Funding Models Forum 2017 - Admitted subacute (subacute WIES2)

I think I can do this in about five minutes in the interest of getting everybody out. So the next two slides are presentations about sub-acute WIES and ED, largely no major significant change I think the purpose of these two slides is to reiterate what the department's trying to do, so that you've got an understanding of what we're trying to achieve, what data sources when using,  so that you can go back make sure they're there right so they're fit for purpose before the department embarks on further reform, so this is an opportunity for you to ask questions as well as for us to kind of explain what we're doing now and what we did this year and what we're doing for future years. So with subacute care we've been on a long journey many, I mean I'm sure a number of you have been around we had craft and ABF model for rehab then it came along the Rudd agreement then the 2012 National Health Forum agreement and then we abandoned craft and replaced it with a new funding model called I-snack which was introduced in 14-15, three iterations of that occurred and then we moved to sub-acute WIES in 16-17 and then sub-acute WIES2 was developed in 17-18. Each version has kind of evolved with time and also aligns with the best classification and the updated data. So I think we've come to a point where the model is fairly stable we've got a pretty stable classification, the data is linked to the admitted data set it's fairly stable it will evolve over time, we've got a few anomalies, a few challenges that are localized to a number of services that we'll need to fix over the next few years, but we're on to that, but I think we've got the large part of the engine of the subacute WIES model ironed out and we'll evolve it based on the data over time.

So the key things to just reiterate is that it's underpinned the subacute WIES model is underpinned by kind of three key things, firstly the classification is AN-SNAP version 4 for this is the national classification this is the best-known classification that are developed nationally so unless there's a better classification out there I think we're sticking with it, it uses a number of fields that are derived from the VAED as well as very clear various collections such as peacock and a-rock, THYM, RUG etc. and it's, I think my plea to you is to make sure that you know that you're clinicians know that what they're recording into the clinical in the tip has the assessments that they do for PHIM, for RUG at admission are important for the funding model it's important for us to get it right and there's also other uses for this clinical information.

We need also make sure that all the activity is reported accurately so the VAED in particular making sure that our care type is right for example if we report it as a rehab care type the patient must meet the rehab care type being there under the care of a rehab  physician and not under care of a geriatrician or a palliative care expert because we don't get it right it puts more variability into the model and the model becomes more unpredictable. The third part of the equation, and it's equally important, is the cost side of it where the cost data collection is evolving and we need to put more focus like historically it's been all admitted acute focused we're using it many more things as I alluded to before 40% of our revenue is derived based on our cost data influencing the national cost data so it's important to get this right. But it will take time I acknowledge that. In terms of the subacute WIES2 model it is a light version of this the WIES model, it has high outlier inlier low outlier not as many cost weights as the WIES model but it has three key cost weights, it has one adjustment only being the Aboriginal and Torres Strait Islander loading of  30%, it also has a different boundary policy being plus or minus 4 at this point in time. For those that are familiar with the national model their boundary policies are even wider and so the department in the first few years of this model has decided to be more maintain more of the risk hence why it's a plus or minus boundary policy rather than adopting what the independent Hospital pricing authority has implemented in the national model and we've kind of used the same approach where one sub-acute WIES is the typical length of stay for all in patient, so again this should be familiar to everybody that just the approach about how we approach it but the key thing is that the model is not intended to fully cost recover, in some cases it will fully cost recover and pay a bit more there are cases where it will under cost recover especially when you're in the inlier zone look at the blue area and you've passed you've exceeded the average length of stay in those cases you will make a loss on those patients compared to the former I-snack model until you get to the higher boundary point where the per diem payment equals the amount it's costing you after that and equalizing the risk and so there's no incentive to keep the patient longer or discharge them earlier it's apart from if you're discharging earlier reset the clock new patient you're back from your back at the low boundary point. So we've got inliers, short stay outliers, long outliers, those are the three weights that we've got no different to the WIES model and as you can see the outlier, low outlier point and the high outlier point is based on average length of stay. There is one key typo in the PFG that I need to make everybody aware of it is box 3.2 the addendum that will be released on Monday will include this, effectively the previous box simply said calculate for palliative care, the sub-acute WIES for each phase level and then sum them up and then subtract leave days times it by a particular weight, that weight doesn't exist and this is simply to clarify what the formulas should have should have been, so effectively what you still do is at each phase of care you calculate the length of stay you work out the AN-SNAP category, you look at look at the table work out the weight and that's the weight for that phase, do it for every single phase sum them up you'll get X amount of subacute WIES, because leave days are collected at the episode level we can't attribute them to a particular phase and the way that we do that is we apply a discount that based on the same day palliative care inlier weight so there is a class called 4PO1 in the policy and funding guidelines for adults or for children and in adults it's 4KO1 it has a weight so what you do is work out the amount of leave days multiplied by the inlier weight published in the table and that's the discount for leave days and so that's it that's the only technical issue that we found with the model so far and hopefully it's the only one.

Just an example if we have a patient who's got three phases of three phases in their episode of care unstable, deteriorating and terminal, we then look at the boundary policy, we look at their length of stay and work out the subacute WIES we do that for each one, these slides will be available, and then at the end of it what we do is we sum up all that revenue and then if the patient has leaves days we then go leave days multiplied by the weight by the price gives you a dollar amount and you subtract it from the amount calculated so that's the only real change that we did the sub-acute WIES model this year and it's the admission to that table that I just want to bring your attention to so.

So I'll continue on with the next slide and we'll we can come to questions after the next presentation.