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An Overview of Canadian Case Mix Initiatives

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An Overview of Canadian Case Mix Initiatives 2008 Australian Casemix Conference, Adelaide November 17, 2008 Jeff Hatcher Canada - Health Care Spending Approximately $ ... – PowerPoint PPT presentation

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Title: An Overview of Canadian Case Mix Initiatives


1
An Overview of Canadian Case Mix Initiatives
  • 2008 Australian Casemix Conference, Adelaide
  • November 17, 2008
  • Jeff Hatcher

2
Canada - Health Care Spending
  • Approximately 160 billion in 2007
  • 11 of GDP
  • 4,900 per person
  • 58 of expenditures hospitals, physicians, drugs
  • Significant increase in drug costs in last 30
    years
  • 70 of expenditures are publicly funded
  • Remaining 30 split equally between private
    insurance and out of pocket

3
Canada Some Current Issues
  • Wait times
  • Health human resources
  • Physicians, nurses
  • Bed shortages
  • Involvement of private sector in health care
  • Financing
  • Delivering

4
CIHI Our Mandate
  • Coordinate, develop and maintain a comprehensive
    integrated approach to health information for
    Canada
  • To provide accurate and timely health information
    for
  • Sound health policy
  • Effective management of the health care system
  • Public awareness of health determinants
  • Well-being of Canadians

5
Whats Included in Canadian Case Mix Systems
  • Acute Inpatient
  • Acute Ambulatory
  • Rehabilitation
  • Inpatient Psychiatry
  • Complex Continuing Care and Long Term Care
  • Home Care

6
Case Mix Groups (CMG)
  • Acute care inpatients
  • Based primarily on diagnoses and interventions
  • ICD-10-CA and Canadian Classification of
    Interventions (CCI)
  • Development and performance at mature level
  • Most complete coverage of all Canadian groupers
  • 21 Major Clinical Categories
  • 588 CMG cells
  • Additional factors adjust the base weight for
    each CMG cell
  • Age, interventions, comorbidities
  • Redeveloped methodology (CMG) released in 2007
  • ICD-10-CA/CCI and Canadian case-cost data

7
Comprehensive Ambulatory Classification System
(CACS)
  • Emergency, day surgery, and outpatient clinic
    patients
  • Based primarily on main problem and main
    intervention
  • ICD-10-CA/CCI
  • 19 Major Ambulatory Clusters
  • 301 CACS cells
  • 112 cells are intervention driven
  • Additional factors adjust the base weight for
    each CACS cell
  • Major investigative technology and visit
    disposition
  • Currently being redeveloped
  • New product to be released in 2011

8
CMG and CACS Resource Indicators
  • Resource Intensity Weight (RIW)
  • Relative cost weight
  • Relative to the average cost of typical acute
    inpatient
  • Expected length of stay (ELOS)
  • CMG
  • Initial release of CMG in 2007 included
    redeveloped RIW and ELOS methodology
  • Significant updates in 2008

9
Rehabilitation Patient Groups (RPG)
  • Developed by the Ontario Ministry of Health and
    Long Term Care
  • Adult, inpatient, rehabilitation patients
  • 21 Clinical Categories
  • 83 RPG cells
  • Episode of care
  • Assessment at admission and another at discharge
  • Episode is grouped based on motor and cognitive
    scores from admission assessment
  • Coverage
  • 206 facilities

10
System for Classification of In-Patient
Psychiatry (SCIPP)
  • Developed as a collaboration of interRAI and the
    Ontario Ministry of Health and Long Term Care
  • Adult, inpatient, mental-health patients
  • 7 Clinical Categories
  • 47 SCIPP cells
  • Episodes of care
  • Assessments at admission, quarterly and at
    discharge
  • Each assessment is grouped, splits based on
    provisional DSM-IV diagnoses and behaviour

11
Resource Utilization Groups (RUG)
  • interRAI Resource Utilization Groups-III
    (RUG-III)
  • Complex continuing care and long term care
    patients
  • 7 Clinical Categories
  • 44 RUG cells
  • Episodes of care
  • Assessments at admission, quarterly, and at
    discharge
  • Each assessment is grouped, splits based on
    therapy time, clinical conditions, and Activities
    of Daily Living score
  • Coverage
  • 123 complex continuing care facilities
  • 219 long term care facilities

12
Resource Utilization Groups Home Care
  • interRAI Resource Utilization Groups-III
    (RUG-III-HC)
  • Home care patients
  • 7 Clinical Categories
  • 23 RUG-HC cells
  • Episodes of care
  • Assessments completed on an infrequent basis
  • Each assessment is grouped, splits based on
    clinical conditions, and Activities of Daily
    Living (ADL) score
  • Services (e.g., therapies, homekeeping) reported
    separately
  • Multiple services with different costs and time
    frames

13
RPG, SCIPP, RUG, and RUG-HC Resource Indicators
  • RPG, SCIPP and RUG
  • Relative resource intensity weights
  • Weighted patient days
  • RUG-HC
  • No resource indicators at present time

14
Use of Case Mix Systems in Canada
  • Utilization management
  • Planning and budgeting
  • Funding
  • Case mix systems used to a small degree
  • Case mix systems will likely play bigger role in
    future

15
CIHI Case Mix Team Whats Keeping Us Busy Today
  • CMG
  • Continual evolution and annual refinement
  • Improvements in cost weight estimation
  • RUG and RUG-HC
  • Rapid growth in number of long term care
    facilities and home care organizations reporting
    data
  • SCIPP
  • Weighted patient day methodology
  • CACS redevelopment
  • Data quality
  • Measurement, impact assessment and mitigation
  • Client education and analytical assistance

16
CIHI Case Mix Team Whats On the Horizon
  • Electronic health record
  • Patients journey through the healthcare system
  • SNOMED-CT
  • Understanding the potential and the impact
  • Population-based grouper
  • Prediction of utilization of various types of
    care
  • Potential for utilization management and funding

17
RPG Assignment
18
SCIPP Clinical Categories
19
RUG Clinical Categories
RUG
-
III
RUG
-
III
-
HC
Clinical Categories
1(Special) Rehabilitation
14
groups
3
groups
2Extensive Care
3
groups
3
groups
3Special Care
3
groups
2
groups
Hierarchical
Clinical Categories
4Clinically Complex
6
groups
4
groups
5Cognitive Impairment
4
groups
3
groups
6Behavioural Problems
4
groups
3
groups
10
groups
5
groups
7Reduce Physical Functions
44
groups
23
groups
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