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The Pricing Framework 2018-19 builds on the six Pricing Frameworks from previous years. The Pricing Framework is the key strategic document underpinning the National Efficient Price (NEP) and National Efficient Cost (NEC) Determinations for the financial year 2018-19.
The Inter-rater reliability study final report was approved by the Pricing Authority in April 2017. The primary aims of the study were to test the inter-rater reliability of the mental health phase of care instrument, gather information about the clinicians' views of the mental health phase of care, identifying ways of increasing the clarity to reduce the ambiguity of the instrument, and to provide recommendations on how the instrument may be refined.
ICD-10-AM/ACHI/ACS Tenth Edition was implemented between 1 July 2017 and 30 June 2019 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 9.0 was implemented from 1 July 2018 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 9.0 is published as a set of three Definition Manuals described below.
The Pricing Framework 2017-18 builds on the Pricing Frameworks from previous years (2012-13, 2013-14, 2014-15, 2015-16, 2016-17). For simplicity, where IHPA has reaffirmed a previous principle, the supporting argument has not been restated in this year’s paper.
The Independent Hospital Pricing Authority (Pricing Authority) is established under the National Health Reform Act 2011 (Cth) (the Act), and by virtue of Section 131(1) of the Act is invested with the following functions relevant to this National Efficient Price (NEP)
Determination 2017-18 (Determination):
The Independent Hospital Pricing Authority (Pricing Authority) is established under the National Health Reform Act 2011 (Cth) (the Act), and by virtue of section 131(1) of the Act is invested with the following functions relevant to this 2017-18 National Efficient Cost Determination (Determination):
This document provides the technical specifications for how the Independent Hospital Pricing Authority (IHPA) developed the Activity Based Funding (ABF) models for the service streams to be funded for the National Efficient Price (NEP) and the National Efficient Cost (NEC) Determinations for 2017-18.
The Independent Hospital Pricing Authority (IHPA) engaged Ernst & Young (EY) to examine trends in the number of privately insured patients being treated in public hospitals and to identify factors contributing to observed trends to assess what impact, if any, the national ABF model has had in the utilisation of private health insurance by patients in public hospitals.