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The Independent Hospital Pricing Authority is committed to providing the Australian health care industry with a nationally consistent method of classifying all types of patients, their treatment and associated costs. Consequently, resources continue to be devoted to the ongoing development of a Diagnosis Related Groups (DRG) classification system based on local clinical practice.
As prescribed in Section 225 of the National Health Reform Act 2011 (the Act), the objectives of the IHPA Work Program are to:
- set out IHPA’s work program for the coming year; and
- invite interested persons (including states and territories) to make submissions to the Pricing Authority about the work program up to 30 days after publication.
An extract of Section 225 of the Act is attached at Appendix 1.
ICD-10-AM/ACHI/ACS Ninth Edition was implemented between 1 July 2015 and 30 June 2017 for classifying episodes of admitted patient care across Australian hospital services.
The ICD-10-AM/ACHI/ACS classification system is comprised of the following classifications:
The Australian Refined Diagnosis Related Group (AR-DRG) Version 8.0 was implemented from July 1, 2016 and is the Australian Diagnosis Related Group (DRG) patient classification system that provides a clinically meaningful way of relating the types of patients treated in the hospital to the resources required by the hospital. AR-DRGs incorporate the ICD-10-AM/ACHI/ACS.
The AR-DRG Version 8.0 is published as a set of three Definition Manuals described below.
The 2015-16 Pricing Framework builds on the three previous Pricing Frameworks (2012-13 Pricing Framework, 2013-14 Pricing Framework and 2014-15 Pricing Framework). For simplicity, where IHPA has reaffirmed a previous principle, the supporting argument has not been restated in this year’s paper. IHPA issued the Pricing Framework prior to releasing the NEP and NEC Determinations, which were made publicly available in March 2015.
Governments agreed to establish the Independent Hospital Pricing Authority (the IHPA) to provide independent advice about the efficient cost of public hospital services. Much of this advice will be evidence‐ based, drawing on technical knowledge and expertise about the classification, costing and funding of public hospital services. But, the IHPA must also balance a range of national policy objectives including improving the efficiency and accessibility of public hospital services.
The Independent Hospital Pricing Authority (IHPA) has commissioned the development of a comprehensive Pricing Framework for use in the implementation of activity based funding (ABF) for Australian public hospitals. This report is a short summary of the implementation options, together with selected consultation questions.