Independent Hospital Pricing Authority

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the Independent Hospital Pricing Authority have just released the pricing determination and cost weights etc, for the National Activity Based Funding Scheme.

Of interest to those here, Hospital Based Podiatry Outpatients $133.66, which has double from the Victorian VACS model currently in place, but Physio has a cost price of $174, Speech Path $143, wound management $219, and nail surgery (which is considered a minor surgical procedure) $2018

These are all based on available data, which for most allied health disciplines in hospitals is not too good. By comparrison an Endocrine consult is costed at $308 (MBS pays between $61 and $212), Vasc Surg $207 and Ortho $190. There is sure to be a fair bit of refinement in these cost weights over the next two years.

 

Steven

Thanks for this info. You would, I imagine, have a far greater grasp of the significance of these numbers than the average podiatrist.

Would you care to make some predictions about the new pricing scheme and its impact on public podiatry services?

LL

 

LL
The new pricing scheme will not have any real affect until it is in full swing in 2014-15.
At that stage I can see inpatient podiatry increasing, as it has done in Victoria under case mix funding. Podiatry interventions, such as sharp debridement of a diabetics foot ulcer can add $7,000 to a payment, and all lesser debridement can also affect a DRG.
This has led to most Victorian public hospitals, who have been activity base funded since 1996, doubling their podiatry services, as the existing podiatrists put together business cases outlining the financial benefit to the health service.
The out patient allied health funding is now more closely aligned to the medical payment, so it provides more opportunity to substitute medical practicioners for allied health and nursing, without any real payment penalty, as payments become more based on the patient that the practitioner, ie what was doe, not who did it.

There are potential opportunities for an increase in podiatry led minor surgical procedures (skin and nail, as the politics of bone surgery as still too great for any hospital to tackle). Nail surgery meets the criteria for an automatic admission, as wel as a minor surgical OP procedure, so decisions will need to be made as to which provides the best funding.

Overall activity based funding with the commonwealth providing 50% of the growth dollars from 2014-5, will provide more opportunities than barriers.

 

Just to be clear, do public sector podiatrists do the minor surgical procedures of skin and nail? or is still an orthopaedic sugeon and his intern student?

 

Depends on the site. It would be incredibly rare for an orthopd to peform such surgery, it is usually performed either by a podiatrist, in a similar way to private practice, or a general surgeon or his registrar, with probable support from an intern. Interns (1st or 2nd year Doctors) can't perform any surgery without direct supervision, and registrars also operate under supervision, but this is sometimes not always direct.

 

thanks stephen,

also to be clear, when such procedures are taken by the podiatrist, what rooms will be utilized for the procedure? a small operating theatre? would there be an assistant nurse for the purposes of infection control room scrubbing and for surgical assistance? it is just very curious because public practices may vary with private etc.

 

At our health service Podiatry performed nail surgeries are performed in the podiatry department, usually with 2 podiatrists, and no-one else (except the odd student)

As the vast majority of nail surgieries across the country are performed by surgeons in a day theatre, often with an anethetist, this drives the average cost of the procedure up, hence the $2000 cost weight. This cost weight, though is likely to be refined as costing data improves etc.

Activity Based Funding is based primarily on what is done, rather than who does it, so when a podiatrist performs a procedure usually performed by a medical practicioner, the cost will be lower, but the payment to the hospital will be the same

 

The document makes interesting reading. Stephen, would you possibly be able clarify with these costing figures is this what public pod departments get funded per consult or per episode of care? or is it what hospital pod departments should be charging the various wards for inpatient care?
On reflection makes private sector seem quite cheap in comparison, but also very cheap if you factor in bed days pushing $1000 (not sure how much it is now?) even if you included a taxi there...

thanks for posting.

 

It is the average cost, based on available data (which at this early stage, quite poor) of providing the service in a public hospital, including all of the associated infrastructure costs of a hospital (payroll, finance, supply, quality, administration, etc. that don't generate income). So it is what the hospital gets paid/funded at, to a capped activity limit, not what it costs the pod dept.The IHPA and Activity Based Funding, are funding instruments for hospitals, if they can perform a procedure below that price, the hospital benefits, if not they may choose not to perform that procedure. As hospitals become more efficient,
including using more nursing and allied health instead of medical, the average cost will likely drop, and so will the associated funding.