against exacerbation and/or complication of an illness and/or injury
which could threaten life or normal function
• perform diagnostic or therapeutic procedures.
Acute care excludes care which meets the definition of mental health care.
Rehabilitation care
Rehabilitation care is care in which the primary clinical purpose or treatment
goal is improvement in the functioning of a patient with an impairment, activity
limitation or participation restriction due to a health condition. The patient will
be capable of actively participating.
Rehabilitation care is always:
• delivered under the management of or informed by a clinician with
specialised expertise in rehabilitation, and
• evidenced by an individualised multidisciplinary management plan, which is
documented in the patient’s medical record, that includes negotiated goals
within specified time frames and formal assessment of functional ability.
Rehabilitation care excludes care which meets the definition of mental health
care.
Palliative care
Palliative care is care in which the primary clinical purpose or treatment
goal is optimisation of the quality of life of a patient with an active and
advanced life-limiting illness. The patient will have complex physical,
psychosocial and/or spiritual needs.
Palliative care is always:
• delivered under the management of or informed by a clinician with
specialised expertise in palliative care, and
• evidenced by an individualised multidisciplinary assessment and
management plan, which is documented in the patient’s medical record,
that covers the physical, psychological, emotional, social and spiritual
needs of the patient and negotiated goals.
Palliative care excludes care which meets the definition of mental health
care.
Geriatric Evaluation and Management (GEM)
GEM is care in which the primary clinical purpose or treatment goal is
improvement in the functioning of a patient with multi-dimensional needs
associated with medical conditions related to ageing, such as tendency to fall,
incontinence, reduced mobility and cognitive impairment. The patient may also
have complex psychosocial problems.
GEM is always:
• delivered under the management of or informed by a clinician with specialised
expertise in geriatric evaluation and management, and
• evidenced by an individualised multidisciplinary management plan, which is
documented in the patient’s medical record that covers the physical,
psychological, emotional and social needs of the patient and includes
negotiated goals within indicative time frames and formal assessment of
functional ability.
GEM care excludes care which meets the definition of mental health care.
Psychogeriatric care
Psychogeriatric care is care in which the primary clinical purpose or treatment goal is
improvement in the functional status, behaviour and/or quality of life for an older patient
with significant psychiatric or behavioural disturbance, caused by mental illness, an agerelated organic brain impairment or a physical condition.
Psychogeriatric care is always:
• delivered under the management of or informed by a clinician with specialised
expertise in psychogeriatric care, and
• evidenced by an individualised multidisciplinary management plan, which is
documented in the patient’s medical record, that covers the physical, psychological,
emotional and social needs of the patient and includes negotiated goals within
indicative time frames and documented through formal assessment of functional
ability.
• Psychogeriatric care is not applicable if the primary focus of care is acute symptom
control.
Psychogeriatric care excludes care which meets the definition of mental health care.
Maintenance (non-acute) care
Non-acute care (maintenance) is care in which the primary clinical purpose or
treatment goal is support for a patient with impairment, activity limitation or
participation restriction due to a health condition.
Following assessment or treatment the patient does not require further complex
assessment or stabilisation. Patients with a care type of maintenance care often
require care over an indefinite period.
Maintenance care excludes care which meets the definition of mental health care.
Newborn care
Newborn care is initiated when the patient is born in hospital or is nine days old or less
at the time of admission. Newborn care continues until the care type changes or the
patient is separated:
• patients who turn 10 days of age and do not require clinical care are separated and,
if they remain in the hospital, are designated as boarders
• patients who turn 10 days of age and require clinical care continue in a newborn
episode of care until separated
• patients aged less than 10 days and not admitted at birth (for example, transferred
from another hospital) are admitted with a newborn care type
• patients aged greater than 9 days not previously admitted (for example, transferred
from another hospital) are either boarders or admitted with an acute care type
• within a newborn episode of care, until the baby turns 10 days of age, each day is
either a qualified or unqualified day
• a newborn is qualified when it meets at least one of the criteria detailed in the
newborn qualification status glossary item in METeOR.
Within a newborn episode of care, each day after the baby turns 10 days of age is
counted as a qualified patient day. Newborn qualified days are equivalent to acute
days and may be denoted as such.
Mental health care
Mental health care is care in which the primary clinical purpose or treatment goal
is improvement in the symptoms and/or psychosocial, environmental and physical
functioning related to a patient’s mental disorder.
Mental health care:
•
is delivered under the management of, or regularly informed by, a clinician with
specialised expertise in mental health;
•
is evidenced by an individualised formal mental health assessment and the
implementation of a documented mental health plan; and
•
may include significant psychosocial components, including family and carer
support.
Case study 1
A 55 year old male is admitted to hospital for treatment of medical complications
due to the medication that he is taking for a diagnosed mental disorder.
The patient is located on a general ward and their bedcard has a general medicine
physician listed.
Whilst admitted the patient is seen by their normal community mental health team
as well as an inpatient mental health team for assessment.
Case study 2
An 85 year old legally blind female with a history of well managed schizophrenia is
admitted from her residential facility for treatment of transient ischaemic attacks
(TIAs) and an ischaemic stroke.
Since admission to the hospital the patient starts demonstrating paranoid psychotic
behaviour that is associated with the TIAs and stroke rather than her mental illness.
Once the patient has completed her medical treatment, the behaviour does not
improve, resulting in the residential facility not being able to accept her back until
her behaviour is under control.
She is transferred to a specialist ward, and the psychogeriatric team assume
responsibility for her care and develop a multidisciplinary plan to manage her
behavioural symptoms.
Case study 3
An 85 year old female has had an acute admission for a fractured humerus after
tripping over in the street.
The patient does not have any other comorbidities, and her regular medications
consist of calcium and vitamin D supplements for the treatment of osteoporosis.
During her acute admission she receives regular intervention by the physiotherapist.
Once the patient is medically stable, her care is taken over by a rehabilitation team
who undertake a functional assessment, develop and commence a multidisciplinary
plan for a slow stream rehabilitation program.
Case study 4
An 65 year old post-stroke patient is on a rehabilitation ward in an acute hospital
whilst undertaking a rehabilitation program.
They have been having an increasing number of epileptic episodes, which lead to a
neurology team taking over care to investigate and further manage the patient’s
epileptic episodes while the rehabilitation program is placed on hold.
There are no beds elsewhere in the hospital, and so the patient stays on the
rehabilitation ward.
Case study 5
A 73 year old male is receiving rehabilitation after an extended acute hospital
admission for a respiratory infection, however is still receiving dialysis twice a week
for chronic renal failure.
To receive the dialysis, the patient is transferred to the dialysis ward for the day, and
then is transferred back to the rehabilitation unit.
Case study 6
An 86 year old female, who lives at home alone has had a fall and fractured her left
and right humerus.
After a week the patient is deemed to be stable.
The rehabilitation team review her and document that she will be accepted into a
rehabilitation program once she has use (either partly or completely) of at least one
of her arms.
Her orthopaedic team anticipate that this may take up to three to four weeks.
Case study 7
A 24 year old ventilator dependent male is a complete quadriplegic who was
admitted to hospital for the treatment of a respiratory infection.
During his admission he returns positive results for vancomycin resistant
enterococci and methicillin-resistant staphylococcus aureus.
The patient is stable, and is currently waiting placement in a suitable facility.
Case study 8
A seven year old male is admitted to a paediatric hospital for treatment of
Osteosarcoma which includes chemotherapy as well as surgery resulting in a below
the knee amputation.
Once the acute treatment is completed, the patient’s family and medical team
decide that a period of rehabilitation is required for the patient to learn how to walk
with his prosthesis.
A paediatric rehabilitation team, in consultation with the medical team and the
patient’s family, agree to take over his care, and develop a multidisciplinary
rehabilitation plan which is documented in the patient’s medical notes.
Diagnosis and
Classifications
Classification and Coding
Standards
#ABF15
27 May 2015
Diagnosis
Patient diagnoses are one of the most valuable health data elements.
Diagnostic information provides the basis for analysis of health service usage and
clinical planning, epidemiological studies and monitoring of specific disease entities.
The importance of diagnosis data in ABF will increase with diagnoses becoming a more
integral part of classification systems built on capturing patient complexity and
modelling across most care settings.
How is diagnosis recorded / reported in Australia?
International Statistical Classification of Diseases and Related Health Problems 10th Revision - Australian Modification (ICD-10-AM)
• 6th edition, 7th edition, 8th edition and 9th edition
• ICD-10-AM is a hierarchical classification of diseases and health related problems.
Systematized Nomenclature of Medicine - Clinical Terms - Australian version
Emergency Department Reference Set (SNOMED CT-AU EDRS)
• SNOMED CT-AU is a clinical terminology which uses a structured vocabulary to
describe the care and treatment of patients.
• There is a subset for emergency department care ie the EDRS.
Australian Rehabilitation Outcome Centre (AROC) impairment type
• AROC impairment codes describe the primary type of patient impairment in a
rehabilitation episode.
How is diagnosis reported in each care setting
Setting
Emergency
Admitted Acute
Non-admitted
Admitted
Subacute
Mental Health
Diagnosis
classification
type used
ICD-10-AM
6th – 9th edition
ICD-10-AM
9th edition
Not reported
ICD-10-AM
9th edition
ICD-10-AM
8th – 9th edition
SNOMED-CT-AU
EDRS
ICD-9-CM
2nd edition
AROC
impairment
type
Application in ABF classification systems
Emergency care – Urgency Related Groups (URG)
• principal diagnosis is used in conjunction with other variables to assign presentations
to URGs
Admitted acute care – Australian Refined Diagnosis Related Groups (AR-DRG)
• diagnosis is used in conjunction with procedures/interventions and coding standards to
assign episodes to DRGs
Admitted subacute and non-acute care – Australian National Subacute and
Non-Acute Patient (AN-SNAP)
• specific diagnoses are used in conjunction with other variables to assign episodes to
AN-SNAP classes
Mental health – Australian Mental Health Care Classification (AMHCC)
(under development)
• diagnosis has been identified as a cost driver; application in the classification system is
under consideration
Impact
Poor quality diagnosis data impacts the ability to:
• monitor and predict disease incidence and prevalence
• plan and model clinical pathways and services eg creates an inaccurate
representation of services required
• accurately assess and model costs associated with disease prevalence, morbidity
and mortality
• classify diagnoses into homogenous groups eg decreases the predictive power of
classifications.
What does this mean and how does variation occur?...
Impact – case example 1
Distribution of presentations to ED
across Major Diagnostic Blocks (MDB).
MDBs are 28 categories into which all
possible principal diagnoses fall.
The diagnoses in each category
correspond to a single body system or
aetiology, broadly reflecting the
speciality providing care.
MDBs are based on the Major
Diagnostic Categories (MDCs) used in
the Admitted Acute AR-DRG
classification system.
Impact – case example 1 cont.
Figures reflect the percentage of total presentations reported by each jurisdiction.
Jurisdictions
MDB
A
B
C
D
No diagnosis code reported
3.1
3.3
4.1
8.3
2B Injury, single site, major
17.9
15.8
11.9
15.4
2BA Injury, single site, minor
4.2
6.5
11.0
4.4
3C Digestive system illness
11.8
11.7
11.1
8.5
4 Psychiatric illness
2.9
3.4
2.4
2.1
6 Other presentation
5.4
10.3
6.0
7.4
Impact – case example 2
Variation in DRG complexity assignment:
DRG complexity
Jurisdiction A
Jurisdiction B
Jurisdiction C
N
%
N
%
N
%
50,922
13.3
30,262
13.0
15,486
10.9
A
Highest consumption
of resources
B
Second highest
consumption of
resources
132,091
34.4
92,086
39.6
46,747
33.0
C
Third highest
consumption of
resources
30,053
7.8
16,547
7.1
14,192
10.0
D
Fourth highest
consumption of
resources
6,809
1.8
1,209
0.5
756
0.5
Z
No complexity split
164,248
42.8
92,374
39.7
64,552
45.5
384,123
100
232,475
100
141,733
100
Total
Impact – case example 3
Clinical documentation and impact to DRG assignment:
Discharge Summary – initial
Presenting problem
•
Hemiplegia
Principal diagnosis
•
Cerebral infarct
Secondary diagnosis
•
Type 2 diabetes mellitus
•
Ex smoker
•
Mid stream urine: E.Coli
•
Na 125 mEg/L
•
Physiotherapy
•
Occupational therapy
•
B70B Stroke and other cerebrovascular disorders
with severe CC
Test results
Interventions
DRG
Impact – case example 3 cont.
Full story of the admission
• A patient is admitted to hospital with right sided weakness and is
subsequently diagnosed with cerebral infarct.
• The patient has a history of type 2 diabetes mellitus and undergoes regular
blood sugar level monitoring while in hospital.
• The patient has residual hemiparesis following the stroke.
• While in hospital the patient becomes feverish and confused, and receives
antibiotics for an E.Coli urinary tract infection. The patient is also placed on
fluid restriction for hyponatraemia.
• The patient receives assessment from both physiotherapy and
occupational therapy.
• Following a period of stay in hospital, the patient is discharged to a
rehabilitation facility.
Impact – case example 3 cont.
Clinical documentation and impact to DRG assignment:
Discharge Summary – revised
Presenting problem
•
Hemiplegia
Principal diagnosis
•
Cerebral infarct
Secondary diagnosis
•
Type 2 diabetes mellitus
•
Urinary tract infection
•
Hyponatraemia
•
Ex smoker
•
Mid stream urine: E.Coli
•
Na 125 mEg/L
•
Physiotherapy
•
Occupational therapy
•
B70A Stroke and other cerebrovascular disorders with
catastrophic CC
Test results
Interventions
DRG
Recording to Output
Capture /
Recording
Output
Coding
Reporting
Causes of variation
Factors affecting recording / reporting of diagnosis:
• different terminology used by clinicians or in IT systems
• clinical documentation recorded by clinicians
• clinical practice eg what is identified as the principal diagnosis for a patient with
multiple factors
• collection practices eg use of coding staff in certain care settings and not others
• different versions of diagnosis are currently used eg different classification type or
different version within the same classification type
• different code sets / pick lists used
• different codes used to record the same condition
• different capacity of IT systems eg some record principal and additional diagnoses
where as some only record the principal diagnosis
• policy and business rules
Variation – case example 4
Collection and reporting of diagnosis across care settings:
Setting
Captured by
Coded by
Reported by:
Emergency
Admitted Acute
Non-admitted
Admitted
Subacute
Mental Health
Clinician
Clinician
Clinician
Clinician
Clinician
-
Coding staff
-
Coding staff;
sometimes not
at all
Coding staff;
sometimes not
at all
Clinician / Clerical
staff
Coding staff
-
Clinician / Clerical Clinician / Clerical
/ Coding staff
/ Coding staff
Variation – case example 5
Variation in diagnosis classification systems used to collect / report ED principal
diagnosis:
Diagnosis classification
system
Total number of
episodes reported
% of episodes
ICD-10-AM, 7th edition
2,077,202
34.7%
ICD-10-AM, 6th edition
1,953,620
32.7%
ICD-10-AM, edition not
specified
297,176
5.0%
1,424,693
23.8%
70,458
1.2%
142,224
2.4%
17,517
0.3%
5,982,890
100.0%
SNOMED-CT-AU
ICD-9-CM, 2nd edition
Other system
No diagnosis classification
Total episodes
Variation – case example 6
Variation in codes used by jurisdictions for presentations to ED with a diagnosis of
pneumonia:
Considerations:
• 11 different codes used to report pneumonia.
• Use of codes varies across jurisdictions.
• Feedback from clinicians indicates that the identification of the type of bacterial
organism would not occur during the ED stay unless it had been identified prior to
presentation.
• Clinical advice also indicated that it is necessary to identify viral pneumonia as distinct
from bacterial or other types of pneumonia.
Variation – case example 6 cont.
Jurisdictions
Code
ICD-10-AM description
A
J129
Viral pneumonia unspecified
67
J13
Pneumonia dt Streptococcus
pneumoniae
J157
Pneumonia dt Mycoplasma
pneumoniae
J159
Bacterial pneumonia
unspecified
J160
Chlamydial pneumonia
J168
Pneumonia dt oth spec infect
organisms
J180
Bronchopneumonia
unspecified
J181
Lobar pneumonia unspecified
J182
Hypostatic pneumonia
unspecified
J188
Other pneumonia organism
unspecified
J189
Pneumonia unspecified
B
C
D
E
F
G
H
Total
271
488
57
40
23
946
645
92
58
40
1
836
4
102
21
13
449
1,209
1,235
30
140
32
3,096
141
0
161
538
504
1,571
213
622
1,144
10,079
1,401
10
2
1
3
27
1,732
4,756
65
151
13,462
0
198
195
365
2,254
423
1,754
5,189
15,553
896
217
708
11,391
28,765
Variation – case example 6 cont.
30,000
28,765
25,000
20,000
15,000
13,462
10,000
5,189
4,756
5,000
3,096
946
836
J129
J13
140
0
3
J160
J168
J157
J159
0
J180
Viral
Bronchopneumonia
Bacterial
Lobar
J181
J182
J188
J189
Other and unspecified
Strategies for improvement – reflection
Refer back to factors causing variation, and discuss potential strategies to improve the
consistency and quality of diagnosis data.
High
“Quick Wins”
“Major Projects”
“Fill Ins”
“Hard Slogs”
Impact
Low
Low
Effort
High
Improvement
• focus on training and education of staff to document/record the correct code
and/or information and create awareness of business rules and policy
requirements
• implement standard lists and terminology for diagnosis codes (including
diagnosis classification version)
• ensure only valid diagnoses are being used as a principal diagnosis eg not
recording external cause codes as principal diagnoses
• assess whether appropriate codes are implemented in IT systems; also the
ease of use for clinicians eg clinically meaningful, burden of use, etc
• ensure IT systems are able to record the required information eg principal and
additional diagnoses
• develop validation of diagnosis mechanisms eg data validation, coding
practices, etc.
Resources
Australian Institute of Health and Welfare – Metadata Online Registry (METeOR)
• Definitions of diagnosis data as per the different national minimum data sets and
data set specifications
• http://meteor.aihw.gov.au/
ICD-10-AM manuals and reference documents (including Australian Coding Standards)
• http://ihpa.gov.au/internet/ihpa/publishing.nsf/Content/Classifications
• https://www.accd.net.au/Icd10.aspx
SNOMED-CT-AU
• http://www.nehta.gov.au/our-work/clinical-terminology/snomed-clinical-terms
Use of classification
systems beyond
Activity Based Funding
Classification and Coding
Standards
#ABF15
27 May 2015
Emergency classification descriptions
Urgency Disposition Groups
(UDGs)
Classify patient presentations to
emergency services
(levels 1, 2 and 3A)
Variables:
- Type of visit
- Episode End Status
- Triage category
Urgency Related Groups
(URGs)
Classify patient presentations to
emergency departments
(levels 3B, 4, 5 and 6)
Variables:
- Type of visit
- Episode End Status
- Triage category
- Major Diagnostic Blocks
URG descriptions
Type of Visit - The
reason the patient
presents to an
emergency
department:
Episode End Status:
The status of the
patient at the end of
the
non-admitted patient
emergency
department service
episode:
Triage: The urgency of
the patient's need for
medical and nursing
care as assessed at
triage:
Emergency
presentation
Admitted to hospital
1. Resuscitation:
immediate (within
seconds)
Return visit, planned
ED completed; not
admitted/referred
2. Emergency: within
10 minutes
Pre-arranged
admission
ED completed;
transfer
3. Urgent: within 30
minutes
Patient in transit
Died in ED
4. Semi-urgent:
within 60 minutes
Dead on arrival
Dead on arrival
5. Non-urgent: within
120 minute
Major Diagnostic
Block: category into
which the patient's
emergency department
stay is
grouped dependent on
diagnosis:
Diagnosis codes are
reported using
SNO-MED,
ICD-10-AM or
ICD-9-CM
Case Study 1
Hospital ABF has conducted an audit and found that there is large cohort
of patients that have a length of stay of between 4 – 48 hours.
All of the patients initially present to the emergency department, however
some are admitted, some stay in ED and some are transferred to other
hospitals.
How can the hospital use the Emergency care classification system to
analyse this cohort of patients?
The AN-SNAP V4 classification
Subacute care comprises the following care types:
• Rehabilitation care
• Palliative care
• Geriatric evaluation and management (GEM) care
• Psychogeriatric care
• Non-acute care
The AN-SNAP classification has:
• 130 classes for subacute and
non-acute care
• 89 for overnight admitted episodes/phases
• 6 for same-day admissions
• 35 for non-admitted episodes/phases.
AN-SNAP Variables
In the admitted branch, the variables used for grouping are:
Care type
• Characteristics of the patient and the goal of
treatment
Function (motor and cognition) on
admission
• All care types
Phase (stage of illness)
• Palliative care
Impairment
• Rehabilitation
Behaviour
• Psychogeriatric
Diagnostic codes
Age
Length of stay (LOS)
• Geriatric evaluation and
management
• Palliative care, rehabilitation, non-acute
and to identify paediatric episode/phases
• Psychogeriatric and
non-acute
Case Study 2
A health service is looking at the existing subacute services to determine
future planning. In particular, paediatric rehabilitation and palliative care
services.
Anecdotally the health service has heard that paediatric patients are having
their acute portion of the admitted episode in one health service, but are
required to transfer to another health service for the purposes of admitted
rehabilitation services.
Additionally, there has been anecdotal evidence that some patients are
unable to access existing speciality subacute services, and are in acute care
hospitals on general wards.
How could AN-SNAP be used to assist with service planning to
accommodate these patients?
Tier 2
Tier 2 categorises a hospital’s non-admitted services into classes which are generally
based on the nature of the service provided and the type of clinician providing the
service.
Composed of four groups:
10 series
Procedures
20 series
Medical
Consultation
30 series
40 series
Diagnostic
services
Allied health
and/or clinical
nurse
specialist
intervention
Case Study 3
A university is setting up a new
postgraduate nursing degree that
is focused on the non-admitted setting
and providing case
management.
The university will be specifically looking
at non-admitted services that are
predominantly nursing led.
How can the university use the Tier 2
classification to assist with planning this
degree?
AR-DRG
ICD-10-AM diagnosis codes and ACHI procedure codes are used to
assign an episode of care to an AR-DRG
Some other factors may also be
considered for certain AR-DRGs:
Length of stay (LOS)
Admission weight for neonates
Mental legal status
Case Study 4
A researcher is conducting a study that
examines surgical interventions for older
patients who fall.
How can DRGs be used to assist in
identifying this group of patients?
Question and Answer