New activity-based funding model for Australian private sector overnight rehabilitation cases: the rehabilitation Australian National Sub-Acute and Non-Acute Patient (AN-SNAP) model

2015 ◽  
Vol 39 (4) ◽  
pp. 365
Author(s):  
Brian Hanning ◽  
Nicolle Predl
Keyword(s):  
Health Service ◽  
Private Sector ◽  
Classification System ◽  
Processing System ◽  
Relative Cost ◽  
Payment Model ◽  
Australian Health ◽  
Funding Model ◽  
Acute Patient ◽  
Payment Models

Traditional overnight rehabilitation payment models in the private sector are not based on a rigorous classification system and vary greatly between contracts with no consideration of patient complexity. The payment rates are not based on relative cost and the length-of-stay (LOS) point at which a reduced rate applies (step downs) varies markedly. The rehabilitation Australian National Sub-Acute and Non-Acute Patient (AN-SNAP) model (RAM), which has been in place for over 2 years in some private hospitals, bases payment on a rigorous classification system, relative cost and industry LOS. RAM is in the process of being rolled out more widely. This paper compares and contrasts RAM with traditional overnight rehabilitation payment models. It considers the advantages of RAM for hospitals and Australian Health Service Alliance. It also considers payment model changes in the context of maintaining industry consistency with Electronic Claims Lodgement and Information Processing System Environment (ECLIPSE) and health reform generally. What is known about this topic? The Australian Health Service Alliance is unaware of any recent studies comparing and contrasting current Australian private sector rehabilitation models with AN-SNAP-based models. What does this paper add? This paper outlines the advantages of an AN-SNAP payment model with regard to paying for services in relation to relative cost and avoiding perverse incentives in relation to rehabilitation patient admission and LOS. What are the implications for practitioners? Basing private sector rehabilitation payment models on AN-SNAP can address deficiencies of traditional payment models.

scholarly journals Combining DRGs and per diem payments in the private sector: the Equitable Payment Model

2005 ◽  
Vol 29 (1) ◽  
pp. 80 ◽  
Author(s):  
Brian W T Hanning
Keyword(s):  
Length Of Stay ◽  
Private Sector ◽  
Classification System ◽  
Relative Cost ◽  
Private Hospitals ◽  
Payment Model ◽  
Continual Improvement ◽  
Robust Classification ◽  
The Many ◽  
Payment Models

The many types of payment models used in the Australian private sector are reviewed. Their features are compared and contrasted to those desirable in an optimal private sector payment model. The EPMTM (Equitable Payment Model) is discussed and its consistency with the desirable features of an optimal private sector payment model outlined. These include being based on a robust classification system, nationally benchmarked length of stay (LOS) results, nationally benchmarked relative cost and encouraging continual improvement in efficiency to the benefit of both health funds and private hospitals. The advantages in the context of the private sector of EPMTM being a per diem model, albeit very different to current per diem models, are discussed. The advantages of EPMTM for hospitals and health funds are outlined.

scholarly journals Factors associated with unplanned readmissions in a major Australian health service

2019 ◽  
Vol 43 (1) ◽  
pp. 1 ◽  
Author(s):  
Julie Considine ◽  
Karen Fox ◽  
David Plunkett ◽  
Melissa Mecner ◽  
Mary O'Reilly ◽  
...  
Keyword(s):  
Health Service ◽  
Hospital Admission ◽  
Acute Care ◽  
Index Admission ◽  
Unplanned Readmission ◽  
Factors Associated ◽  
Australian Health ◽  
Increased Risk ◽  
Patient Groups ◽  
Comorbidity Index

Objective The aim of the present study was to gain an understanding of the factors associated with unplanned hospital readmission within 28 days of acute care discharge from a major Australian health service. Methods A retrospective study of 20575 acute care discharges from 1 August to 31 December 2015 was conducted using administrative databases. Patient, index admission and readmission characteristics were evaluated for their association with unplanned readmission in ≤28 days. Results The unplanned readmission rate was 7.4% (n=1528) and 11.1% of readmitted patients were returned within 1 day. The factors associated with increased risk of unplanned readmission in ≤28 days for all patients were age ≥65 years (odds ratio (OR) 1.3), emergency index admission (OR 1.6), Charlson comorbidity index >1 (OR 1.1–1.9), the presence of chronic disease (OR 1.4) or complications (OR 1.8) during the index admission, index admission length of stay (LOS) >2 days (OR 1.4–1.8), hospital admission(s) (OR 1.7–10.86) or emergency department (ED) attendance(s) (OR 1.8–5.2) in the 6 months preceding the index admission and health service site (OR 1.2–1.6). However, the factors associated with increased risk of unplanned readmission ≤28 days changed with each patient group (adult medical, adult surgical, obstetric and paediatric). Conclusions There were specific patient and index admission characteristics associated with increased risk of unplanned readmission in ≤28 days; however, these characteristics varied between patient groups, highlighting the need for tailored interventions. What is known about the topic? Unplanned hospital readmissions within 28 days of hospital discharge are considered an indicator of quality and safety of health care. What does this paper add? The factors associated with increased risk of unplanned readmission in ≤28 days varied between patient groups, so a ‘one size fits all approach’ to reducing unplanned readmissions may not be effective. Older adult medical patients had the highest rate of unplanned readmissions and those with Charlson comorbidity index ≥4, an index admission LOS >2 days, left against advice and hospital admission(s) or ED attendance(s) in the 6 months preceding index admission and discharge from larger sites within the health service were at highest risk of unplanned readmission. What are the implications for practitioners? One in seven discharges resulted in an unplanned readmission in ≤28 days and one in 10 unplanned readmissions occurred within 1 day of discharge. Although some patient and hospital characteristics were associated with increased risk of unplanned readmission in ≤28 days, statistical modelling shows there are other factors affecting the risk of readmission that remain unknown and need further investigation. Future work related to preventing unplanned readmissions in ≤28 days should consider inclusion of health professional, system and social factors in risk assessments.

scholarly journals Learning from the transfer of a fellowship programme to support primary care workforce needs in the UK: a qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023384 ◽  
Author(s):  
Carol Bryce ◽  
Rachel Russell ◽  
Jeremy Dale
Keyword(s):  
Health Service ◽  
Qualitative Study ◽  
Workforce Development ◽  
Urgent Care ◽  
The South ◽  
The West ◽  
Clinical Placements ◽  
Funding Model ◽  
West Midlands ◽  
The Impact

ObjectivesService redesign, including workforce development, is being championed by UK health service policy. It is allowing new opportunities to enhance the roles of staff and encourage multiprofessional portfolio working. New models of working are emerging, but there has been little research into how innovative programmes are transferred to and taken up by different areas. This study investigates the transferability of a 1-year post-Certification of Completion of Training fellowship in urgent and acute care from a pilot in the West Midlands region of England to London and the South East.DesignA qualitative study using semistructured interviews supplemented by observational data of fellows’ clinical and academic activities. Data were analysed using a thematic framework approach.Setting and participantsTwo cohorts of fellows (15 in total) along with key stakeholders, mentors, tutors and host organisations in London and the South East (LaSE). Fellows had placements in primary and secondary care settings (general practice, emergency department, ambulatory care, urgent care and rapid response teams), together with academic training.ResultsSeventy-six interviews were completed with 50 participants, with observations in eight clinical placements and two academic sessions. The overall structure of the West Midlands programme was retained and the core learning outcomes adopted in LaSE. Three fundamental adaptations were evident: broadening the programme to include multiprofessional fellows, changes to the funding model and the impact that had on clinical placements. These were felt to be key to its adoption and longer-term sustainability.ConclusionThe evaluation demonstrates a model of training that is adaptable and transferable between National Health Service regions, taking account of changing national and regional circumstances, and has the potential to be rolled out widely.

A health management competency framework for Australia

2020 ◽  
Vol 44 (6) ◽  
pp. 958
Author(s):  
Zhanming Liang ◽  
Felicity Blackstock ◽  
Peter Howard ◽  
Geoffrey Leggat ◽  
Alison Hughes ◽  
...  
Keyword(s):  
Health Service ◽  
Health Services ◽  
Middle Level ◽  
Competency Framework ◽  
Competency Assessment ◽  
Australian Health ◽  
Assessment Program ◽  
Service Managers ◽  
And Training ◽  
Management Competency

ObjectiveThis study examined whether the management competency framework for health service managers developed in the Victorian healthcare context is applicable to managers in other Australian states. MethodsAn online questionnaire survey of senior and middle-level health service managers in both community health services and hospitals was conducted in New South Wales and Queensland. ResultsThe study confirmed that the essential tasks for senior and middle-level managers are consistent across health and social care sectors, as well as states. Core competencies for health services managers identified in the Victorian healthcare context are relevant to other Australian states. In addition, two additional competencies were incorporated into the framework. ConclusionThe Management Competency Assessment Program competency framework summarises six competencies and associated behaviours that may be useful for guiding performance management and the education and training development of health service managers in Australia. What is known about the topic?The evidence suggests that competency-based approaches can enhance performance and talent management, and inform education and training needs, yet there has been no validated competency framework for Australian health service managers. What does the paper add?This paper explains the process of the finalisation of the first management competency framework for guiding the identification of the training and development needs of Australian health service managers and the management of their performance. What are the implications for practice?The Management Competency Assessment Program competency framework can guide the development of the health service management workforce in three Australian states, and may be applicable to other jurisdictions. Further studies are required in the remaining jurisdictions to improve the external validity of the framework.

scholarly journals Good reasons to vaccinate: mandatory or payment for risk?

2020 ◽  
pp. medethics-2020-106821
Author(s):  
Julian Savulescu
Keyword(s):  
Public Health ◽  
Health Service ◽  
Community Service ◽  
Expected Utility ◽  
Perceived Risk ◽  
Payment Model ◽  
Cash Payment ◽  
Mandatory Vaccination

Mandatory vaccination, including for COVID-19, can be ethically justified if the threat to public health is grave, the confidence in safety and effectiveness is high, the expected utility of mandatory vaccination is greater than the alternatives, and the penalties or costs for non-compliance are proportionate. I describe an algorithm for justified mandatory vaccination. Penalties or costs could include withholding of benefits, imposition of fines, provision of community service or loss of freedoms. I argue that under conditions of risk or perceived risk of a novel vaccination, a system of payment for risk in vaccination may be superior. I defend a payment model against various objections, including that it constitutes coercion and undermines solidarity. I argue that payment can be in cash or in kind, and opportunity for altruistic vaccinations can be preserved by offering people who have been vaccinated the opportunity to donate any cash payment back to the health service.

Litigation in otolaryngology – trends and recommendations

2006 ◽  
Vol 120 (12) ◽  
pp. 1001-1004 ◽  
Author(s):  
J R Savage ◽  
G M Weiner
Keyword(s):  
Risk Management ◽  
National Health Service ◽  
Health Service ◽  
Private Sector ◽  
Clinical Assessment ◽  
The Other ◽  
Good Communication ◽  
Record Keeping ◽  
Delay In Diagnosis ◽  
Medical Defence

Background: Seeking to identify where litigious claims against otolaryngologists are targeted (i.e. areas of highest risk) within the NHS and private sector would have positive implications in risk management and limiting the amount of litigation against otolaryngologists.Method: The National Health Service Litigation Authority (NHSLA) and Medical Defence Union (MDU) were contacted and anonymous data obtained on claims within ENT.Results: 887 claims were notified – 457 NHSLA and 430 MDU. The commonest claim in both groups was failure or delay in diagnosis (12 per cent NHSLA, 23 per cent MDU). The other commonest claims were all related to complications (nerve damage 10 per cent, deafness 8 per cent and dental damage 5 per cent). Dissatisfaction with results was 8 per cent total and, within the private sector, was almost exclusively in rhinology.Conclusions: This study once again emphasizes the need for thorough clinical assessment, record keeping and good communication with patients. Recognising these areas of highest risk may limit future claims.

Professional Nursing Governance in a large Australian health service

2012 ◽  
pp. 3259-3280
Author(s):  
Paul N Bennett ◽  
Cherene Ockerby ◽  
Jo Begbie ◽  
Cheyne Chalmers ◽  
Robert G Hess ◽  
...  
Keyword(s):  
Health Service ◽  
Australian Health ◽  
Professional Nursing
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