Victorian Ambulatory Classification & Funding System (VACS)

Clinical Specialties and Weights

Clinical specialties form the basis of the VACS system. There are 47 categories, all of which are weighted, except for allied health and emergency medicine. The 35 ‘weighted’ and 12 ‘unweighted’ clinical specialties are outlined below.

Hospital staff make the initial assignment of hospital clinics to the categories defined under the classification system. These assignments are then evaluated by the VACS Clinical Panel of eminent senior clinicians from a range of specialties. A move from annual to quarterly reporting (in May, August, November and February) began in May 2006, in response to the VACS Clinical Verification and Activity Audit recommendations.

The table below lists the cost weights for each of the 35 weighted clinical categories. These are derived annually as part of the Victorian Cost Weight Study.

Victorian Ambulatory Classification System Weights 2011-12

VACS Code	Description	Weight
101	General medicine	1.703
102	Allergy	2.107
103	Cardiology	1.078
104	Diabetes	0.991
105	Endocrinology	1.356
106	Gastroenterology	1.122
107	Haematology	2.223
108	Nephrology	1.435
109	Neurology	1.377
110	Oncology	1.615
111	Respiratory	1.511
112	Rheumatology	1.535
113	Dermatology	1.117
114	Infectious diseases	1.833
115	Developmental neurological disability	1.035
201	General surgery	1.147
202	Cardiothoracic	2.054
203	Neurosurgery	1.595
204	Ophthalmology	0.872
205	Ear, nose and throat	0.942
206	Plastic surgery	0.839
207	Urology	1.089
208	Vascular	1.088
209	Pre-admission	1.481
301	Dental	1.375
310	Orthopaedics	1.078
311	Orthopaedic applications	0.578
350	Psychiatry and behavioural disorders	2.244
401	Family planning	1.096
402	Obstetrics	0.770
403	Gynaecology	0.815
404	Reproductive medicine	1.415
405	Dysplasia and colposcopy	0.863
501	Paediatric surgical	0.619
502	Paediatric medical	0.837
550	Emergency medicine	n/a
601	Audiology	n/a
602	Nutrition	n/a
603	Optometry	n/a
604	Occupational therapy	n/a
605	Physiotherapy	n/a
606	Podiatry	n/a
607	Speech pathology	n/a
608	Social work	n/a
609	Other allied health services	n/a
610	Cardiac rehabilitation	n/a
611	Hydrotherapy	n/a

Notes:

1. The 2011–12 DRAFT cost weights have been set using the 2009-10 VACS cost data (except for VACS 101, 209, 404 and 405 which have been set using a 2 year rolling average, and categories 102 & 204 which have been set using a 3 yr rolling average)
2. Weights are not detailed for VACS 550 - 611 as these categories are funded as fixed grants

Patient Encounters

Hospitals are funded on the basis of patient encounters. The encounter is defined as the clinic visit, plus all ancillary services (pathology, radiology and pharmacy) provided within the 30 days either side of the clinic visit. The 30-day window has been chosen to encompass the majority of services associated with a particular visit and to enable a reasonable and practical time period for reporting and funding. This approach more closely reflects patterns of clinical care and provides better resource utilisation and controls than the “unbundled” fee-for-service or occasions of service systems.

In categories 101–502, a doctor, endorsed nurse practitioner (or for categories 401 and 402, a midwife performing equivalent responsibilities) must see the patient at each encounter.

Some examples of bundling to form the encounter for cost weight purposes

Patient A 04–06–2010: Imaging examination conducted in preparation for clinic visit. 20-06-2010: Initial visit to the Oncology clinic (VACS 110-Oncology)  25–06-2010: Follow up visit (VACS 110-Oncology). 03-07-2010: As a result of the subsequent clinic visit, pharmacy and pathology services were ordered and a repeat pharmacy prescription given. 08–07–2010: Visit to the Nephrology clinic (VACS 108 - Nephrology) Bundling Process All components of encounter are linked by 1) UR Number and 2) Clinic Code.  If code is missing from patient record, UR number is sufficient to identify ancillary services. For this patient the imaging will be linked to the initial Oncology visit.  The subsequent pharmacy and pathology services will be linked to the follow up Oncology visit. AIMS Reporting June 2010 – Two encounter under VACS 110 Oncology (includes clinic visit and imaging, pathology) June 2010 – One encounter under VACS 110 Oncology (clinic visit, pharmacy and pathology) July 2010 – One encounter under VACS 108 Nephrology

Patient B 12–06–2010: Initial visit to the ENT clinic (VACS 205 – Ear, Nose and Throat). 27–06–2010: Flu visit to ENT Clinic (VACS 205 – Ear, Nose and Throat). Patient B would be reported in AIMS as having 2 encounters in June 2010 under VACS 205 ENT June 2010: Two encounters for VACS 205 ENT

For reporting purposes, only the clinic visit needs to be reported as VACS activity. Encounters are paid on the basis of the cost weight, which is derived from the annual Cost Weight Study, and incorporates the ancilliary services. For more details see the Casemix Funding in Victoria website.

Previously, VACS ancillary services, such as pathology, radiology and pharmacy were reported on the AIMS S2 Non-Admitted Form, as part of Commonwealth reporting requirements. Since July 2005, the AIMS S9 and S2 forms have been combined into the S9 -111 Form. For more details on these forms see the AIMS Public Hospital User Manual (Version 17.0, July 2009).