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92917 Using Health Care Data For Decision Making

tag 0 Download 5 Pages / 1,173 Words tag 11-10-2021


Read the following case scenario.

Provide a response that demonstrates an understanding of the application and management of health data and refers to literature related to the identified issues and associated tasks.

In the response, apply your findings to the hospital so as to assist the executive group in decision making and planning.

Case Scenario – UTS Hospital

UTS hospital is a well-established charitable hospital operated on a not for profit basis. It has 250 beds in an inner-city location. The population of the local community, from which it draws the majority of its patients, is ageing: 40% are over the age of 65 years. UTS hospital has an excellent reputation for innovative care, rapid uptake of new technologies, teaching and research. It gets very little support from the government for running costs, although previous governments have been generous in meeting the cost of constructing new buildings and refurbishing old ones.

The hospital is in financial difficulty. Over 90% of the funding to the hospital for acute inpatients comes from private health insurers. The remainder is from the Department of Veterans Affairs, patients who pay for their own admissions, compensable patients from motor vehicle and workplace insurance, and patients whose stay is paid from a research grant. The rate of reimbursement from private insurers is based on a negotiated rate for each AR-DRG. Every year, insurance companies negotiate with the hospital the rate it pays for each AR-DRG (i.e. a type of casemix- or activity-based funding). The fees are based on the average length of stay for each AR-DRG using the Australian cost weights.

The Chief Executive Office (CEO) has called a special meeting of the executive to discuss the issues 14/07/2017 (Spring 2017) © University of Technology Sydney Page 8 of 14 The Chief Executive Office (CEO) has called a special meeting of the executive to discuss the issues facing the hospital and to plan the action they need to take. Present at the meeting are the Health Information Manager (HIM), the Chief Financial Officer (CFO) and the Chief Information Officer (CIO).

The HIM is of the opinion that casemix-based funding using AR-DRGs are not the best method to record performance because they do not suit the type of patients treated by UTS Hospital. She states the majority of patients is older and more complex, and need to stay longer than the average length of stay for each AR-DRG. She suggests that AR-DRGs are useless for measuring the hospital’s performance when the length of stay of the patients is different to that of the average hospital. She is of the view that the hospital should go back to insurance funds and negotiate a return to the funding of patients on a fixed per diem basis.

As the HIM's assistant, you are tasked with examining UTS Hospital data, and preparing a summary for the HIM to use in the upcoming meeting.

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