Nhcdc round 19 Independent Financial Review

Victoria

1. Jurisdictional overview

   1. Management of NHCDC process

The Victorian Department of Health and Human Services (VIC Health) is responsible for the collation, review and submission of data to the NHCDC. All major Victorian health services are required to operate and maintain patient level costing systems to determine accurate patient level costs. This is specified within VIC Health’s annual Victorian Policy and Funding Guidelines.

The Victorian patient level costing process is supported by the Victorian Clinical Costing User Group (VCCUG). The VCCUG is a public health service led group, supported by VIC Health. It is comprised of costing staff from Victorian health services, a number of costing vendor representatives and departmental staff. This group meets on a monthly basis to discuss and action jurisdictional and where relevant national costing issues. Currently a member of the VCCUG holds a position on Independent Hospital Pricing Authority’s NHCDC Advisory Committee (NAC).

VIC Health conducts an annual costing collection known as the Victorian Cost Data Collection (VCDC) that collects patient level costed data from metropolitan, regional and sub-regional Health Services. The VCDC is used to support the development of Victoria’s annual funding model, to support the analysis of cost data for budget and benchmarking purposes and to meet the NHCDC requirements.

Victorian health services submit cost data to the VCDC ensuring they adhere to the specifications and Business Rule documentation. The cost data is then mapped to the NHCDC data specification. The VCDC Business Rules and VCDC file specification documentation are reviewed and updated annually.

VIC Health is responsible for transforming the VCDC data into the format required for the NHCDC file specification. Upon receipt of the health service submission to the VCDC, VIC Health staff undertake a three stage validation process. The first validates the structure and content of the file specification. The second links the cost data to the existing activity datasets that have been submitted to the department. Examples of these include the Victorian Admitted Episodes Dataset (VAED), Victorian Emergency Minimum Dataset (VEMD) and the Victorian Non-Admitted Health Minimum Dataset (VINAH). The third maps to the Victorian cost buckets. Following this process a series of reports are provided to the health service for review. Health services are then offered the opportunity to resubmit their reviewed data. VIC Health does not adjust any costing record submitted by the health service (for inclusions, exclusions or validity).

Following the completion of this validation process, a series of quality assurance (QA) checks are undertaken to test the data for a range of cost quality controls, including low and high cost episodes and comparisons over a period of time. These are again reviewed by health services who advise on the validity of the costed record to finalise the number of costed records for the Victorian cost data set. To accompany the validation and quality assurance checks, a series of reconciliation templates are submitted as part of the VCDC process. These are submitted five days post the health services final VCDC submission. These templates are of a similar format to the current IFR templates and include a Director's attestation sign-off.

The dataset provided through the VCDC submission informs the NHCDC submission. The format of the VCDC allows the VCDC output to be mapped to the NHCDC file specification. VIC Health undertakes this mapping. VIC Health reviews the specification each year and performs a number of data checks against the NHCDC specifications to enable submission to IHPA.

Prior to the final NHCDC submission to IHPA, a brief is provided to the Deputy Secretary of VIC Health demonstrating the type and number of activity and the associated costs to be submitted to IHPA for NHCDC purposes. This brief is first approved by the Assistant Director, Funding Policy and System Development and Director, Policy and Planning, and the Deputy Secretary, Health Service Policy & Commissioning.

VIC Health nominated three hospitals to participate in the IFR for Round 20 based on the hospital sampling criteria provided. The hospitals selected to participate included, The Royal Women’s Hospital, Austin Health and Swan Hill District Health.

Key initiatives since Round 19 NHCDC

VIC Health implemented a number of initiatives since the Round 19 NHCDC submission. These have been summarised below:

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  Revised the 2014-15 VCDC documentation to be clearer and less ambiguous for implementation, including:
  
• 
  Expanded sections to include clear definitions, guidance and actions/outcomes for costing and reporting data to the VCDC.
  
• 
  Updated and expanded on reference files, such as Chart of Account mapping and lists of classifications e.g. Diagnosis Related Group (DRG), Urgency Related Group (URG), Tier2, Australian National Subacute and Non-Acute Patient (ANSNAP).
  
• 
  Incorporated other documents for information such as methodologies for determining and allocating specific costs including:
  
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  Medical Indemnity;
  
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  National Blood Authority;
  
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  Health Purchasing Victoria;
  
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  Home based Non-Admitted Services; and
  
• 
  North Western Mental Health reporting arrangements.
  
• 
  Updated validation rules for files and streamlined the file expectations including the rules surrounding the creation and submission of the files.
  
• 
  Expanded and defined the scope of the collection for activity and expenditure including guidance on episode matching and linking to patients and how costs are to be identified and submitted.
  
• 
  Provided specific guidance on the reporting requirements for Non-Admitted Services and Mental Health.
  
• 
  Revised and updated the linking rules of the cost data to the relevant activity datasets including linking to VAED, VEMD, and incorporating new rules for VINAH (including preparation for the move to patient level data for non-admitted patients) and Client Management Interface (CMI) for Mental Health (MH).
  
• 
  Defined clear rules on cross matching algorithms that redirect costs such as admitted emergency and radiotherapy costs to admitted patients, and incorporating new rules for mental health consultation liaison services to emergency or admitted patients and unqualified newborn costs redirected to the mother DRG.
  
• 
  Developed and incorporated the submission of the cost data for each phase of care for palliative care patients.
  
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  Revised and updated the cost bucket matrix to better reflect the types of costs to be analysed at a service cost group level. For example, medical costs will now map to the medical costs bucket and not the nursing costs bucket.
  
• 
  Expanded and updated the data quality assurance checks to be performed on final submissions for admitted, emergency and non-admitted services and included new checks for mental health and subacute services. These QA reports are sent to the health services and require feedback regarding the exclusion of records.
  
• 
  Revised and updated the financial reconciliation templates to be more user-friendly and elaborated on the content to be provided.
  
• 
  Included the communication details provided to Health services’ at each stage of the process.²²
  

In addition, VIC Health has implemented cost data review forums, where comparative data is presented for the benchmarking of health services. These forums involve both costing and operational staff from the health services. Cost data is now also available in the benchmarking tool for admitted, emergency and non-admitted patients.

2.