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Section A - Policy
5. Non-Admitted Patients & Emergency Services Funding
5.1 Victorian Ambulatory Classification System
General and specialist services in outpatient and emergency departments play a key role in the health care system and represent a vital service and interface between inpatient and community care. The Victorian Ambulatory Classification System (VACS) was introduced for funding purposes from 1 July 1997 for all Group A hospitals, and in 1998 - 99 was extended to the Ballarat Health Services and the Bendigo Health Care Group.
1999 - 2000 will see the full implementation of activity based funding for outpatient services in VACS hospitals, with the removal of the compensation grant. Consistent with the earlier policy applied to Group A hospitals, a second and final year compensation grant will be paid to Ballarat Health Services in 1999 - 2000. The Bendigo Health Care Group will be fully funded under VACS in 1999 - 2000.
Activity levels are now considered to be stable and from 1999 - 2000 any additional throughput will be allocated in accordance with the general principles for inpatient growth. Budgets will continue to be capped meaning that hospitals will be allocated a specified maximum budget and funding is guaranteed up to the budget ceiling. Where hospitals failed to reach target levels set for 1998 - 99, adjustments for the current year have been made.Where activity fails to reach target levels across the agreed profile of services, the variable grant may be adjusted during the course of the year.
For 1999 - 2000, the VACS cost weights have been determined on the basis of a "three year rolling average cost" as recommended to the Department by the consultants conducting the 1998 - 99 Victorian Cost Weights Study. This will smooth fluctuations in average cost which have been noted in some VACS categories and ensure greater stability in the system. The 45 VACS categories will be unchanged from 1998 - 99.
A separate VACS target for DVA encounters has been set and these encounters will be funded at a higher rate than non-DVA public VACS encounters.
Chapter 13 Casemix Formula describes the funding components of the non-admitted patient grant for 1999 - 2000. Further details on the development of VACS, the definition of the "encounter" and the ambulatory funding model are outlined in the publication Victorian Ambulatory Classification and Funding System - VACS, September 1998.
5.1.1 Clinical Panel
The VACS Clinical Panel has evaluated all new and reviewed clinics notified by hospitals to the Department during 1998 - 99. Hospital specific clinic schedules for 1999 - 2000 have been set and hospitals will be advised of changes to their individual clinic schedule by August 1999. The current process of notification of clinic changes will continue during 1999 - 2000.
5.1.2 Reporting and Audit
Reporting under the new system will continue through the Agency Information Management System (AIMS). Reports on occasions of service need to continue as part of State responsibilities under the existing Australian Health Care Agreement. The AIMS S9 form will be used for reporting data as part of the Victorian Ambulatory Classification System for non-admitted patients funded by Program 111. In the case of a new clinic commencing during the year, or changes to existing clinics, assignment to a VACS category will be made by the hospital. The hospital will be required to advise the Department of any changes occurring during the year. An annual review by the Clinical Panel will assess the assignment of all new and reviewed clinics.
The findings of the VACS audit will be circulated in early 1999 - 2000 to Networks and hospitals. Generally the system has been found to be reliable, stable and accepted by the hospital field.
5.2 Non-Admitted Patient Grants - Other Hospitals
In 1999 - 2000, non-admitted patient budgets for the remaining Group B hospitals will continue to be divided into an emergency services grant and an outpatient grant. The Emergency Services Grant has been established on the same basis for Group A hospitals. Non-admitted patient budgets for Group C, D and E hospitals essentially will be unchanged from 1998 - 99.
As part of the ongoing improvement in the allocation of funding levels and service planning, the Department has commissioned a study to investigate outpatient and emergency services activity in non-VACS funded rural hospitals. The project will involve the assessment of existing data on the non-admitted outpatient and emergency services and will survey and document existing services within the broad hospital groups, including a description of external factors influencing service provision. The project will report in late 1999 and its recommendations will be considered by the Department for 2000 - 2001.
5.3 Emergency Services Funding
The Emergency Services Categorisation and Funding Taskforce continues to provide advice to the Department on the categorisation of emergency departments and funding levels. The existing model for establishing the emergency services grants will continue for 1999 - 2000. The categorisation of hospital emergency departments for the purpose of establishing emergency service grants for 1999 - 2000 is outlined in table 5.
Table 5: Emergency Department Categorisation and Notional Funding Levels for 1999 - 2000
| Categorisation |
($’000s) |
|
|
|
$8,728.1
|
Alfred, Austin and Repatriation Medical Centre, Monash Medical Centre, Royal Melbourne |
|
|
$5,433.4
|
Box Hill, Dandenong, Frankston , Geelong, Northern, St Vincent’s, Western (Footscray) |
|
|
$3,796.9
|
Ballarat, Bendigo, Maroondah |
|
|
$2,170.1
|
Angliss, Goulburn Valley, Latrobe Regional |
|
|
$1,627.7
|
Mildura, Wangaratta, Warrnambool |
|
|
$1,085.1
|
Central Wellington, Hamilton, Sandringham, Swan Hill, West Gippsland, Williamstown, Wodonga |
|
|
$542.6
|
Wimmera, Echuca, Bairnsdale |
|
|
(Specialist)
|
Royal Children’s ($4,364.0), Sunshine ($3,054.7), Royal Victorian Eye & Ear ($2,181.9), Royal Women’s ($1,091.1), Mercy - East Melbourne ($763.7) |
It must continue to be stressed that the grant does not represent the total actual emergency department cost, as emergency services funding is also provided through inpatient WIES payments. Training and Development Grants also contribute to funding of staff working in all areas of hospitals, including hospital medical officers and registrars.
A review of triage practices across hospitals will be undertaken during 1999 - 2000 by nominated Emergency Physicians in conjunction with the Department.
In order to enhance the capacity for patients to receive sensible and consistent health promotion and illness prevention messages, together with illness care, selected outer suburban hospitals with emergency departments (all E2 hospitals with the exception of St. Vincent’s Hospital and including Maroondah Hospital) will receive $85,000 each to establish health promotion support centres focussing on emergency care. These centres are intended to provide teaching and resources for mainstream staff - importantly the very large number of hospital staff who rotate through emergency departments. It is intended that opportune health promotion be encouraged as part of emergency care, where appropriate - not an activity conducted by "someone else".
Hospital waiting areas will also be provided with dedicated internet facilities, allowing patients and visitors to explore the Better Health Channel, which will progressively provide a wealth of information on good health, illness, care options, and available services.
The output based funding model for outpatient radiation oncology services which was introduced for the 1998 - 99 financial year will be continued in 1999 - 2000. Each provider will be paid a variable payment for radiotherapy treatment up to a target number of weighted activity units. The existing cost weights for planning, simulation, megavoltage treatment, dosimetry and consultations will continue to be applied in 1999 - 2000. A study will be commissioned in the new financial year to update these weights.
In 1999 - 2000 the target number of units for each provider will be set at the base targets for 1998 - 99 plus up to 2.5 per cent growth in public patient services in 1999 - 2000. The 1999 - 2000 price per weighted activity unit is set at $103.10.
In 1998 - 99, overall growth remained at around 4 per cent, and was made up solely of private patient services. Based on data transmissions to the Agency Information Management System (AIMS) from providers to April 1999, public patient services declined at all facilities during 1998 - 99. Three of the four service providers did not meet their 1998 - 99 targets.
The 2.5 per cent allowance for growth in public patient services in 1999 - 2000 has been included for the purpose of checking the overall decline in public patient services.
Associated costs closely related to megavoltage activity will continue to be paid at the standard rate of 45 per cent of the variable payment. The associated costs include other associated departmental costs, such as allied health, patient transport, patient accommodation and staff education costs. The specified grants made in 1998 - 99 will be indexed on CPI and continue to be paid to providers of specialist services including SXRT, DXRT, Brachytherapy and Stereotactic Radiosurgery.
Payments will continue to be made subject to transmission of a data report from each centre indicating occasions of service undertaken. The AIMS Form 111-S8 of AIMS has been revised with separate public, private and Department of Veterans’ Affairs entries.
The location of three facilities providing radiotherapy services in Metropolitan Melbourne and one in Geelong has posed significant geographic access problems to rural Victorian residents. The establishment of the Murray Valley Private Hospital located in Wodonga has provided the opportunity for some rural residents requiring radiotherapy services to receive these locally. The hospital began operating in March 1999. With the objective of addressing the problem of access for rural residents, the Department is entering into an agreement to enable purchase of public inpatient radiotherapy services from the Murray Valley Private Hospital. Negotiations with the Commonwealth have led to an agreement for all radiation oncology outpatients at Murray Valley Private Hospital to be funded under the Commonwealth Medicare Benefits Scheme.
A joint Commonwealth/State Radiotherapy Single Machine Unit Trial was announced in September 1998 by Minister Wooldridge and Minister Knowles. Three sites in rural Victoria, Ballarat, Bendigo and La Trobe Valley, will be part of this trial.