ABF TASKFORCE Emergency Department Funding Model ABF Taskforce Susan Dunn, Manager, ABF Workstreams, Xiao Cai, Manager, ED and Non admitted Workstreams ABF Taskforce Contents  Review of classification  2013/14 model changes  Outstanding issues  Scenario’s  URG/UDG Tool  ABM BIS Emergency Departments Classification System •Urgency Related Groups (URG) •Urgency Disposition Groups (UDGs) UDG Components (1 -3a) –Triage Category –Disposition (mode of separation) URG Code and Description: UDG 1 Admitted Triage 1 URG Components (3B -6) –Triage Category –Disposition (mode of separation) –ED principal diagnosis 27 MDB URG Code and Description: URG 3 Admitted Triage 1 - Injury URG Components: ED Diagnosis Diagnosis code maps to Major Diagnostic group •Acute bronchitis, unspecified 3B Respiratory system illness •Stroke, not specified as haemorrhage or infarction 3E Neurological illness Note: Only first entered diagnosis is used ED ABF MODEL CHANGES FOR 2013/14 URG/UDG classification changes in 13/14  Five additional classes o Died in ED o Non Admitted Return Visit Triage cat 1, 2, 3 o Non Admitted Return Visit Triage cat 4, 5 o Admitted Return Visit, any triage category o Transfer presentations NEW URG/UDG Price Weights (NWAU) NEP Adjustments 2013/14 Price adjustments  Error URGs/UDGs receive no payment  Indigenous - A patient based adjustment of 4%  The rural/remote adjustment does not apply to ED patients in 2013/14 Calculation of Price NWAU(13) = URG_PriceWeight * (1+Aindig) Funding = State Price($4671) x NWAU(13) Code Domain Description Current ED Error Results OUTSTANDING ISSUES Code Domain Description Transport  Cost is accounted for in the costing model  As an overhead  At patient level, depending on patient linkage ability  Costing Standards  No specific direction in Cost Accounting Guidelines  Will consider this for next round Code Domain Description Homelessness  In acute,  Remoteness adjustment uses Postcode  Statistical Local Area (SLA) of Address  Hospital SLA  In ED  Remoteness adjustment removed from model Code Domain Description FAQ – Scenario 1 •Patient in ED, then admitted to EMU before discharge ED episode URG 16 Admitted Triage 2 – Circulatory system illness NWAU – 0.1936 Funding:$904 Acute Admitted Episode DRG F74Z Chest Pain NWAU - 0.2693 Funding:$1258 Code Domain Description FAQ – Scenario 2 •Patient transferred from smaller hospital and expected to go straight to ward •Goes to ED first •Then Admitted to ward Hosp A Acute Admitted Episode DRG F74Z Chest Pain NWAU - 0.2693 Funding: $1258 Hosp B ED episode URG 16 Admitted Triage 2 – Circulatory system illness NWAU – 0.1936 Funding: $904 Hosp B Acute Admitted Episode DRG F42C CRC DSRD –AMI +IC IN PR SD NWAU – 0.6032 Funding: $2,818 Code Domain Description FAQ Scenario 3 •ED provides telephone support to patient/GP •Pt transferred to hospital, admitted directly to ward, bypassing ED •Activity Based Management (ABM) : •Appropriate clinical practice, reduced demand on ED Beds, less waiting time for other patients, meeting NEAT targets Telephone NWAU ED NWAU Acute Admitted DRG NWAU Code Domain Description FAQ Scenario 4 •Patient attends ED for a GP related issue •Returns multiple times •ABF : Planned Vs Unplanned URG •ABM Issues: Impact on ED bed capacity, increased waiting ties, workforce issues, chronic care management programs, Impact on Emergency representation and NEAT KPIs ED NWAU ED NWAU ED NWAU ED CASE STUDIES INTERESTING PATIENT Code Domain Description FAQ Scenario 5 •Compare •Patient attending ED triaged as cat 4, deteriorates, requires full resus, admitted to ICU •Same patient triaged as cat 2 and seen within 10 minutes ED Cat 4 Admission Cardiac URG 33 Admitted Triage 4 –All other MDB groups NWAU 0.1470 OR ED Cat 2 Admission Cardiac URG16 Admitted Triage 2 – Circulatory illness NWAU 0.1936 Admitted DRG episode Including ICU hours or a bundled DRG IT system will update triage cat. Example of URG Funding  ED URG/UDG tool ABM BIS TOOL Average Cost of URG 3 per ED Presentation 2011-12 Emergency URG 3 Admitted Triage 1 - Injury Average Cost - Peer Groups A1 to C1 - Draft 3,500 3,000 2,500 2,000 1,500 1,000 500 0 LHD Benchmarking – Avg Cost Per NWAU (ED) Facility Benchmarking – Avg Cost Per NWAU (ED) Interesting Patient The following example is an interesting patient: For 2011-12 the patient had: - Total 99 Episodes - 86 ED presentation (42k) - 13 Acute admission (14k) From the presentation and admission history, the patient was in and out of the hospital frequently sometimes for consecutive days. INTERESTING PATIENT INTERESTING PATIENT – Mar 2012 INTERESTING PATIENT – ADMISSION HISTORY Further ABF Information  Resource kit available: http://internal.health.nsw.gov.au/communications/ funding_reform/resources.html  Email: abf@doh.health.nsw.gov.au