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This report presents the results of phase one of the project to develop Australian Refined Diagnosis Related Groups (AR-DRG)1 Version (V) 8.0. This phase focuses on the case complexity component of the classification that has not been reviewed for many years
The Pricing Framework for Australian Public Hospital Services 2014-2015 builds on the two previous Pricing Frameworks (2012-2013 Pricing Framework and 2013-2014 Pricing Framework). For simplicity, where IHPA reaffirmed a previous principle, the supporting argument was not restated in this paper.
ICD-10-AM/ACHI/ACS Eighth Edition was implemented between 1 July 2013 and 30 June 2015 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 7.0 was implemented from July 1, 2014 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 7.0 is published as a set of three Definition Manuals described below.
In June 2012, the Independent Hospital Pricing Authority (IHPA) published the National Efficient Price Determination for 2012-13, and the Pricing Framework for Australian Public Hospital Services 2012- 2013 that underpinned the determination. In September 2012, IHPA released a consultation paper on key issues that IHPA was considering in the preparation of the Pricing Framework for Australian Public Hospital Services 2013-2014.
This Discussion Paper develops the elements of a Draft Pricing Framework for use by the Independent Hospital Pricing Authority in the national implementation of activity based funding (ABF) for Australian public hospitals.