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2. Basis For Determining Government Funding
2.1 Components of Funding A hospital’s funding will be based on: These grants and admitted patient and outpatient target volumes are shown in Section A and shown in the agency’s Health Service Agreement. Funding is provided to hospitals and Networks on the basis that the current range of services provided are continued. Before hospitals or Networks undertake a significant change in the range or scope of services, the planning implications of such a move must be discussed and agreed with the Department. In rural areas, the appropriate discussion should be held with the Regional Provider Manager or Acute Health Manager. In the metropolitan area discussions should be held with the Acute Health Program and the Region. In all cases, the Director of Acute Health Division must provide the final approval. Hospitals will also receive revenue from private patients. Government Grant payments to hospitals will consist of the hospital’s entitlements as specified in the HSA and Conditions of Funding, net of relevant patient revenues (see clause 4). 2.2 Calculation of the Payment For Admitted patient Services 2.2.1 The term "weighted inlier equivalent separation" means the measure of activity calculated by multiplying the DRG weight by the number of Inlier Equivalent Separations in the DRG and summing over all DRGs. For 1999 - 2000 this statistic will be abbreviated as WIES7. The method and calculation of WIES7 is shown in Section C. Notional Fixed Grant 2.2.2 The following rates have been applied to Target A (fixed) when calculating the notional fixed grant for 1999 - 2000: Major Providers (Network and Barwon Health):$833 Rural Group B (greater than 10,000 WIES)$847 Rural Group B (less than 10,000 WIES) & Group C$868 Rural Group D$891 Rural Group E$891 Under the formula separate weights have been provided for certain DRGs (e.g. renal dialysis and high theatre/prosthetics DRGs) for the purpose of calculating fixed and variable WIES7. Under WIES7 the notional fixed Target A is lower or equal to the variable Target A. Variable Grant 2.2.3 The Variable admitted patient payments are calculated as follows: 2.2.4 Option & Tender Pool. Conditions for these payments are outlined in Section A. 2.2.5 Quarterly targets will be determined by the agency. Actual throughput against target will be reviewed at the end of the second, third and fourth quarters. Funding adjustments may be made where actual performance varies significantly (more than 2%) from the nominated quarterly targets. 2.2.6 Nursing Home Type Patient Payment. The hospital will receive $126 for each nursing home type bed day as reported in the VAED. 2.2.7 Rural/Isolated Payment. This payment provides a contribution for isolated and rural hospitals for additional costs incurred in transferring patients in non-metropolitan areas. This payment is supplementary to the higher fixed WIES payment received by non-metropolitan hospitals and does not purport to represent a payment for total ambulance transfer costs. The payment is as follows: For isolated hospitals the additional ambulance transfer payment is $35 for each weighted inlier equivalent separation up to the agreed contract volume. For other rural hospitals the additional payment is $14 for each weighted inlier equivalent separation up to the agreed contract volume. 2.3 Department of Veteran Affairs (DVA) Patients. New funding arrangements for eligible DVA patients came into place from 1 July 1998. In accordance with these arrangements, separate capped public targets and uncapped veterans estimates were incorporated into hospital budgets during 1998 - 99 for WIES, rehabilitation and nursing home type beddays. Hospitals received payment at a premium to casemix for these services to eligible veterans. Payment required an exact match of hospital veteran data with DVA records. In addition, a premium was paid for VACS encounters and allied health occasions of service based on a three month survey. For each hospital, the Department will specify an estimate of DVA patient throughput for the following services: Notwithstanding the provisions of Clause 2.2 the Department will pay a premium to the casemix rate applicable for all eligible DVA patients matched with DVA records (as reported in the VAED or where appropriate AIMS) including numbers in excess of the estimate. If hospitals do not achieve the DVA target, any funding which has been cash flowed will be recalled at the full DVA rate. The Department will work with hospitals to collect electronically, veteran data for VACS, allied health and outpatient radiotherapy which will allow DVA to confirm eligibility. 2.3.1 If the hospitalisation of an eligible veteran is likely to exceed a continuous period of 35 days, hospitals shall ensure that the veteran’s status is reviewed and that either:
Where an admitted veteran’s length of stay is greater than 35 days and no acute care certificate in accordance with (a) above has been forwarded to DVA, hospitals will only be reimbursed at the Nursing Home Type patient payment rate. 2.4 Non-Admitted Patients Grant. 2.4.1 The Victorian Ambulatory Classification System (VACS) operates in selected hospitals. For details of the VACS system and funding allocations including emergency department allocations for 1999 - 2000 refer to Section A. 2.4.2 For non-VACS funded hospitals, the non-admitted patients grant is for the provision of services specified in the Health Service Agreement. 2.4.3 If there is a significant reduction in services to non-admitted patients in non-VACS funded hospitals the grant may be reduced during the course of the financial year. (A significant change for the purpose of this clause is defined as one which involves a reduction in the service levels of more than ten percent.) 2.4.4 Hospitals are responsible for providing such ambulance transport as is necessary, on clinical grounds, to ensure access for outpatients without charge to these patients. 2.4.5 Where hospitals failed to reach target levels set for 1998 - 99, adjustments have been made for the 1999 - 2000 targets. 2.4.6 The Victorian Ambulatory Classification System patient payments are calculated as follows: VACs rate per weighted encounter....................$109 Allied healthper occasion of service...................$40 2.5 Training and Development Grants. 2.5.1 The Training and Development Grant is allocated to fund the specific programs and positions specified in the Health Service Agreement. The grant will be paid to the employer of the funded position. Where training positions include a period of rotating placements, participating agencies are required to ensure that the host agency receive a proportion of the grant equal to the length of the rotation. 2.5.2 Where positions remain unfilled by staff with credentials approved by the Department or programs offered by the hospital are not operated at budget levels, the Training and Development Grant will be adjusted to reflect actual performance. 2.5.3 Funding for all nursing programs is based on the academic year and is dependant on adequate financial acquittals being provided to the Department of Human Services regarding expenditure of the Grant. 2.5.4 Graduate Nurse Programs must meet the following criteria:
In addition, the programs should conform to the Graduate Nurse Program Guidelines Department of Human Services (September 1997). 2.5.5 For the Graduate Nurse, Student Midwife and Postgraduate Programs, approval must be sought from the Department of Human Services for any increase in numbers over and above projected numbers submitted at the start of the academic year. 2.5.6 Student Midwives 2.5.7 Rural Supplement
2.5.8 The research and development component of the Training and Development Grant is designed to fund research infrastructure for the hospital (including support for institutional ethics committees) together with support for academic units based at the hospital, including units funded by universities and independent research institutes. Hospitals in receipt of this grant will need to demonstrate that at least the amounts allocated have been expended for these purposes. 2.5.9 The Training and Development Grant also includes a component (10%) designed to fund the cost associated with clinical placements of undergraduate students including medical, nursing and allied health students. The allied health undergraduate component is allocated on the basis of clinical placement days. 2.6 Payments for Specified Purposes. 2.6.1 Additional payments will be provided to the hospital for the purposes specified in the Health Service Agreement. 2.6.2 Where the grant is based on a particular level of service, and there is a significant reduction in such services, the grant may be reduced during the course of the financial year. (A significant change for the purpose of this clause is defined as one which involves a reduction in the service levels of more than ten percent.) 2.7 Victorian Maintenance Dialysis Program. 2.7.1 Hospitals participating in the Victorian Maintenance Dialysis Program will receive funding in two components: a program grant; and (for admitted patients) a case payment. 2.7.2 The program grant will be received by parent hospitals. Parent hospitals are required to negotiate with satellite centres arrangements for the provision of satellite dialysis services to be funded by the program grant. 2.7.3 A grant will be provided for each patient receiving dialysis supervised by the hospital. The rates are: In-Centre :.........................................................$24,660 pa Satellite Haemodialysis..........................................$19,624 pa Home Haemodialysis:.............................................$27,961 pa Intermittent Peritoneal Dialysis................................$25,318 pa Continuous Ambulatory Peritoneal Dialysis..................$35,183 pa This grant is provided for patients receiving care supervised by a public hospital and will not be paid for patients dialysed in private hospitals. 2.7.4 The grant will be based on monthly statistical returns from the hospital (AIMS Form 111/S6). 2.7.5 Funds will be advanced on the basis of current patient numbers as recorded in the Health Service Agreement and payments adjusted for actual service provision on a quarterly basis. 2.7.6 Total numbers of patients being dialysed in Victoria will be monitored, and if the increase in numbers exceeds the number provided for in Section A, the payments may be capped by the Department. 2.7.7 For dialysis services provided within the hospital, variable payments will also result from the VAED coding of the admitted patients as set out in Section C. 2.8 Rehabilitation 2.8.1 Only those agencies specifically designated by the Department as providers of rehabilitation services are eligible for payment of rehabilitation grants. 2.8.2 The new system VicRehab will apply for all designated units with 20 beds or more. In 1999 - 2000, this includes: 2.8.3 Funding for these units will be based on weighted units for Level 2 patients using the CRAFT classification. It will also include specified grants for Level 1 and Level 2 categories: amputees, spinal, head injury and burns cases. DVA patients (refer Chapter 2) will continue to be paid at a bedday rate. 2.8.4 A budget/activity cap will be allocated to VicRehab agencies. Rehabilitation weighted units and bed days will be calculated from data reported in the VAED. No payment will be made for services in excess of the target. 2.8.5 For two years payment is guaranteed to the current Network and rural regional levels. Compensation grants will be paid for two years. 2.8.6 Level 1 rehabilitation is for use by designated specialty programs providing rehabilitation following spinal cord injury, head injury or amputation and where the rehabilitation episode directly follows the acute care episode in which the injury was the principal diagnosis. Subsequent episodes of care following the initial rehabilitation episode are not classified as Level 1. The Level 1 bedday rate is $350 per bedday. 2.8.7 Funding for designated units of less than 20 beds will continue to be block funded based on the following bedday rates: Level 1:$350 per bed day Level 2:$291 per bed day Agencies designated at Level 3 (interim designation) will be paid at Level 2 rates. 2.8.7.1 A target bedday cap will apply to these agencies. Where the actual number of bed days provided is less than the allocation payments will be adjusted to reflect the actual service provision. No payment will be made for services in excess of the target.
2.9 Radiation Oncology. A standard payment per weighted activity unit, introduced in 1998 - 99 will be continued in 1999 - 2000. Payments will be based on monthly statistical returns from the hospital (AIMS 111/S8). Funding will be provided at the rate of $103.10 per weighted activity unit. Growth of up to 2.5% on public patients will be funded at the full variable rate. 2.10 Hospital Accreditation Guidelines for funding through the Accreditation Outcomes Program are outlined in Section A - Appendix 3. 2.11 Specific Purpose Grants for Admitted patient Services to Persons from Non-English Speaking Backgrounds (NESB Grants) 2.11.1 Networks and hospitals will be notified of NESB grants for 1999 - 2000. They will be calculated on the same basis as in 1998 - 99. 2.11.2 The broad intent of the NESB grant is to encourage hospitals to improve service delivery to admitted patients of non-English speaking background. Hospitals receiving grants are required to be able to spend the amounts allocated on strategies which are consistent with those outlined in the publication Working with Patients from non- English speaking backgrounds: Guidelines for Health Agencies. 2.12 Hospital Access Program. Hospital Access Program performance bonuses will be determined in accordance with the provisions of Section A - Appendix 4. 2.13 Hospital in the Home. Hospital in the Home incentive payments will be determined in accordance with the 1999 - 2000 HITH Policy. Hospitals are required to operate within Guidelines as outlined in Section A - Appendix 7. 2.14 Hospital Complaints Indicator Program In 1999 - 2000, the Quality Branch proposes piloting two indicators relating to complaints management: a state wide indicator to monitor the number of hospitals regularly reporting data to the Office of the Health Services Commissioner (OHSC); and an indicator to monitor the effectiveness of hospital complaints management processes.
2.15 Neonatal Services As a result of the Review of Neonatal Services, hospitals with Neonatal Intensive Care Units and Special Care Nurseries will be expected to undertake some specific activities. These are: Targeted hospitals are receiving growth funding in 1999 - 2000. In order to retain these growth funds, these hospitals are required to show evidence of the following: For Special Care Nurseries:
Neonatal Intensive Care Units:
2.16 Redirection of Funds. Where total earnings for the Acute Health program exceed the expenses incurred in delivery of the full quantity of services specified in the Health Services Agreement, the surplus may be used by the hospital for any purpose connected with its agreed function. 2.17 Privacy 2.16.1 The Hospital, its employees, agents or subcontractors must comply with the Department's Information Privacy Principles and any relevant legislative provisions that bind the Department in relation to privacy as amended from time to time including in relation to the collection, retention, management, use, quality, disclosure or transfer of information regardless of whether the Hospital, its employees, agents or subcontractors are bound by those legislative provisions. 2.16.2 The Hospital must ensure that its employees, agents and subcontractors comply with this requirement. 2.16.3 In this clause: |
