Non-admitted care

Non-admitted acute and non-admitted subacute hospital services are provided to public patients in a range of settings. These patients do not undergo a formal admission process and do not occupy a hospital bed.

Scope

Non-admitted services currently in scope for Activity Based Funding (ABF) include acute outpatients (specialist clinics); Multidisciplinary Case Conference - patient not present, home enteral nutrition and total parenteral nutrition; genomics; health independence program; home renal dialysis; and community palliative care.

Exclusions

Most non-admitted patient service events reported to the AIMS S10 data collection or VINAH data collection will be allocated a price weight based on the National Efficient Price. However, a price weight will not be allocated for Tier 2 clinics that are funded by another Victorian funding model.

This includes:

• Services that are not currently within scope of the National Health Reform Agreement including home and community care, aged care assessment services and services funded via the Community Health Program.
• Private Clinics, where the patient will pay an out-of-pocket fee.
• Non-admitted services that are not funded by the department are not in scope.

Classification

Victoria is required to classify non-admitted activity using the Tier 2 Non-Admitted Definitions Manual. Tier 2 is a broad classification system that allocates activity into classes, based on the nature of the service provided and the type of clinician providing the service. The structure of the classification is first differentiated by the nature of the non-admitted service provided. The major categories are:

• procedures
• medical consultation services
• diagnostic services
• allied health and/or clinical nurse specialist intervention services.

Classification rules exist to guide the decision making regarding to which Tier 2 class a clinic should be classified. The IHACPA has developed two reference documents to assist with consistently allocating non-admitted services to a Tier 2 class:

• Tier 2 Non-Admitted Services Compendium
• Tier 2 Non-Admitted Services National Index.

Price weights expressed as national weighted activity units (NWAU) are set out in the annual National Efficient Price Determination.

Registration of Non-Admitted Specialist Clinics

All acute funded non-admitted specialist clinics or services are to be registered in the Non-Admitted Clinic Management System which can be accessed via the HealthCollect Portal.

Registration of clinics allows all eligible non-admitted services to be linked to the most appropriate available Tier 2 class for classification and funding purposes. Private clinics run by practitioners exercising rights of private practice under private practice arrangements are also required to be registered. Note, private services can only be provided if the same service is provided on a public basis.

Counting

The unit of count adopted for all non-admitted services is ‘service event’.

A non-admitted patient service event is defined as an interaction between one or more healthcare provider(s) with one non-admitted patient. This event must contain therapeutic or clinical content and result in a dated entry in the patient’s medical record. The interaction may be for assessment, examination, consultation, treatment or education.

Rules for counting are as follows:

Family members and/or carers accompanying a patient to an appointment must not be counted as additional non-admitted service events when they did not receive a service meeting the definition of a non-admitted patient service event.

A non-admitted patient service event must be counted once only, regardless of the number of healthcare providers present.

• Only one non-admitted patient service event may be counted for a patient at a clinic on a given calendar day.
• When a family member and/or carer act on behalf of the patient without the patient being present (and all the other requirements for a non-admitted patient service event are met) then this may be counted as a service event on behalf of the patient. If there were multiple interactions within a clinic on a given calendar day, regardless of whether a family member and/or carer was with or without the patient being present, then these would be counted as a single service event.
• Non-admitted services events delivered via telehealth where two public hospital service non-admitted clinics are involved are counted twice. One service event is counted at the clinic where the patient attends and one service event is counted at the clinic providing the consultation.
• A non-admitted patient, who is not admitted or registered in an emergency care setting, discussed at a multidisciplinary case conference (MDCC) may be counted as a non-admitted patient service event when the patient is not present.

Patient education services can be counted as non-admitted patient service events where they meet the definition of a non-admitted patient service event. Staff immunisation, education and training must not be counted as a non-admitted patient service event. Services provided to patients in the admitted or emergency care settings must not be counted as non-admitted patient service events. This includes any attendance or appointment by an admitted patient at a non-admitted service.

Services from diagnostic clinics (30 series) are not counted as non-admitted patient service events. These services are provided as part of a related non-admitted patient service event. Diagnostic services do not require clinic registration.

More information is at the non-admitted patient service event counting rules in the Tier 2 Non-Admitted Services Compendium.

Pricing

The department uses the National Efficient Price Determination price weights for Tier 2 clinics published by the Independent Health and Aged Care Pricing Authority.

Costing

All Victorian health services are required to submit annual patient-level cost data to the Victorian Cost Data Collection (VCDC). VCDC data is then submitted to the National Health Cost Data Collection (NHCDC) via the Independent Health and Aged Care Pricing Authority (IHACPA).

Cost data should consider all services and consumables used in the treatment of the patient, including diagnostic imaging and pathology, pharmacy, equipment, maintenance, overheads, tests, drugs and consultations with all healthcare provider(s) involved.