Intent: This assessment item focuses on the ability to concisely respond to specific questions and to demonstrate an understanding of the management and application of health data. Objective(s): This...

Intent: This assessment item focuses on the ability to concisely respond to specific questions and to
demonstrate an understanding of the management and application of health data.


Objective(s): This assessment task addresses subject learning objective(s):
A, B, C, D and E
This assessment task contributes to the development of graduate attribute(s):
1.2, 2.1, 2.2, 3.2 and 4.0


Type: Case study


Weight: 30%


Task:
1. Read the following case scenario.


2. Provide a response that demonstrates an understanding of the application and management of
health data and refers to literature related to the identified issues and associated tasks.


3. In the response, apply your findings to the hospital so as to assist the executive group in decision
making and planning.


4. The response should include appropriate and properly formatted tables and figures


Case Scenario – UTS Hospital
UTS hospital is a well-established charitable hospital operated on a not for profit basis. It has 250
beds in an inner-city location. The population of the local community, from which it draws the majority
of its patients, is ageing: 40% are over the age of 65 years. UTS hospital has an excellent reputation
for innovative care, rapid uptake of new technologies, teaching and research. It gets very little
support from the government for running costs, although previous governments have been generous
in meeting the cost of constructing new buildings and refurbishing old ones.
The hospital is in financial difficulty. Over 90% of the funding to the hospital for acute inpatients
comes from private health insurers. The remainder is from the Department of Veterans Affairs,
patients who pay for their own admissions, compensable patients from motor vehicle and workplace
insurance, and patients whose stay is paid from a research grant. The rate of reimbursement from
private insurers is based on a negotiated rate for each AR-DRG. Every year, insurance companies
negotiate with the hospital the rate it pays for each AR-DRG (i.e. a type of case mix- or activity-based
funding). The fees are based on the average length of stay for each AR-DRG using the Australian
cost weights.


The Chief Executive Officer (CEO) has called a special meeting of the executive to discuss the issues
facing the hospital and to plan the action they need to take. Present at the meeting are the Health
Information Manager (HIM), the Chief Financial Officer (CFO) and the Chief Information Officer (CIO).


The HIM is of the opinion that casemix-based funding using AR-DRGs are not the best method to
record performance because they do not suit the type of patients treated by UTS Hospital. She
states the majority of patients is older and more complex, and need to stay longer than the average
length of stay for each AR-DRG. She suggests that AR-DRGs are useless for measuring the
hospital’s performance when the length of stay of the patients is different to that of the average
hospital. She is of the view that the hospital should go back to insurance funds and negotiate a return
to the funding of patients on a fixed per diem basis.
As the HIM's assistant, you are tasked with examining UTS Hospital data, and preparing a summary
for the HIM to use in the upcoming meeting.


You are asked to include the following information in the summary:
1.Background
•    Definitions for per-diem and casemix funding.
•    Description of the differences of these two funding models.
•    Identification of the pros and cons of the casemix-based funding approach compared to a fixed per diem rate.
•    Description of how casemix funding is achieved in Australian hospitals.
•    Conclude this section with a statement of the aim of the analysis.


2.Method
•    A brief description of software and techniques used to examine the data


3. Results


•    Visual presentation to describe the relationship between Length of Stay (LoS) and age for the entire dataset, accompanied by a description of the findings.
•    Tabulated presentation of the top most frequent AR-DRG for patients aged 70 years and older, accompanied by a description of the findings.


4. Discussions
•    A brief discussion of the findings in relation to the two funding models.


5. Conclusion and recommendation
•    Provide a short statement of conclusion and recommendation that is linked to the UTS Hospital.