Improving Patient Flow reviewing the overlap in

DRGs amp ACFI funding to increase capacity and care in Health amp Aged Care

14 Mar 16

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March 14 2016Healthaged care Chronic Conditions Patient Flow primary careWalter de Ruyter

AuthorWalter de Ruyter

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ACFI and DRGs are performance based instruments under the auspice of the Federal Government and accessed by both aged care providers and state and territory governments Service providers meet strict criteria for the release of these funds In the case of DRGs the cost weights are reviewed validated by States and Territories in conjunction with the Federal Government to ensure their efficacy in funding episodes of care

The following is an example A resident in an aged care facility is transferred from hospital back to their aged care residence with a VAC dressing[i] The cost of this dressing is $1100 a week and the aged care provider receives ACFI revenue of approx $1400 a week Comparatively the cost if this resident was to continue their stay in hospital is $8400 a week which includes the cost of the VAC dressing at $1100 a week This example is one of many where there are informal arrangements between hospitals and aged care providers where the hospital has given a supplement of care such as a VAC dressing to complement the funding the aged care provider has available to care for the early return home of their resident

The resident subsequently passed away peacefully in their own nursing home bed three weeks following discharge from the hospital The cost of their aged care bed plus VAC dressing was $7500 but the cost if they had stayed in hospital was estimated at $25200 The saving to the broader health system was $17700 In this instance the VAC dressing cost is captured in the DRG classification to pay for hospital care The cost of the VAC dressing could be identified in the DRG case weight and paid as a supplement to the aged care service complementing their existing ACFI claim for this resident The trigger for payment would be capturing this increment of care in a clinicalcare pathway under the auspice of the hospital participating in an integrated networked approach between the hospital aged care provider and primary care network

The result would be a dynamic performance-based approach to cross subsidy between two funding instruments which complement Medicare the National Disability Insurance Scheme (NDIS) and the Pharmaceutical Benefits Scheme (PBS) managed collaboratively by State and Federal Government This approach complements Consumer Directed Care (CDC) where eligible funding follows the consumer to point of need ndash being their home ndash rather than point of service such as a hospital

[i] Application of a vacuum pump using a foam dressing to a wound Negative-pressure wound therapy (NPWT) is a therapeutic technique using a vacuum dressing to promote healing in acute or chronic wounds and enhance healing of first and second degree burns

The Whole of Hospital Strategies to Improve Patient Flow conference taking place in May will examine approaches to drive patient centred care through intelligent service design Book your place by March 24th to save $200