Download DRG Workshop - r f z o . r s

Gaming.
Sub-acute patients.
RIC AND LINDY
DRG Workshop
Belgrade, 18-22.November 2013.
Generating additional data counts
for more funding
• “Paper cases” administrative discharges
and readmission in Hungary
• Change of care type in NSW.
• “Empty cases” in Slovenia
• Admitting cases in Emergency
Departments and Outpatients –
• ?can these be legitimate?
DRG Workshop
Belgrade, 18-22.November 2013.
DEFINITIONS AND RULES
PRIVATE AND
DISCRETIONARY
ELECTIVE??
ED PATIENTS
DRG
INPATIENTS
BUNDLED
OUTPATIENTS
FFS AMB
PATIENTS
TRAUMA AND
ACUTE
ILLNESS
AGED CARE
AND MENTAL
HEALTH
PROGRAMS
CHRONIC CARE
PROGRAMS
SAME DAY INPATIENTS
DRG Workshop
Belgrade, 18-22.November 2013.
Admitting outpatients as short
stay inpatients
• Rapid growth in Victoria of same day episodes
• Clear evidence of admitting cases that can be
treated in ambulatory setting
• Cases that can be treated either way
becoming all inpatient – eg
– dialysis and chemotherapy
• REMOVE PAYMENT INCENTIVE - CAPS
DRG Workshop
Belgrade, 18-22.November 2013.
UPCODING
CA$EMAX
1000
500
100
0
70% ACCURACY
30% CREATIVITY – SUBECT TO EDITS
DRG Workshop
Belgrade, 18-22.November 2013.
DRG creep in Hungary
DRG Manipulations: (I) report higher severity, (ii) shift outpatient to inpatient
1994-1995
7000
1994
1995
6272
6000
5313
5000
cases
4139
4000
3000
3596
2839
2000
1000
52
0
218 P (complications)
6
Workshop 442 P (other minor surgery)
219 P (withoutDRG
complications)
Belgrade, 18-22.November 2013.
Source: Nagy, J., 1999
Change of care type or discharge
and readmission for rehabilitation
• How many times per stay?
• How many times per day?
• Can we pay for them both
together?
• What is the right time?
DRG Workshop
Belgrade, 18-22.November 2013.
How to detect and control gaming
„The only way to pay doctors is to change the
system every three years, because by then
they will have found ways to get round it to
their own advantage”
Bob Evans
• All casemix systems adjust the system
every year
• New cost weights and recalibrated price
• Potential to cap or reweight overprovision.
DRG Workshop
Belgrade, 18-22.November 2013.
Fine tuning of the system:
addressing negative effects
• Upcoding (creep), “paper” (readmitted) cases
– Monitor and control provider reporting of cases
– Continuous cost weight revision
• Efficiency and quality
– Addressing undertreatment (quality/effectiveness):
• creating new groups
• *DRGs for sophisticated care, but only selected providers
– Quicker-sicker problem: readmission before maximum day
limit does not pay extra
DRG Workshop
9
Belgrade, 18-22.November 2013.
The difference between gaming and
fraud
• Fraud is repeated offences with intention
• Fraud is knowing violation of reporting
rules
• Fraud is materially profiting from
systematic ‘mistakes’
• Fraud is attempting to hide payments
claimed that do not relate to a real service
DRG Workshop
Belgrade, 18-22.November 2013.
QUESTIONS
• How can these issues be addressed in
Serbia?
• What is done now about professional
review?
• How is fraud detected and controlled?
DRG Workshop
Belgrade, 18-22.November 2013.
PART 2
SUB ACUTE CASEMIX
DRG Workshop
Belgrade, 18-22.November 2013.
“SUB ACUTE CARE”
• REHABILITATION
• PALLIATIVE CARE
• GERIATRIC EVALUATION AND MANAGEMENT
• PSYCHOGERIATRIC
• ??MAINTENANCE (OR NURSING HOME TYPE)?
DRG Workshop
Belgrade, 18-22.November 2013.
SNAP – SUB ACUTE INPATIENT
DRG Workshop
Belgrade, 18-22.November 2013.
SNAP – SUB ACUTE AMBULATORY
DRG Workshop
Belgrade, 18-22.November 2013.
CARE TYPE
CHANGE OF CARE TYPE
‘ACUTE
SERVICES’
‘REHABILITATION
SERVICES’
DAY OF EPISODE OF CARE OR SPEL
DRG Workshop
Belgrade, 18-22.November 2013.
CARE PATHS AND CLASSIFICATIONS
For a clinical pathway you must FOR DRG’s you must have:
have:
• an episode of care.
• an episode of care.
• diagnoses.
• diagnoses.
• a care planning process.
• know what was done to the
patient
- at least in general terms.
• a team approach to patient
management.
• discretion in choice of the most
cost effective care.
• decisions made before the
treatment is undertaken.
• decisions made after the
treatment is completed.
DRG Workshop
Belgrade, 18-22.November 2013.
REHABILITATION CASEMIX
DRG Workshop
Belgrade, 18-22.November 2013.
REHAB CAN BE ACCESSED
• As part of an acute episode (DRG) (usually?)
• As a separate “ACUTE” DRG episode
• As a separate admission type (where substantial)
– Different care type – ‘SUBACUTE’
• As a series of one off referrals from a community
provider for eg
• PHYSIO, OT, PSYCHOLOGY, SPEECH THERAPY, POD ETC
• As a planned package/program of care on an
ambulatory basis or combination.
DRG Workshop
Belgrade, 18-22.November 2013.
The Oz classification smorgasbord
DRG Workshop
Belgrade, 18-22.November 2013.
TWO EXAMPLE REHAB
CLASSIFICATIONS
DRG Workshop
Belgrade, 18-22.November 2013.
MEASURES OF FUNCTION AVAILABLE
FOR CLASSIFICATIONS
• ICF – International classification of function –
WHO
• FIM
• Barthels
• RUGs
DRG Workshop
Belgrade, 18-22.November 2013.
Rehabilitation Patient Groups –
Ontario 2008
• 83 RPG in the new classification system
• Relies on the following data elements where
applicable:
– 1. Rehabilitation Client Code
– 2. Admit Motor Functional Independence
Measure (FIM) score
– 3. Admit Cognitive FIM score
– 4. Patient Age
DRG Workshop
Belgrade, 18-22.November 2013.
Rehabilitation Patient Groups –
Ontario 2008 –1 of 2
1. Stroke
2. Traumatic Brain
Injury
3. Non-Traumatic Brain
Injury
4. Neurological
1100. M=12-38 and Age<=68
1110. M=12-38 and Age>=69
1120. M=39-50
1130. M=51-84 and C=5-25
1140. M=51-84 and C=26-29
1150. M=51-69 and C=30-35
1160. M=69-84 and C=30-35
1200. M-12-13 and C-5-21
1210. M=14-47 and C=5-21
1220. M=48-84 and C=5-21
1230. M=12-44 and C=22-28
1240. M=45-84 and C=22-28
1250. M=12-84 and C=29-35
1300. C-5-21
1310. C=22-32 and Age <= 61
1320. C=22-32 and Age>=62
1330. C=33-35
1400. M-12-32
1410. M=33-55
5. Traumatic Spinal
Cord Injury
6. Non-Traumatic
Spinal Cord Injury
7. Amputation, NonLower Extremity
8. Amputation, Lower
Extremity
9. Osteoarthritis
10. Rheumatoid
Arthritis and Other
Arthritis
DRG Workshop
1420. M=56-74 Belgrade, 18-22.November 2013.
1430. M=75-84
1500. M-12-16
1510. M=17-41 and Age <= 30
1520. M=17-41 and Age >= 31
1530. M=42-84
1600. M-12-28
1610. M=29-54 and Age >=51
1620. M=29-54 and Age<=50
1630. M=55-72
1640. M=73-84
1700. M-12-63
1710. M=64-84
1800. M-12-41
1810. M=42-64
1820. M=65-84 and C=5-31
1830. M=65-84 and C=32-35
1900. M-12-59
1910. M=60-84
2000. M-12-68
2010. M=69-84
(M = motor FIM score; C=cognitive FIM score
Rehabilitation Patient Groups –
Ontario 2008 –2 of 2
11. Pain
2100. M-12-68
2110. M=69-84
12. Fracture of Lower
Extremity
2200. M-12-47 and Age >- 84
2210. M=12-30 and Age <= 83
2220. M=31-47 and Age <=83
13. Replacement of Lower
Extremity
2230. M=48-51
2240. M=52-84 and Age >= 79
2250. M=52-84 and Age <= 78
2300. M-12-53 and C-5-33
2310. M=12-53 and C=34-35
2320. M=54-68 and C=5-33
2330. M=54-60 and C=34-35
2340. M=61-68 and C=34-35
2350. M=69-84
14. Other Orthopedic
2400. M=12-51 and C-5-33
2410. M=12-51 and C=34-35
2420. M=52-64 and C=5-33
2430. M=52-64 and C=34-35
16. Pulmonary
17. Burns
18. Major Multiple Trauma,
Other Multiple Trauma and
Major Multiple Fracture
19. Major Multiple Trauma,
with Brain or Spinal Cord
Injury
20. Ventilator Dependent
Respiratory Disorders
21. Other Disabilities
2440. M=65-84
15. Cardiac
2500. M-12-49 and C-5-30
2510. M=12-49 and C=31-35
DRG Workshop
2520. M=50-67 andBelgrade,
Age <= 82
18-22.November 2013.
2530. M=68-84 and Age <= 82
2540. M=50-84 and Age >= 83
2600. M-12-36 and Age >- 80
2610. M=37-84 and Age >= 80
2620. C=5-33 and Age <= 79
2630. C=34-35 and Age <= 79
2700. M-12-84 and C-5-35
2800. M-12-24
2810. M=25-55 and Age <= 24
2820. M=25-48 and Age >= 25
2830. M=49-55 and Age >= 25
2840. M=56-84
2900. M-12-34
2910. M=35-59
2920. M=60-84
3000. M-12-84 and C-5-35
3100. M-12-46
3110. M=47-58
3120. M=59-84 and Age <= 58
3130. M=59-84 and C=5-33 and
Age >= 59
3140. M=59-84 and C=34-35
and Age >= 59
Victorian Rehabilitation
• •Designated Rehabilitation Units
– –Agencies are designated for Rehabilitation Units
• –10 beds or more and must meet designation criteria
• –Paid by per diem grants (or for CRAFT agencies a mix
of episode & per diem since 1999)
• •Non-Designated
– –Payment through Casemix AN-DRG system by
WIES
DRG Workshop
Belgrade, 18-22.November 2013.
CRAFT Development
• Objective to develop a casemix classification
system for Rehabilitation patients which could be
effectively adopted as a casemix funding method
• Important therefore that the model meet the
following criteria:
–
–
–
–
–Clinical similarity
–Resource homogeneity
–Administrative ease
–Suitable for funding agencies
DRG Workshop
Belgrade, 18-22.November 2013.
Functional Status Issues
• Functional status is not used in other DRGs, but
• Functional status is basic to rehabilitation
practice, assessment and theory –
– so important to consider in a classification
• Main issues with regard to functional status:
– Choice of standard measure instrument
• Barthel
• FIM
• Barthel was chosen originally by Clinical Panel of
advisers for collection in Victoria.
• It can also be mapped to FIM
DRG Workshop
Belgrade, 18-22.November 2013.
Craft Categories
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Short Stay (overnight stay 1-3 days)
Stroke/NeurologicalAdmission Barthel score <60
Stroke/NeurologicalAdmission Barthel score ≥ 60
Orthopaedic Fracture Admission Barthel score < 60
Orthopaedic Fracture Admission Barthel score ≥ 60
Orthopaedic Replace Hip/Knee Admission Barthel score < 60
Orthopaedic Replace Hip/Knee Admission Barthel score 60 – 79
Orthopaedic Replace Hip/Knee Admission Barthel score ≥ 80
Other Orthopaedic Admission Barthel score < 60
Other Orthopaedic Admission Barthel score ≥ 60
Cardio/Pulmonary
Amputation
Head Injury/Major Multiple Trauma
Spinal
Burns
DRG Workshop
Other Rehabilitation Admission
Barthel score < 60
Belgrade, 18-22.November 2013.
Other Rehabilitation Admission Barthel score ≥ 60
Casemix Rehabilitation and Funding
Tree (CRAFT)
DRG Workshop
Belgrade, 18-22.November 2013.
Options for Funding
• Episode Costs -Payment for an episode of care
– Advantages:
• Promotes and rewards efficiencies and standard practice across agencies
• Provides a clearer benchmark for units for planning, funding and the
evaluation of services–
– Disadvantages:
• Variability in LOS (“Quicker And Sicker” risk)
• Per Diem Costs -Payment based on a day rate–
– Advantages:–
• More closely approximates existing care
• May better reflect service differences–
– Disadvantages:–
• Does not encourage efficiencies or standard practice across agencies
• Consultations with field –episode preference
DRG Workshop
Belgrade, 18-22.November 2013.
NON-ADMITTED DIFFERENCES
• Lower? cost structures (usually , not necessarily):
– Can be a substitute program for admitted or
– A separate different care model (eg voc placement) .
– Community can be an essential part of the rehab.
• Goals can be staged – series of sub programs.
• Function dependent goals and decision points.
• Combinations of services can change depending
on progress.
– Dx can change – certainly needs can.
DRG Workshop
Belgrade, 18-22.November 2013.
PAYING FOR NON-ADMITTED REHAB
Minimum requirements Oz
•
Criterion 1 Rehabilitation care provided by a specialist rehabilitation team on an admitted
or non-admitted basis in a specialist rehabilitation unit (a separate physical space.)
– and
•
Criterion 2 Rehabilitation care provided by a multi-disciplinary team which is under the
Clinical management of a consultant in rehabilitation medicine or equivalent.
– and
•
Criterion 3 Rehabilitation care provided for a person with an impairment and a disability
and for whom there is reasonable expectation of functional gain.
– and
•
Criterion 4 Rehabilitation care for whom the primary treatment goal is improvement in
functional status.
– and
•
Criterion 5 Rehabilitation care which is evidenced in the medical record by:
– an individualised and documented initial and periodic assessment of functional ability by use of a
recognised functional assessment measure.
– an individualised multidisciplinary rehabilitation plan which includes negotiated rehabilitation goals and
indicative time frames.
DRG Workshop
MORE DETAIL
Belgrade, 18-22.November 2013.
MENTAL HEALTH CARE AND
CASEMIX
DRG Workshop
Belgrade, 18-22.November 2013.
Mental Health Services as a Part of
Health Care? (1/2)
• We spend between 7 and 13% of recurrent health
expenditure on mental health as the primary condition.
• Compared with cardiovascular diseases (10.9%), nervous
system disorders (9.9%), musculoskeletal diseases (9.2%),
injuries (8.0%), respiratory diseases (7.5%) and oral health
(6.9%). AIHW (Mental health services in Australia 2004–05).
• The big growth factor in the last decade has been increased
expenditure on drugs for depression.
• DEPRESSION has highest burden of disease disease where
Quality of Life is factored in (rather than mortality).
DRG Workshop
Belgrade, 18-22.November 2013.
Mental Health Services as a Part of Health
Care? (2/2)
• Acute hospitals
– MH alone 3% of separations, 9.7% of bed-days
– MH+D&A 3.7% of separations, 10.7% of bed-days.
• Special inpatient facilites
– Mental health is one of the few clinical specialties where
a proportion is done in specialised inpatient and
outpatient treatment services.
– These are operated both on a voluntary and compulsory
basis – and they may involve legal incarceration.
– $534AUD million pa in Australia
• Private sector hospitals / clinics
– Mental health is one of their biggest products
– Both as direct care and
as a comorbidity with other
DRG Workshop
conditions – liaison
Belgrade,
psychiatry
18-22.November–2013.
major issue.
What is the scope of mental health
services? (1/2)
• Drug and alcohol services are grouped together as
the same service statistics?
• Community support services – even such things as
housing assistance can be included in mental health
care.
• Rehabilitation and social independence programs
• Cognitive diseases often associated with aging
– Alzheimers, Senile dementias etc – may be here or in
Aged care.
– “Psychogeriatric” can be siloed as a completely different
care stream.
DRG Workshop
Belgrade, 18-22.November 2013.
What is the scope of mental health
services? (2/2)
• “Developmental” disorders
– Autistic disorders
– Severe learning disorders
– Hyperactivity
• What about mental health as a CC of other
conditions?
– Mental health diagnoses and their related treatments are one
of the most common comorbidity factors in the treatment of
physical conditions.
– Generally these costs are not taken into account in the
estimates on mental health expenditure.
– Some patients can be treated
for mental health problems when
DRG Workshop
actually not eligible from
health
Belgrade,their
18-22.November
2013.insurance status – by
being admitted for a less urgent physical condition.
Casemix classifications of mental health?
(1/2)
• DRG type Classifications
–
–
–
–
AR-DRGs
CMS DRGs
HRGs
etc
• Ambulatory and community classifications
– APCs??
– DBGs
• Care path based classifications
– Care packages
– Care programs
– DSM 4 Procedure axis
DRG Workshop
Belgrade, 18-22.November 2013.
Casemix classifications of mental health?
(2/2)
• Mental health status classifications - eg
–
–
–
–
HoNOS - http://www.crufad.com/phc/honosglossary.htm
- http://pb.rcpsych.org/cgi/content/full/29/11/419/TBL1?ck=nck
CIDI – DIS http://www.crufad.unsw.edu.au/cidi/cidi.htm
BDI – HAS – etc. etc.
http://www.swin.edu.au/victims/resources/assessment/affect/bdi.ht
ml
– General assessment tools – mental status components.
• Sf36, SF12 - http://www.crufad.com/phc/sf-12.htm
• FIM - http://www.tbims.org/combi/FIM/index.html
• ICF - http://www.who.int/classifications/icf/site/onlinebrowser/icf.cfm
• Mixed classifications
– Combination of inputs relating to patient characteristics and Px’s
– DSM
DRG Workshop
Belgrade, 18-22.November 2013.
The World Health Organization (WHO) Composite
International Diagnostic Interview (CIDI)
• The CIDI is a comprehensive, fully-structured interview designed to
be used by trained lay interviewers for the assessment of mental
disorders according to the definitions and criteria of ICD-10 and DSMIV.
• The CIDI allows the investigator to:
- Measure the prevalence of mental disorders
- Measure the severity of these disorders
- Determine the burden of these disorders
- Assess service use
- Assess the use of medications in treating these disorders
- Assess who is treated,
•
http://www.hcp.med.harvard.edu/wmhcidi/
DRG Workshop
Belgrade, 18-22.November 2013.
Is Mental Health so different from
other health services?
COST RISK FACTORS
Legal status
MENTAL HEALTH
OTHER SPECIALTIES
++
-
+++
+
++++
+
High level of
discretionary
treatments
+++
++
High variability in
proven efficacy for
most treatments
+++?
-?+?
Social support
differentiation
High level of “talking
therapies”
DRG Workshop
Belgrade, 18-22.November 2013.
SOME PRACTICAL PROBLEMS
• Discrete funding silos
– Continuity gaps
– Availability versus suitability
• Information barriers
– Privacy
– Professional territoriality
– Patient disempowerment – stigma - chronicity
• Accessible/current best practice protocols
DRG Workshop
Belgrade, 18-22.November 2013.
Why do some insurers want
to limit access to MH care?
• Differential eligibility restrictions – eg
– Longer wait for coverage for mental health as a
pre-existing condition.
– Exclusion of mental health coverage.
• USA’s parity legislation – THE OBAMA
REFORMS
• Expenditure caps – lifetime hospital admission
cap.
DRG Workshop
Belgrade, 18-22.November 2013.
USA CMS – INPATIENTS
Episode and per-diem mixture
DRG Workshop
Belgrade, 18-22.November 2013.
AUSTRALIAN CASE STUDY
“YOU CAN KEEP SOME OF THE PEOPLE HAPPY SOME OF THE
TIME….”
DRG Workshop
Belgrade, 18-22.November 2013.
DRG Workshop
Belgrade, 18-22.November 2013.
DRG Workshop
Belgrade, 18-22.November 2013.
http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-d-casemix-toc~mental-pubs-d-casemix-mh
AR-DRG CATEGORIES
U40Z Mental Health Treatment, Sameday, W ECT
U60Z Mental Health Treatment, Sameday, W/O ECT
U61ASchizophrenia Disorders W Mental Health Legal
Status
U61B Schizophrenia Disorders W/O Mental Health
Legal Status
U62A Paranoia & Acute Psych Disorder W Cat/Sev CC
or W Mental Health Legal Status
U62B Paranoia & Acute Psych Disorder W/O Cat/Sev
CC W/O Mental Health Legal Status
U63A Major Affective Disorders Age >69 or W
(Catastrophic or Severe CC)
U63B Major Affective Disorders Age <70 W/O
Catastrophic or Severe CC
U64Z Other Affective and Somatoform Disorders
U65Z Anxiety Disorders
U66Z Eating and Obsessive-Compulsive Disorders
DRG Workshop
U67Z Personality Disorders andBelgrade,
Acute
Reactions
18-22.November 2013.
U68Z Childhood Mental Disorders
• 12 CATEGORIES
•
•
•
•
DX BASED ICD
LEGAL
NO D & A
LARGE
DATABASE FOR
GROUPER
CALIBRATION
• INPATIENT
ONLY
DRGs/HRGs and Mental Health
• Politically rejected for payment because “poor
predictor of individual service cost”
– Are other specialities so sensitive??
• Not usually considered for use with other
variables
– Facility – level – availability support.
– Extended care programs – capitation – add on
DRG Workshop
Belgrade, 18-22.November 2013.
MH-CASC .. CONTINUING STORY
OR GRAND FAILURE??
• Scoped to fund MH by outcomes – or even outputs –
across all settings
• How can you get a setting independent input
independent grouping of ‘products’
–
–
–
–
–
Diagnosis
Severity measures
Comorbidities
Chronicity – Acuity
Social constraints – eg supports, legal risk
DRG Workshop
Belgrade, 18-22.November 2013.
UK CASE STUDY
RESOURCE HOMOGENEITY VS CLINICAL MEANINGFULNESS
REVISITED
DRG Workshop
Belgrade, 18-22.November 2013.
HRG v3.5 MH CATEGORIES
• T01 - Senile Dementia
• T03 - Schizophreniform
•
DX
BASED
DSM4?
Psychoses without Section
• T07 - Depression without Section • BROAD SCOPE
• T08 - Presenile Dementia
– Eg A&D INCLUDED
• T09 - Anxiety Syndromes
• IP / OP ?
• T10 - Alcohol or Drugs NonDependent Use >18
• SMALL DATASET
• T11 - Alcohol or Drugs NonFOR GROUPER
Dependent Use <19
NORM
• T12 - Alcohol or Drugs
Dependency
• INCLUDES A & D
• T13 - Eating Disorders or
Obsessive Compulsive Disorders
• T14 - Acute Reactions or
Workshop
Personality Disorders Belgrade,DRG
18-22.November 2013.
UK PbR STUDY SETTING DEPENDENT CATEGORIES
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Cty No or std CPA Low prob daily act HONOS10
Cty No or std CPA High prob daily act HONOS10
Cty Std CPA Low prob daily act HONOS10
Cty Std CPA High prob daily act HONOS10
Cty Enh CPA Low prob daily act HONOS10
Cty Enh CPA High prob occ act HONOS12
Cty Enh CPA High prob occ act HONOS12
Cty Enh CPA Low prob occ act HONOS12
IP/OP no or std CPA working age
IP/OP no or std CPA above working age
IP/OP enh CPA Low cog prob HONOS4 no section ord
IP/OP enh CPA Low cog prob HONOS4 section ord
IP/OP enh CPA High cog prob HONOS4 0-2 phys prob
IP/OP enh CPA High cog prob HONOS4 >2 phys prob
IP Low social prob HoNOS social
IP Med social prob HoNOS social
IP High social prob HoNOS social
CPA=Care Programme Approach
17
CATEGORIES
 SETTING/
PROBLEM / FN
BASED
 CARE
APPROACH
 SMALL
DATASET
 COSTING?
DRG Workshop
 RELIES ON
Belgrade, 18-22.November 2013.
http://www.gpsa.org.au/media/docs/mentalhealth/honos_information.pdf
HONOS

UK PbR STUDY SETTING INDEPENDENT CATEGORIES
;W/o Section;No or std CPA;Dx= F0, F2, F5, F6, F7;;;
;W/o Section;No or std CPA;Dx=F1, F3, F4 ,F9;No or low prob daily activities
(HoNOS 10);;

ONLY
WORKING
AGE +

LEGAL, DX
AND HoNOS

78%
RECORDS
EDIT
REJECTED

N=11,364
;W/o Section;No or std CPA;Dx=F1, F3, F4 ,F9;High prob daily activities (HoNOS 10);
Wkg age;
;W/o Section;No or std CPA;Dx=F1, F3, F4 ,F9;High prob daily activities (HoNOS 10);
Above wkg age;>3 HoNOS psych
;W/o Section;No or std CPA;Dx=F1, F3, F4 ,F9;High prob daily activities (HoNOS 10);
Above wkg age;1-3 HoNOS psych
;W/o Section;Enh CPA;Dx=None, F1, F7, F8;No or low prob daily activities (HoNOS
10);;
;W/o Section;Enh CPA;Dx=None, F1, F7, F8;High prob daily activities (HoNOS 10);;
;W/o Section;Enh CPA;Dx=F0, F2, F3, F4, F5, F6, F9;Med or hi CRU complexity;Low
or no cognitive prob HoNOS4;
;W/o Section;Enh CPA;Dx=F0, F2, F3, F4, F5, F6, F9;Med or hi CRU complexity;High
cognitive prob HoNOS4;
;W/o Section;Enh CPA;Dx=F0, F2, F3, F4, F5, F6, F9;Low CRU complexity;;
;W Section;>2 HoNOSpsych;Enh CPA;Dx= None, F1, F3, F4;;
;W Section;>2 HoNOSpsych;Enh CPA;Dx=F0, F2, F5, F6, F9;;
;W Section;>2 HoNOSpsych;No or std CPA;;;
;W Section;0-2 HoNOSpsych;;;;
DRG Workshop
Belgrade, 18-22.November 2013.
pat
Categories Suggested by the Care Path Study
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•
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•
•
•
•
•
•
Acute non-psychotic low
Acute non-psychotic med
Acute non-psychotic high
Non-psychot overval idea
Non-psychot chaotic & challenging
Drug & alcohol
First episode psychosis
Chronic severe low sympt
Chronic severe high sympt
Severe psychot episode
Severe depression
Dual diag
Assertive outreach
DRG Workshop
Belgrade, 18-22.November 2013.
• CARE PATH
DEFINITIONS
• CLINICIAN GROUPING
VS ALGORITHM
GROUPING
• COST VARIANCE
ANALYSIS
• N=2,287 PATIENTS
Ideas on classification dimensions from the
forensic MH study.
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Socio demo
Offence
Clinical
IP/cty
Medico-legal
Seclusion
• DEMOGRAPHIC STUDY
• DISTRIBUTION OF
ACCESS AND SERVICE
PROVISION
• SECLUSION AS
MANAGEMENT TOOL
• COSTS
DRG Workshop
Belgrade, 18-22.November 2013.
DEFINITIONS AND
RULES
AGED CARE
ED PATIENTS AND MENTAL
BUNDLED OUTPATIENTS
FFS OUTPATIENTS
TRAUMA
AND ACUTE
ILLNESS
HEALTH
PROGRAMS
INPATIENTS
PRIVATE AND
CHRONIC
DISCRETIONARY
SAME DAY INPATIENTS CARE
ELECTIVE??
PROGRAMS
DRG Workshop
Belgrade, 18-22.November 2013.
DRG Workshop
Belgrade, 18-22.November 2013.
Patient Classification Systems
• “There is no such thing as a
bad classification – only
people who are more or less
happy with the category to
which their case is assigned”
• Ric Marshall, PCSI Summer School, 17 June, 2010
DRG Workshop
Belgrade, 18-22.November 2013.
Patient Classification Systems
• “There is also the validity of
the classification categories for
particular uses.
• And then there is the reliability
of the data”
Anon
DRG Workshop
Belgrade, 18-22.November 2013.