Victorian Cost Data Collection - Better Health...

Department of Health

Victorian Cost Data Collection

Business Rules for Reporting 2012-13 Cost Data

Revision History – changes from prior year (2011-12 VCDC process) Page Section Sub Heading Description

5 Purpose New narrative

6 Costing principles Scope of Costing Hospital Activity, Scope of Expenditure

New narrative

7 Teaching and Research

Linking Ancillary services

New narrative re transitioning to compliance

Reference to AHPCS standards

8 Depreciation

Medical indemnity

New narrative re transitioning to compliance

New narrative re new process

10 Program definitions Minor heading change

13 Definitions and Guidelines N – Non-admitted Update link to 2012-13 reference dataset.

17 Definitions and Guidelines Stream Update link to 2012-13 reference dataset.

Table 5 updated to reflect changes in reference dataset.

26 File Implementation File Naming Convention Inclusion of MMM (month) extension in file name. Inclusion of zipped file format.

34 Appendix Appendix Clinical Costing Standards Association of Australia (CCSAA) Clinical Costing Version 5.1.17. Reference to Radiotherapy and Borders guidelines page 126.

Contents

Contents 3

Glossary of Acronyms and Abbreviations 4

Purpose 5

Costing Principles 6

Reporting Requirements 7

Teaching & Research - (Note: Victoria in transition to full compliance) 7

Linking of Ancillary Services 7

Depreciation - (Note: Victoria in transition to full compliance) 8

Medical Indemnity 8

Blood Costs 9

Post Domiciliary Nursing 9

Drug Costs 9

Medical Costs 10

Definitions & Guidelines 11

Program „episodeProgram‟ Definitions 11

Episode Number Format 19

Stream 20

Clinic Code 22

Area 22

Account 23

Service Location 30

Date of Service 31

Data Validations 32

General validations 32

Admitted data validations 32

Non-admitted data validations 33

Financial Reconciliation 34

Cost Allocations 34

Glossary of Acronyms and Abbreviations

AHPCS Australian Hospital Patient Costing Standards

CCOA Common Chart of Accounts

CCU Critical Care Unit

CMBS Commonwealth Medical Benefits Schedule

DH Department of Health

ED Emergency Department

ESSU Emergency Short Stay Unit

GL General Ledger

IHPA Independent Hospital Pricing Authority

HACC Home and Community Care

HEN Home Enteral Nutrition

HIV Human Immunodeficiency Virus

HSA Health Services Agreement

OP Outpatient

PBS Pharmaceutical Benefits Schedule

S&W Salaries and Wages

VACS Victorian Ambulatory Classification System

VAED Victorian Admitted Episodes Dataset

VCCUG Victorian Clinical Costing User Group

VCDC Victorian Cost Data Collection

VEMD Victorian Emergency Dataset

VINAH Victorian Non-admitted Health Minimum Dataset

VMO Visiting Medical Officer

VRMDS Victorian Radiotherapy Minimum Dataset

Purpose

All Victorian metropolitan and major rural Health Services are required to submit annual patient level cost data to the Victorian Cost Data Collection (VCDC), refer Victorian health policy and funding guidelines.

Victoria is currently in transition to a National Pricing Model and uses the VCDC as the base data for submission to the Independent Hospital Pricing Authority (IHPA) for National Hospital Cost Data Collection (NHCDC).

Cost outputs need to be managed by Health Services to ensure the reporting of costs is in alignment with the Australian Hospital Patient Costing Standards (AHPCS).

The VCDC dataset reflects Health Services‟ level of resource and service provided for patient care and is used to:

inform the setting of Victorian and National weights,

inform development of funding models and budget proposals,

analysis of the cost of health care,

bench marking comparisons,

best practice quality improvement initiatives.

This document provides guidance to Health Services in the costing and reporting of 2012-13 patient level cost data while in transition to the National Pricing Model.

The aim for 2012-2013 reported cost data is to

comply with the VCDC File Specifications,

comply with the Australian Hospital Patient Costing Standards (AHPCS) V2.0 - excluding standards relating to Depreciation (DEP 1.001, 1A.001,1B.001,1C.001 1D.001 and 1E.001), Teaching (SCP 2A.002) and Research (SCP 2B.001); and

be used for benchmarking and best practice improvement initiatives.

This document has been developed by the department in consultation with the Victorian Clinical Costing User Group (VCCUG).

Costing Principles

Scope of Costing Hospital Activity

Health Services will allocate costs to all hospital outputs as listed below (refer AHPCS SCP 1.003):

Admitted patients by care type Emergency department presentations Non-admitted patients Hospital auspiced community health and Teaching and research

Note: Health Services are in transition and moving towards fulfilling this scope. Interim instructions for Teaching and Research are outlined below.

Scope of Expenditure All expenditure incurred by or on behalf of the Health Service related to day-today delivery of services is to be included, refer AHPCS (SCP 2.002). All costs submitted to the VCDC must be allocated to a cost area that has a cost centre mapping of "Final" (AHPCS) or the equivalent "Direct" (CCSAA)."

….One of the end aims of the costing process is to redistribute all overhead cost centres across final costs centres so that statistics can be created for specific patient care costs." Refer AHPCS GL 4.003 - Cost centre Mapping

Costs of resources will be matched to the period in which they actually incurred Costing will be based on the accrual ledger used in the creation of audited financial statements, refer AHPCS (GL 1.002.) Work in progress (WIP): Patients who are admitted but not discharged within the current financial year will be treated as WIP. Interim cost calculation based on the summation of costs to the end of the fiscal period will be classified as WIP and will ensure an accurate reflection of costs. WIP activity and costs are held over until the patient is discharged, coding completed and classifications and DRG weights assigned, refer AHPCS COST 5.001. Health Services must allocate 100% of General Ledger (GL) operating expenses in the costing process, to all patient episodes, or where no feeder exists, a derived patient episode.

The level of derived episode created will depend on the granularity of the GL and activity data available. For example, if a Health Service provides several sub-acute ambulatory services to patients, they may wish to create only one derived episode per costing period (i.e. year, month or quarter depending on costing practices) to allocate all the costs for providing these services. Alternatively, more specific expenditure details may be available that allows the site to separate costs for different services e.g. Post-Acute Care (PAC) or Hospital Admission Risk Program (HARP). Non-HSA expenses should not be included in the costing process unless they relate to the provision of patient services and can be allocated to the appropriate non-HSA funded activity e.g. expenses relating to private practice or Commonwealth funded activity should be included if the activity data is brought in from feeder systems. Note: These Non HSA costed activity will be required to be identified for inclusion/exclusion of funding models (as required ) through various classification group e.g. specified clinic codes, refer AHPCS GL 5C.001 Matching Activity and Cost - Commercial Business Entities. Health Services are in transition and moving towards fulfilling this scope.

Reporting Requirements

Victorian Health Services are required to report 2012-13 patient cost data to DH by 31 October, 2013.

This data must be reported to the VCDC in compliance with the VCDC File Specifications for Reporting

of 2012-13 Cost Data. VCDC File Specification 2012-13 Reference Files available at

http://www.health.vic.gov.au/hdss/vcdc/index.htm.

This deadline provides an opportunity for resubmissions, if required, to ensure data conforms to VCDC

File Specifications.

Data reported to the VCDC reflects costs for “episodes of care” provided to patients. Types of „episodes

of care” in the VCDC are defined by an „episodeProgram‟ code. Examples are Admitted and Emergency

episodeProgram. Refer to the following Definitions and Guidelines in this document for a detailed

explanation of these.

Cost data in the VCDC is reported at the level of Cost Area and Account Type. This allows the cost data

to be utilised for NHCDC reporting requirements, as well as prior year comparisons to Victorian Cost

Groups and funding model developments.

For the VCDC 2012/13 service date is not required as a mandatory field, there is no need to change

specifications to reflect this; the file can be submitted with this field empty.

Victorian Cost Groups are based on the former Clinical Costing Standards Association of Australia‟s

(CCSAA) Cost Groups. The Department of Health will be responsible for mapping and rollup of VCDC

data to NHCDC reporting requirements. This will be on the basis of the cost area prefix and account

codes provided by Health Services in their VCDC submission.

Teaching & Research - (Note: Victoria in transition to full compliance)

2012-13 HSA operating expenses relating to teaching and research activities are to be allocated to

patient cost outputs. If feeder data exists then it should be allocated as direct products, or alternatively

as indirect costs. Cost should first be allocated to the most appropriate cost area within the costing

system (e.g. medical units for teaching and training undertaken by medical staff) and then allocated to

episodes using the most appropriate cost allocation. The following table outlines the preferred indirect

cost allocation methods for the most common types of operating cost incurred with teaching, training and

research activities.

Table 1: Indirect Allocation Methods for Teaching and Research

Expense Type Allocation Method

S&W Medical Medical EFT

S&W Nursing Nursing EFT

S&W Allied Health Allied Health EFT

S&W Other Other EFT

MS/GS Expenditure

Linking of Ancillary Services

Ancillary services such as diagnostic imaging, pathology and pharmacy should be linked to the episode

of care where the service was ordered and/or delivered. The location where the service was ordered

should take precedence over where the service was delivered, refer AHPCS–COST 5.001, and COST

5A.001.


If dates are used to link services, then the rules should generally follow the following preference:

1. identify an emergency episode with the date/time of the service, or

2. identify an admitted episode encompassing the date/time of the service, or

3. identify a non-admitted consultation matching the date of the service, or

4. identify a non-admitted consultation up to 30 days prior to the service date, or

5. Identify a non-admitted consultation up to 30 days after the service date.

Where the funding source of these ancillary services is known, they should be linked to an episode of the

same funding type. For example, public funded ancillary services should only be linked to a public non-

admitted consultation.

Matching of other services to the relevant episode should therefore consider the type of service. For

example:

- Chemotherapy drugs dispensed prior to admission should be linked to a relevant admitted episode

and not to an unrelated non-admitted presentation.

- Radiotherapy treatment should be linked to a non-admitted radiotherapy episode and not to a non-

admitted medical consultation.

- Allied health practitioners do not generally order diagnostic investigations or prescribe medication

and therefore these episodes should in most instances be excluded from the linking process.

- Visiting nursing services should not generally attract diagnostic or pharmacy services.

Depreciation - (Note: Victoria in transition to full compliance)

Reporting of depreciation costs to the VCDC is not required for 2012-13 activity. If Health Services bring

depreciation costs into the costing process, then they should be allocated to a non-patient derived

episode and not reported to the VCDC. Victorian Health Services are currently in transition to full

adoption of AHPCS; for 2012-13 depreciation methodologies are not able to be consistently applied and

are not required for inclusion into VCDC.

Medical Indemnity

Medical Indemnity (MI) costs must be included in costs reported to VCDC for 2012-13 activity. Accurate allocation of costs to the appropriate product types is critical to the developments of the National Pricing and funding models. This will ensure the price weights and any adjustments (e.g. ICU adjustment) adequately represent resource use. It is mandatory that MI costs be allocated across relevant clinical areas. Where possible, allocation should reflect the medical specialties cost areas according to the risk profile presented in the current VMIA Premium Allocation Model (PAM) summary. Feedback from the Health Services resulted in multiple methods to allocate MI costs during the 2012-13 transition year. MI costs can be treated as an indirect cost and allocated using medical FTE, doctor minutes or doctor work schedules (if available). MI costs can also be treated as an overhead using the amount listed in the VMIA PAM summary as allocation statistics. These overheads are then allocated to patients based on cost drivers of the specialty/unit cost groups. The VMIA PAM model is based on DRG specialties, with the emergency allocation based on VAED admission type of “E”. Health Services should note that the PAM cost allocations may not align with their clinical specialty cost groups. In these instances local knowledge should be used to allocate costs to the most appropriate clinical cost area.

Health Services are requested to record their MI allocation method for quality assurance feedback to the department. Allocation Examples Emergency costs to be allocated to ED activity where possible. These costs have been identified as a separate data element in the PAM summary derived from the VAED admission type = “E” emergency. Anaesthetics costs to be allocated to patients that have theatre utilisation. e.g. use Anaesthetics minutes as the allocation base. ICU costs to be allocated to patients that spent time in ICU. e.g. use minutes in ICU (as per ward extract) rather than doctor minutes. Medical Specialty costs to be allocated to the specific Medical Specialty activity. Health Services can continue to apply existing allocation methods to split costs between Outpatient and Inpatient Activity and assign using existing Health Service Indirect allocation. Note: These costs have been identified in the PAM summary and derived from the DRG specialty. Health services are encouraged to continually improve allocation methodology and it is hoped a consistent approach is developed with VCCUG for future cost submissions.

Blood Costs

The AHPCS require blood costs to be reported however for 2012-13, as the department funds this cost

on a state-wide basis these costs are not included in Health Services HSA expenses. Consequently the

department will be identifying these costs incurred by Health Services‟ separately for reporting to the

Independent Hospital Pricing Authority (IHPA).

Post Domiciliary Nursing

Domiciliary nursing services are provided on a non-admitted basis to patients post-delivery and discharge from hospital. For 2012-13 the costs are to remain linked to the relevant admitted episode prior to the date the service was provided. The area (dhCostArea) should be a code in the range C1156-1200 to allow identification of these costs from admitted costs for reporting to NHCDC or other purposes.

Drug Costs

Drug costs need to be identifiable within the cost outputs as one of the following. This can be achieved by either reporting the type of drug cost using the appropriate account (dhAccountType) and/or the area (dhCostArea) field. For reporting purposes under the CCSAA cost outputs, cost records with any of three these account codes or any area code in the range N0002-1000 will be reported in the cost output group „Pharmacy‟.

Drug Type dhAccountType dhCostArea

Pharmaceutical Benefits Schedule (PBS) PharmPBS N0896, N0897*

High cost drugs funded under Section 100 (S100) PharmS100 N0898, N0897*

Non-PBS PharmNPBS N0002-0499,N0897*, N0899-N1000

*Cytoxic Drugs - these may be PBS, S100 or NPBS drugs and therefore if reported with this dhCostArea need to be identified by the appropriate dhAccountType.

Medical Costs

Medical costs are often difficult to allocate accurately as limited patient level activity data exists and/or the costs within the GL are difficult to apportion accurately to services provided. Where possible, health services should separate the surgical medical costs (e.g. operating room expenses) from non-surgical medical expenses (e.g. consultation) for reporting. This allows for the accurate identification of full Operating Room costs. To achieve this health services may need to apportion surgical expenses to a separate cost area and report with an area code which maps to a „MedSurg‟ cost output under the Victorian cost outputs, and OR cost output under the AHPCS.

Definitions & Guidelines

Program ‘episodeProgram’ Definitions

The program field (episodeProgram) identifies the type of cost episode reported. The following

categories are applicable for 2012-13 cost data. The appropriate linking keys have also been defined to

assist in linking costing data to other activity data reported to the Department such as the Victorian

Admitted Episodes Dataset (VAED), the Victorian Emergency Minimum Dataset (VEMD), the Victorian

Non-admitted Health Minimum Dataset (VINAH) and the Victorian Radiotherapy Minimum Dataset

(VRMDS). The Department will however undertake final linking where program = E or R cost data to the

VAED using existing linking algorithms based on campus, ur, eStart and eEnd fields.

Table 2: Episode Program Values and Key Definitions

Value Description Episode Key

(ekey)

DH Unique Key (dhKey) Encounter ID

(encounter)

A Admitted CCS Unique Key VAED Unique Key N/A

B Boarders CCS Unique Key N/A IP CCS Unique Key

C Community Health CCS Unique Key N/A N/A

E Emergency Department CCS Unique Key VEMD Unique Key IP CCS Unique Key*

N Non-Admitted CCS Unique Key VINAH Contact Identifier

or N/A or UNALLOCATED

N/A

M Mental Health CCS Unique Key CMI/ODS Admission ID or

Contact ID

CMI/ODS State-wide UR

O Organ Procurement CCS Unique Key N/A N/A

R Radiotherapy CCS Unique Key VRMDS Unique Key or

UNLINKED

IP CCS Unique Key*

S Research CCS Unique Key N/A N/A

T Teaching & Training CCS Unique Key N/A N/A

U Other Non-Admitted CCS Unique Key UNALLOCATED or

UNLINKED

N/A

W Other Admitted CCS Unique Key N/A N/A

X Other/Non-Patient CCS Unique Key N/A N/A

* = If episode occurred while patient was admitted and can be linked to an admitted episode

CCS Unique Key = Clinical Costing System Unique Key

IP CCS Unique Key = Clinical Costing System Unique Key of an admitted episode

N/A = Not applicable for these episodes. Field is to be omitted or submitted as blank or NULL.

A – Admitted Episodes

Program value „A‟ is valid for all care types reported to the Victorian Admitted Episode Dataset (VAED).

B – Boarders

Program value „B‟ is valid for hospital boarders who are receiving food and/or accommodation but for

whom the hospital does not accept responsibility for treatment and/or care. Hospital boarders are not

admitted to the hospital and not reported as unique episodes to the VAED. Babies in hospital at age 9

days or less cannot be boarders. They are admitted patients with each day of stay deemed to be either

qualified or unqualified (Appendix 1).

Permutation 1 – Presentation to ED

Emergency DepartmentEmergency Department

VEMD Departure Date/Time

VEMD Departure Date/Time

VEMD Arrival Date/Time

VEMD Arrival Date/Time

Episodes Created

VEMD VAED Costing

Y N E – All costs

Episodes Created

VEMD VAED Costing

Y N E – All costs

ServicesServices

Minimal costs should be allocated to boarders reflecting only the cost of food and/or accommodation

provided to them.

C – Community Health

Program value „C‟ is valid for services provide by Health Services and funded by the Department of

Health‟s Community Health Care program area funding. This includes the following areas:

- Diabetes Self-Management

- Community Health

- Aboriginal Promotion and Chronic Care

- Family Planning

- Family and Reproductive Rights Education Program

- Primary Health

- Women‟s Health

- Integrated Chronic Disease Management

- Refugee Health Services

- Healthy Mothers Healthy Babies

- Children‟s Weight Management

E – Emergency

Program value „E‟ is used to identify VEMD reportable activity in a recognised Emergency Department

(ED). The cost records associated with these episode records should reflect the care provided while the

patient was in the ED. Where possible the admitted eKey (episodeKey) should be reported with the

Emergency episode (via the encounter field) for admitted emergency episodes to assist linking of the two

episodes. The VEMD unique key should be reported as the dhKey (dhUniqueKey) for all emergency

episodes.

Emergency Short Stay Units (ESSUs) are considered admitted areas and should be reported with an

area (dhCostArea) code in the range B0102-0200. Consequently health services may need to separate

these costs from other ED costs within the costing system if they are not separately reported in the GL.

The following examples provide guidance on the linking of services and costs to program = A (admitted)

and E (emergency) episodes.

Example 1: Patient presentation to ED treated and sent home or transferred to another facility.


ED Departure Date/Time

ED Departure Date/TimeED Arrival & Admit

Date/Time

ED Arrival & Admit Date/Time

Episodes Created

VEMD VAED Costing

Y Y E – Cost in EDA -Cost after ED Departure

Episodes Created

VEMD VAED Costing

Y Y E – Cost in EDA -Cost after ED Departure

Permutation 2 – Presentation to ED, sub

sequentially admitted to a ward

Ward Ward

ServicesServices

Discharge Date/Time

Discharge Date/Time


ED Arrival/Admit Date/Time

ED Arrival/Admit Date/Time

Episodes Created

VEMD VAED Costing

Y Y E – All costsA – No Costs

Episodes Created

VEMD VAED Costing

Y Y E – All costsA – No Costs

Permutation 3 – Presentation to ED & admitted to

ED

ServicesServices

ED Departure/ Discharge Date/Time

ED Departure/ Discharge Date/Time

Example 2: Patient presentation to ED treated and subsequently admitted to a ward.

Example 3: Same day admission in ED subsequently discharged home.

Note: This may result in an admitted episode with zero or minimal costs that may be rejected on

submission to VCDC.

HITH Admit

Date/Time

HITH Admit

Date/Time

Episodes Created

VEMD VAED Costing

Y x 2 Y E x 2 – All costs relating to EDA – All Costs relating to HITH admission

Episodes Created

VEMD VAED Costing

Y x 2 Y E x 2 – All costs relating to EDA – All Costs relating to HITH admission

Permutation 7 – Presents to ED during HITH

admission

ServicesServices

HITH Discharge Date/Time

HITH Discharge Date/Time

EDED EDED

WardWard

ED Arrival Date/Time

ED Arrival Date/Time

Admit Date/Time

Admit Date/Time

Episodes Created

VEMD VAED Costing

Y Y E – Cost after dischargeA – Cost up to discharge

Episodes Created

VEMD VAED Costing

Y Y E – Cost after dischargeA – Cost up to discharge

Emergency Department Emergency Department

ServicesServices



Discharge Date/Time

Discharge Date/Time

Example 4: Patient presentation to ED, admitted for treatment to an Emergency Short Stay Unit

(ESSU), subsequently transferred to a ward.

Note: Where possible the admitted eKey (episodeKey) should be reported with the Emergency episode

(via the encounter field). ESSU costs should be reported with an area (dhCostArea) code in the range

B0102-0200.

Example 5: Admitted to a ward for treatment, treated in ED on discharge from ward.

Example 6: Presents to ED during HITH admission

N - Non-admitted

Program value „N‟ is valid for all service events that are currently, or could be, reported to the Victorian

Integrated Non-Admitted Health Minimum Dataset (VINAH). This includes the following:

- Sub-Acute Ambulatory Services

- Hospital Admission Risk Program

- Post-Acute Care

- Community Palliative Care

- Family Choice

- Victorian HIV Service

- Victorian Respiratory Support Service

- Medihotel*

- Specialist Outpatients– Medical & AH – public and CMBS billed**

- Victorian Perinatal Data Collection

- Transition Care Program

- Residential In-Reach

- Hospital Based Palliative Care Consultancy Team

*If the cost is part of an episode that is or could be reported to VINAH then these costs must be

reported with program = N. However, if the cost of medihotels forms a part of an episode that is

reported to the VAED then these costs must be reported with program = A.

**Information reported in the field fund (fundingSourceType) will be used by the Department to

determine the funding stream for Specialist Clinics Outpatients (OP). For example MV Public

Eligible = VACS funded Outpatients and QM Private Clinic = MBS funded Outpatients. For valid

fund codes refer to VINAH Manual 2013-13 (VINAH v8), Section 3-15 „Contact Account Class‟.

All episodes reported with program = N must report a stream (episodeProgramStream) code and where

a registered clinic (clinicCode) exists in the department‟s Non-admitted Clinic Management System, the

following fields must also be reported:

fund (fundingSourceType)

mediNo (medicareNumber)

mode (episodeDeliveryMode)

type (episodeSessionType)

sex (gender)

dob (dateOfBirth)

atsi (indigenousStatus)

pcode (postcode)

M - Mental Health

Program value „M‟ is valid for mental health services that are not reported under any other program code

(e.g. Preventative and Recovery Care Services (PARCS)). An example is admitted services not reported

to the VAED. The following hierarchy should be followed in considering whether an episode belongs to

program M. If patient level data is not available, then costs should be allocated to a derived episode i.e.

ekey = YYYYMM-Area (refer to notes in this documents relating to Aggregate Episodes).

Flow Diagram 1: Allocation of Program = M (Mental Health)

Mental Health

Service

VEMD

VAED

VINAH

Program = E

Program = N

Program = A

Episode Program

= M

No

No

No

Yes

Yes

Yes

O - Organ Procurement

Program value „O‟ is valid for services relating to organ procurement (posthumous), which is the

procurement of human tissue for the purpose of transplantation from a donor who has been declared

brain dead. Costs allocated to these episodes should reflect procedures undertaken including

mechanical ventilation and tissue procurement. These patients are not admitted to the hospital but

should be registered by the hospital.

R – Radiotherapy

Program value „R‟ is valid for episodes that relate to the provision of radiotherapy services, including

treatment and consultations.

The provision of any non-admitted radiotherapy services to an individual patient on a single day are to be

reported as a separate program R episode. Costs to be allocated to these episodes include the following

service events:

Consultations

- Medical – is the provision of specialist consultations by a Radiation Oncologist or multi-disciplinary

team. The initial consultations will usually result in the prescribing of a course of radiotherapy

treatment. During treatment, patients are also reviewed regularly by the Radiation Oncologist. Post

treatment, further consultation will be provided to the patient to review their progress and

outcomes. Ancillary services (e.g. diagnostic imaging, pathology, pharmacy) provided within 30

days either side of the consultation is considered a component of the consultation service event.

- Nursing – includes scheduled consultations by a registered nurse or nurse practitioner. It should

be noted that VACS (Specialist Outpatients) funded consultations must be reported as Program =

N.

- Allied Health – includes scheduled consultations provided by allied health practitioners but

excludes VACS (Specialist Outpatients) funded consultations. It should be noted that VACS

funded consultations should be reported as program = N.

Planning (includes the processes involved in creating a treatment plan from the Radiation Oncologist‟s

prescription and simulation stages)

- Simulation – includes the processes for establishing a treatment volume and patient position,

documenting appropriate measurements and applying tattoos to the patient. It is performed either

using a „treatment simulator‟ or a CT scanner.

- Dosimetry – includes the processes for measurement and calculation of the dose of radiation for

the radiotherapy treatment.

- Mould room - the production of positioning masks, tissue substitutes and specialised shielding for

many different treatment areas.

Treatment (the use of radiation to destroy cells administered by either external beam therapy or

internally)

- External beam – is the delivery of megavoltage or kilo voltage treatment.

- Brachytherapy – is the use of radioactive sources that are inserted directly into, or immediately

adjacent to tumours.

Course - A course of radiotherapy involves:

- A prescription by a Radiation Oncologist outlining the anatomical region/site(s) to be treated,

fractionation, and total dose to be delivered; and

- All phases of radiotherapy delivered for the management of a single disease entity relating to a

decision to treat.

The dhKey (dhUniqueKey) reported to the VCDC for program = R should reflect the Course ID reported

to the VRMDS for treatment (MVT, KVY, brachytherapy), planning (simulation, dosimetry and mould

room) service events. A dhKey (i.e. Course ID) is not required for consultation service events as many of

these may be provided independent of treatment, but should be provided if known.

Admitted Radiotherapy Treatment

Treatment provided to admitted patients (including brachytherapy) should generate a separate episode

and not be „bundled‟ to the admitted episode for reporting to the VCDC. The admitted episodes eKey

should be reported in the encounter filed for the radiotherapy episode.

Further guidelines on costing and reporting Radiotherapy activity can be referenced in Appendix (Clinical

Costing Standard Guideline 4).

S – Research Program value „S‟ is valid for derived episodes used to allocate non-operating expenses related to research (i.e. SPF funded research) if these costs are brought into the costing system.

T – Teaching & Training Program value „T‟ is valid for derived episodes used to allocate non-operating expenses related to teaching and training (i.e. SPF funded) if these costs are brought into the costing system.

U – Other Non-Admitted Program value „U‟ is to be used to identify all service events that are not on the list of VINAH reportable activity.

Program = U should be used to report the following costs:

- Non-HSA funded activity such as private patient clinics that are operated by the health service.

- Commonwealth funded activity, such as Home and Community Care (HACC) funded services (i.e.

visiting nursing services).

- Services provided to patients in their homes. For example Home Enteral Nutrition (HEN) services.

- Unlinked services. For example ancillary services such as pharmacy, pathology and imaging

services that cannot be linked to a patient episode.

- Unallocated services. For example, costs allocated to a derived episode where no feeder data

exists.

- Emergency services that are not reported to VEMD.

All episodes reported with program = U are not required to report a stream code.

W – Other Admitted Program value „W‟ is valid to identify admitted episodes that are not reported to the VAED, for example patients admitted into Residential Aged Care units.

X – Other/Non-Patient Program value „X‟ is to be used to identify non-patient episodes that are created to allocate costs to for reporting purposes, such as Non-HSA expenditure for business units operated by the health service.

Episode Number Format

Unlinked Services

Where episode numbers must be created for services that cannot be linked to an existing episode, the

following format for the episode number is to be applied and reported as the ekey value. Service Areas

are to reflect the type of feeder extract that generates the episode.

Service Area-UR-Date (YYYYMMDD)

i.e. PATH-123456-20120701

The dhKey for these episodes must be populated with UNLINKED and the program = U.

Table 3: Service Areas

Value Description

AH Allied Health

DIAG Diagnostic Imaging

PATH Pathology

PRO Procedure Suite

PHAR Pharmacy

RT Radiotherapy

OTH Other

Aggregated (Derived) Episodes

Where patient level feeder data is not available, cost should be allocated to a single „derived‟ episode.

For example, community health services may not be able to provide patient level data, but the cost of

operating the service can be identified. A cost area for this service should be created within the costing

system and the costs should be allocated through the costing process to a „derived‟ episode. This

practice will also allow for the allocation of indirect costs to the cost area and reporting of full costs of the

service. The following format of values for reporting of the ekey should be used to create and report

such episodes.

YYYYMM-AREA (Note: the date will be the last month of the processing period. If processing annually

this will be June e.g. 201306).

Examples are provided below:

Table 4: Service Areas

eKey Description

201306-PAC 2012-13Post Acute Care

201306-CHS 2012-13Community Health Services

201306-MH 2012-13Mental Health Services

201306-MEDIHOTEL 2012-13Medihotel

201306-INTERIMCARE 2012-13Interim Care (Care Type F)

The dhKey for these episodes must be populated with UNALLOCATED.

Stream

The stream field (episodeProgramStream) identifies the funding stream for VINAH reportable episodes.

Only values from the VINAH Program/Stream are to be used (Table Identifier HL70069 at

http://www.health.vic.gov.au/hdss/vinah/2012-13/manual/vinah8_sect3_data_elements.pdf

Table 5: VINAH Program Stream Codes

VINAH Program Stream Stream Description

SACS 1 Rehabilitation

2 Specialist Continence

3 Specialist Cognitive

4 Specialist Pain Management

5 Specialist Falls

6 Specialist Wound Management

7 Younger Adult/Transition

8 Specialist Paediatric Rehabilitation

9 Specialist Polio

11 Specialist Movement Disorders

19 Specialist Other*

HARP 21 HARP - Respiratory Disease

22 HARP - Heart Disease

23 HARP – Diabetes

24 HARP - People with Complex Needs

25 HARP - People with Psychosocial Needs

26 HARP – Renal

27 HARP – HIV

29 HARP - Other*

PAC 31 Post-Acute Care

PC 41 Community Palliative Care

FCP 51 Family Choice Program

VHS 61 Victorian HIV Consultancy

62 Victorian HIV Mental Health Service

63 HIV Outreach Ambulatory Care

64 HIV CALD service

65 Horizon Place

66 Chronic Viral Illness Program

67 Victorian NPEP service

68 HIV Outreach Allied Health

69 Sexual Health and Wellbeing Service*

VRSS 81 Victorian Respiratory Support Service

MediH 91 Medi-hotel

OP - Medical 101 General Medicine*

103 Cardiology

106 Gastroenterology

107 Haematology

108 Nephrology

109 Neurology

110 Oncology

111 Respiratory

112 Rheumatology

113 Dermatology

114 Infectious Diseases

116 Immunology, includes Allergy

117 Endocrinology, includes Diabetes

118 Hepatobiliary and Pancreas

119 Burns



VINAH Program Stream Stream Description

201 General Surgery

202 Cardiothoracic

203 Neurosurgery

204 Ophthalmology

205 Ear, Nose and Throat

206 Plastic Surgery

207 Urology

208 Vascular

209 Pre-admission

301 Dental

310 Orthopaedics

311 Orthopaedic applications

312 Wound care

313 Allied Health - stand-alone

350 Psychiatry and Behavioural Disorders

402 Obstetrics

403 Gynaecology

406 Reproductive medicine and Family planning

VPDC 1001 Perinatals – Mother

1002 Perinatals - Baby*

TCP 1101 Transition Care Program

RIR 1201 Residential In-reach

HBPCCT 1300 Hospital Based Palliative Care Consultancy Team*

1301 Symptom Control/Pain Management

1302 Discharge Planning

1303 Psychosocial Support/Advocacy

1304 Assessment

1305 Terminal (end of life) Care

1306 Symptom Control/Pain Management/Discharge Planning

1307 Symptom Control/Pain Management/Psychosocial Support

1308 Symptom Control/Pain Management/Assessment

1309 Symptom Control/Pain Management/Terminal (end of life) Care

1310 Discharge Planning/Psychosocial Support/Advocacy

1311 Discharge Planning/Assessment

1312 Discharge Planning/Terminal (end of life) Care

1313 Psychosocial Support/Advocacy/Assessment

1314 Psychosocial Support/Advocacy/Terminal (end of life) Care

1315 Assessment/Terminal (end of life) Care

(*) For aggregate records where a specific VINAH Stream value is not known, but the VINAH program is known, the default value

identified in bold on the following table is to be used.

Italics denotes new Streams. Please note that a number of streams have been removed in the 2012-13 reference table.

Clinic Code

The clinic code provided in the field clinic is a health service defined clinic identifier. It is to be reported for episodes where program = N and there exists a hospital generated clinic identifier for Tier 2 registered clinics on the Non-Admitted Clinic Management System. Refer: http://docs.health.vic.gov.au/docs/doc/Non-admitted-clinic-management-system In the event where it is known that costs belong to a VINAH program, but it is not known which specific VINAH program/stream, the description of the stream should be entered into this field (e.g. „SACS‟,‟ HARP‟,‟ VHS‟,‟ VDPC‟,‟ HBPCCT‟) For episodes where program = „U‟ and stream = „9999‟, a clinic description meaningful to the health service is to be entered in this field and advised to the Department for reconciliation purposes.

Area

As part of the costing process health services must map general ledger (GL) costs to a cost area within

their costing system. Depending on the software application that is being used, this cost area can also be

referred to as the cost centre, department or area. To enable consistent interpretation of cost data, health

services are required to prefix these cost areas with an alphanumeric code that can be interpreted

consistently for reporting purposes and is reported to the VCDC in the field area. The appropriate prefix

should be applied to both direct and indirect cost areas. An area code can be used more than once in a

hospital costing system however the full cost area name (prefix plus description) should be unique. A

mapping of these prefixes to the Australian Hospital Patient Costing Standards (AHPCS) and the Clinical

Costing Standards Association of Australia (CCSAA) cost outputs has been provided in the VCDC File

Specification For Reporting of 2012-13 Cost Data available at

http://www.health.vic.gov.au/hdss/vcdc/index.htm

Cost area prefixes and descriptions have been used from the Victorian Common Chart of Accounts

(CCOA) to allow greater correlation between hospital financial and costing systems. Some additional

cost areas have been added to allow meet NHCDC and Victorian reporting requirements. For example,

A0250 Birth Centre cost area has been added to allow identification of these costs and mapping to the

appropriate AHPCS and CCSAA outputs.

Clinical units cost centre ranges from the CCOA have also been „split‟ to allow for identification of

medical surgical costs (i.e. operating room/theatre surgeon costs) from other medical non-surgical costs.

There are instances where cost areas defined as Overhead cost centres under the AHPCS may be

allocated using direct cost allocation methods if appropriate feeder data exists. The cost areas listed in

Table 5 below have been identified as such areas. The prefix to be used to identify the cost area is the

same regardless of whether the costs are allocated using direct or indirect methods. However, if the

costs are reported as direct costs a mapping to the AHPCS and Victorian Cost Outputs has been

provided (part of VCDC File Specification 2012-13 Reference Files). Costs allocated using indirect

methods will not appear with these cost area prefixes in the VCDC output as they are allocated to other

direct cost areas.

Table 6: Examples of Direct or Indirect Cost Areas

Area Code Description AHPCS Final Code

(NHCDC)

AHPCS Overhead

Code (NHCDC)

CCSAA Service

Cost Group (Vic)

A8152-0100 Theatre Sterile

Supply Unit

GenOR CSSD Theatre

N2602 Interpreters OtherAllied Interp Allied Health

P0002-0050 Central Sterile

Supply

GenOR CSSD Theatre

P0052-0100 Chaplaincy OtherAllied Chap Allied Health

P0448 Ambulance GenWard PatTransport Nursing

http://docs.health.vic.gov.au/docs/doc/Non-admitted-clinic-management-system


P0450 Patient Transport GenWard PatTransport Nursing

P0499 Porters & Orderlies GenWard PortOrd Nursing

P0500 Patient Residential

Accommodation

MedHot ResAcc Nursing

R0152-0199 Food & Dietary

Services

GenWard PatFood Nursing

Account

An account type is a group of general ledger expenditure account codes defined by an input type (rather

than function as defined by a cost centre) that describe expenses incurred. The following account types

are defined for use in reporting in the field account for 2012-13 cost data to VCDC.

Table 7: Account Values

Value Description AHPCS Line Item

Blood* Blood Products Blood

Deprec* Depreciation Deprec

GS Goods & Services GS

Hotel Hotel Services Hotel

Imag Imaging Imag

Lease Leases Lease

MS Medical Supplies MS

OnCosts Labour On Costs OnCosts

Path Pathology Path

PharmNPBS Pharmacy - Non PBS or S100 reimbursed PharmNPBS

PharmPBS Pharmacy - PBS reimbursed PharmPBS

PharmS100 Pharmacy - Section 100 reimbursed PharmPBS

Pros Prosthesis Pros

PtTransport Patient Transport GS

SWAdmin Salary & Wages Administration SWOther

SWAdminOc Salary & Wages Administration On Costs OnCosts

SWAH Salary & Wages Allied Health SWAH

SWAHOc Salary & Wages Allied Health On Costs OnCosts

SWHMO Salary & Wages Hospital Medical Officers SWMed

SWHMOOc Salary & Wages Hospital Medical Officers On Costs OnCosts

SWHotel Salary & Wages Hotel SWOther

SWHotelOc Salary & Wages Hotel On Costs OnCosts

SWMed Salary & Wages Medical SWMed

SWMedOc Salary & Wages Medical On Costs OnCosts

SWMedSup Salary & Wages Medical Support SWAH

SWMedSupOc Salary & Wages Medical Support On Costs OnCosts

SWNurs Salary & Wages Nursing SWNurs

SWNursOc Salary & Wages Nursing On Costs OnCosts

SWOther Salary & Wages Other SWOther

SWOtherOc Salary & Wages Other On Costs OnCosts

SWSess Salary & Wages Sessional Medical Staff SWMed

SWSessOc Salary & Wages Sessional Medical Staff On Costs OnCosts

* Not mandatory for 2012-13cost data reporting

The Department will map the VCDC data to the AHPCS Line Item value for reporting to NHCDC.

AHPCS Line Item values of Exclude (costs not in scope) and Cap (capital works) are not valid account

values for reporting of data to the VCDC for 2012-13 as these costs are out of scope.

A mapping of Victorian CCOA Account Codes to valid account values has been provided in the VCDC

File Specification 2012-13 Reference Files available at http://www.health.vic.gov.au/hdss/vcdc/index.htm.

The table also identifies how the account values will be reported to the NHCDC under the AHPCS rollup.

The following provides further clarification on definitions of account values in accordance to the AHPCS

V2.0.

Salary & Wages

Salary and wages are the main forms of payments made to an employee. Generally, they are considered

as payments:

a) made to an individual

b) made as remuneration for services and

c) provided under a contract of service (employment contract).

Salaries and wages include ordinary hours worked, penalty rates, overtime, professional development,

and allowances (e.g. district/remote, on-call, living out, uniform and laundry). On-costs are excluded.

All salary and wages need to be allocated to one of the following ten categories.

1. Nursing

Nursing salary and wages includes the following categories of staff:

• Registered Nurses;

• Enrolled Nurses;

• Establishment Based Student Nurses and

• Trainee/pupil nurse.

2. Medical Officers (non VMO or HMOs)

Medical Officers salary and wages are incurred by Medical Officers employed by the health

service.

3. Hospital Medical Officers (HMOs)

Medical salary and wages includes the following categories of staff employed by a health service:

• Specialist and General Practice Medical Officers;

• Registrar;

• Residents and

• Interns.


4. Sessional Clinicians

Sessional Clinicians‟ salary and wages are incurred by Clinicians employed by the health service

on a sessional or Visiting Medical Officers (VMO) basis. VMOs are defined as a medical

practitioners appointed by the health service to provide medical services for hospital (public)

patients in an honorary, sessional or fee-for-service basis.

5. Allied Health

Allied Health salary and wages includes qualified staff (other than qualified medical and nursing

staff) engaged in duties of a diagnostic, technical and therapeutic services. This account type

should also include diagnostic and health professionals whose duties are primarily or partly of an

administrative nature. Exclusions to this definition are Medical Scientists, Medical Imaging

Technologists/Radiographers, Medical Physicists, Nuclear Medical Technologists, Pharmacists,

and Radiation Therapists who are identified as Medical Support.

Staff must be registered or working towards registration and must have current practicing

certificate with an applicable registered body or training towards registration under the direct

supervision of the relevant diagnostic or allied health professional.

Allied health is a collective term for a wide range of tertiary qualified health professionals, other

than medical and nursing, including but not limited to:

• Art /Music Therapists

• Audiologists

• Clinical Psychologists

• Dentists

• Dieticians/Nutritionists

• Occupational Therapists

• Orthoptists

• Orthotists/Prosthetists

• Pharmacists (Community/Hospitals)

• Physiotherapists

• Podiatrists

• Radiation Therapists

• Social Workers

• Speech Pathologists

6. Medical Support

This category includes Medical Scientists, Medical Imaging Technologists/Radiographers, Medical

Physicists, Nuclear Medical Technologists, Pharmacists and Radiation Therapists.

7. Hotel and Allied Services

This category includes staff engaged in the provision of hotel services that support the provision of

care to patients including cleaning, domestic, catering and laundry staff. It also encompasses staff

engaged in the provision of personal care to patients or residents, who are not formally qualified or

undergoing training in nursing or allied health professions and are not allocated as an overhead

cost. This category includes attendants, assistants or home assistants, home companions, family

aides, ward helpers, ward assistants, assistants in nursing and Aboriginal Health Workers.

8. Administrative and Clerical Staff

This category includes staff engaged in administrative and clerical duties including ward clerks and

administrative staff.

http://www.anzata.org/mambo/

9. Other Salary & Wages

This category includes staff salary and wages costs that cannot be allocated to any one specific

category above. Agency and external contract staff expenses that are not defined by a specific pay

type should also be grouped to this category.

On Costs

On costs are long service leave, leave loading, payroll tax, workers compensation payments (excluding

premiums that are a goods and services cost) and redundancy payments.

Goods and Services

Goods are defined as items of merchandise, finished products, supplies or raw materials. In some cases,

the term is extended to cover all inventory items or assets such as cash, supplies, and fixed assets.

Services are defined as labor performed by an individual or organisation on behalf of others. It is the

provision of services for which payment is received from a client.

Goods and Services also include Repairs and Maintenance costs and are defined as the costs incurred:

- to bring an asset back to an earlier condition or to keep the asset operating at its present

condition;

- on existing non-current assets that maintain the usefulness of an asset; or

- on repairs and maintenance of assets that are to be expensed in the Operating Statement.

Medical Supplies

Medical and surgical supplies, includes medical and surgical equipment, medical instruments and

medical aides.

Medical surgical supplies are items that:

- are usually disposable in nature; and or

- cannot withstand repeated use by more than one individual; and or

- are primarily and customarily used to serve a clinical purpose; and or

- generally are not useful to a person in the absence of illness and injury; and or

- may be ordered and used by clinical staff.

Medical and surgical supplies include external prosthetics such as prosthetic legs, external breast

prostheses, prosthetic eyes, wigs and other such devices.

It also includes dressings, minor surgical instruments, medical gases, disposable medical supplies, x-ray

supplies, medical and surgical appliances such as splints, crutches and wheelchairs.

In addition, includes items of medical equipment, surgical instruments and patient appliances which have

a life of less than one year.

Supplies that cannot be classified under these definitions should be classified under goods and services.

Pharmaceuticals

PBS reimbursed pharmaceuticals

A "pharmaceutical benefit" within the meaning of the Act refers to:

(a) An item which is listed in the Schedule of Pharmaceutical Benefits; or

(b) An item, which is listed in the Schedule of Pharmaceutical Benefits and is supplied by an approved

supplier under Part 7 of the NHA subject to subsidy

http://www.allbusiness.com/glossaries/goods/4942350-1.html

http://www.allbusiness.com/glossaries/services/4947659-1.html

S100 reimbursed pharmaceuticals

Section 100/high cost drugs‟ criteria for inclusion of drugs in the program can be summarised as follows:

- Ongoing specialist medical supervision required.

- Treatment of chronic medical conditions; not acute episodes of inpatient treatment (includes out

patient, day patient and discharge medication).

- Highly specialised drugs

- Marketing approval in Australia for approved indications.

- High unit cost and identifiable patient target group.

PBS non- reimbursed pharmaceuticals

Non-PBS drugs are prescribed when a patient‟s clinical condition does not match the restriction on the

Schedule of Pharmaceutical Benefits. A non-PBS prescription is written using a PBS prescription form.

However, the drug must be identified as “Non-PBS” on the prescription.

This category also includes the purchase, production, distribution, supply and storage of drug products

and clinical pharmacy services of all drugs that are not reimbursed by PBS or S100.

Prostheses

The term „Prostheses,‟ includes surgically implanted prostheses, human tissue and other medical

devices. Implanted prostheses include cardiac pacemakers and defibrillators, cardiac stents, hip and

knee replacements and intraocular lenses, as well as human tissues such as human heart valves,

corneas, bone (part and whole) and muscle tissue.

Criteria for listing on the Prostheses List

Products meeting all of the following criteria are eligible for consideration for inclusion on the Prostheses List:

- The product must be included or being considered for inclusion on the Australian Register of

Therapeutic Goods; and

- The product must be provided to a person as part of an episode of hospital treatment or hospital-

substitute treatment; and

- A Medicare benefit must be payable in respect of the professional service associated with the

provision of the product (or the provision of the product is associated with podiatric treatment by an

accredited podiatrist); and

- The product should be:

a. surgically implanted in the patient and be purposely designed to:

i. replace an anatomical body part; or

ii. combat a pathological process; or

iii. modulate a physiological process; and

b. essential to and specifically designed as an integral single-use aid for implanting a product

that is only suitable for use with the patient in whom that product is implanted; or

c. critical to the continuing function of the surgically implanted product and is only suitable for use

by the patient in whom that product is implanted; and

- The product has been compared to alternate products on the Prostheses List or alternate

treatments and:

a. have been assessed as being, at least, of similar clinical effectiveness; and

b. the cost of the product is relative to its clinical effectiveness.

Pathology

Pathology costs are goods and services used in the provision of a pathology service and consumables.

These costs can also be the actual cost as billed by a provider and is defined, but not limited, to the

following:

- Animal Testing

- Autopsy

- Clinical Biochemistry

- Cytogenetics

- Cytology

- Forensic

- General Pathology

- Genetics

- Haematology (laboratory)

- Histopathology

- Immunology (laboratory)

- Microbiology

- Mortuary

- Pharmacology

- Specimen collection services

- Toxicology

Imaging

Imaging cost are goods and services used in the provision of an imaging service. These costs can also

be the actual cost as billed by a provider and is defined, but not limited, to the following:

- Angiography

- Computed Tomography (CT)

- General Imaging

- Echo Cardiogram

- Mammography

- Magnetic Resonance Imaging (MRI)

- Nuclear Medicine

- Positron Emission Tomography (PET)

- Plain X-ray (including films and contrast)

- Ultrasound

Hotel

Hotel costs include the following:

- Cleaning products and services

- Linen and laundry services

- Food services (patients)

- General hotel services

Blood

These costs are defined as the:

- Blood products that are used or intended for use for human therapeutic or diagnostic purposes

and that:

a. consist of human blood or components of human blood; or

b. are derived from human blood; or

- Blood-related products that are used or intended for use for human therapeutic or diagnostic

purposes and that:

a. are alternative, analogued or complementary to the use of blood products; and

b. are regarded as blood-related products for the National Blood Agreement; or

- Services, equipment or procedures that are regarded as blood-related services for the National

Blood Agreement and that:

a. are used in the collection, supply or use of blood products or blood-related products; or

b. are alternatives to the use of blood products or blood-related products; or

c. reduce the need for blood products or blood-related products; or

d. otherwise affect the demand or supply of blood products or blood-related products.

Lease

Lease costs are related to an agreement whereby the lessor conveys to the lessee in return for a

payment or series of payments the right to use an asset for an agreed period of time.

Depreciation

These costs are related to the systematic allocation of the depreciable amount of an asset over its useful

life.

- Building Depreciation - Includes fixed fit out such as items fitted to the building. Examples

include lights and partitions.

- Equipment Depreciation - Includes non-fixed building fit out including facility fit out items such as

theatre tables, moveable furniture, and chemotherapy chairs etc.

Service Location

The service location should be reported to identify where the service was ordered or if that is unknown,

where it was delivered. Ideally the feeder system data should identify the location of where the service

was ordered from. If this is not possible, then a match of the location of the patient on the date of service

can be used.

Two levels of specificity can be reported. Reporting at level one is mandatory for 2012-13 cost records,

with level two optional.

Table 8: Service Location Codes – Level 1

Level 1 Description

100 Inpatient

200 Emergency Department

300 Non-Admitted

400 Community Health

Table 9: Service Location Codes – Level 2

Level 2 Description

101 Ward

102 Intensive Care Unit

103 Coronary Care Unit

104 High Dependency Unit

105 Neonatal Intensive Care Unit

106 Special Care Nursery

107 Operating Room

108 Specialist Procedure Suite

109 Hospital in the Home

200 Emergency Department

301 Specialist Consultation Suite

302 Other Procedure Suite

303 Private Practice

304 Radiotherapy Service

305 Post Natal Domiciliary Nursing Service

306 Other Domiciliary Nursing Service

307 Medihotel

400 Community Health

Date of Service

A date of service (ddMMMyyyy) is the date of when services are provided to a patient within an episode

of care. This is useful if a service location cannot be identified via a feeder system, then a match of the

location of the patient on the date of service can be used.

For admitted episodes, the date of service is only required for the first date of any service in each specific

location when reporting at level 2, and should only change if the location changes. For example, when

the patient moves from a ward to ICU then the date of service for reported costs in the ward will be the

first day in the ward, and ICU cost will have the first day of admission to ICU. If a patient presents to

ICU twice within an admitted episode, then cost records should be reported separately for each stay in

ICU.

Ideally the feeder system data should identify the date of when the service was ordered, or delivered for

services that do not require ordering (e.g. bed days). If this is not possible, then the service date (e.g.

test date) or the date that the service was provided to the patient (e.g. reporting date) should be used.

Note: There has been a change to the file specifications - for the VCDC 2012/13 service date is not

required as a mandatory field to be submitted, there is no need to change specifications to reflect this,

the file can be submitted with this field empty. VCDC File Specification 2012-13 Reference Files

available at http://www.health.vic.gov.au/hdss/vcdc/index.htm.


Data Validations

The following validations will be applied to data accepted to the VCDC.

General validations

The following validations apply for all episodes. Episode failing these validations will be flagged with an

error and reported to the health services.

1 the sum of the (iCost + dCost) for each area (dhCostArea) should be > zero

ACTION: if not true then flag as error

2 the sum (iCost + dCost) of all records for an episode should have a cost > zero


Admitted data validations

The following validations only apply to admitted episodes (program = A) using data from the VCDC

submission (italic fields) linked to the VAED. Episodes failing these validations will be flagged for review

by the health services.

3 If the episode has a length of stay of 1 day where the admission date=separation date (i.e. sameday episode):

- the separation mode is a death or transfer (VAED.SEPMODE= „D‟,‟T‟), then the total cost (sum of iCost + dCost for all records in an episode) should be >$40

- all other separation modes should have a total cost >$50


4 If the episode has a length of stay (LOS) of 1 day and is a duration of < 24:00 hours and the admission date is not the same as the separation date (i.e. overnight stay):

- the separation mode is a death or transfer (VAED.SEPMODE= „D‟, „T‟) and the total cost (sum of iCost + dCost for all records in an episode) should be > $40

- all other separation modes should have a total cost >$50


5 If the episode has a length of stay of > 1 day and is a duration of >24:00 hours and the admission date is not the same as the separation date (i.e. overnight stay):

- the vicdrg of the corresponding financial year is „P66D‟ or „P67D‟ then the per diem (sum of all records for an episode dCost + iCost /los)cost should be >$50

- all other vicdrg of the corresponding financial year

- the separation mode is a death or transfer should have a per diem cost > $70

- all other separation modes should have a per diem cost >$100


6 The sum of all records for an episode dCost + iCost should be < $200,000

ACTION: if not true flag as warning

7 If the vicdrg of the corresponding financial year is valid (as per prescribed list) and not blank, then

- The per diem cost of episodes should be < 5 times the per diem average of the prior year

ACTION: if not true then flag as warning (E7)

8 If the care type is sub-acute (either „2‟, „6‟, „7‟, „K‟, „J‟, „P‟)

- the vicdrg of the corresponding year is valid (as per prescribed list) then the per diem cost should be < $3,000

- the per diem cost should be > $100

ACTION: if not true then flag as warning

9 If the ICU hours is > 0 the sum of the (iCost + dCost) where CCSAA Service Cost Group = ICU should be >0


10 If the ICU hours is = 0 the sum of the (iCost + dCost) where CCSAA Service Cost Group = ICU should = 0


11 If the CCU hours is > 0 the sum of the (iCost + dCost) where CCSAA Service Cost Group =CCU should be >0

ACTION: if not true then flag as error and review

12 If the CCU hours is = 0 the sum of the (iCost + dCost) where CCSAA Service Cost Group =CCU should = 0


13 If the DRG is Surgical (second character of the vicdrg of the corresponding year is either a „0‟, „1‟, „2‟, „3‟, „4‟ or „5‟ )and

- the sum of (iCost + dCost) where CCSAA Service Cost Group =(TheatreOR and TheatreNonOR) = 0 and

AND

- then the sum of (iCost + dCost) where CCSAA Service Cost Group =(MedSurg and MedNonSurg) should >$50,

ACTION: if not true then flag as warning

14 If the episode is flagged with a E13 warning then check to see if any of the procedure code is from either blocks „1331‟, „1909‟ or „1912‟ of Australian Classification of Health Interventions. (Refer to

VCDC File Specification 2012-13 Reference Files, worksheet Anaesthetic Procedure Codes

at http://www.health.vic.gov.au/hdss/vcdc/index.htm).

ACTION: if true flag as warning

15 If the episode procedure code is contained in the „prosthesis code‟ table, then episode must contain a record with account =PROS AND dCost >0 (Refer to VCDC File Specification 2012-13 Reference Files, worksheet Prosthesis Codes at http://www.health.vic.gov.au/hdss/vcdc/index.htm).


Non-admitted data validations

The following validations only apply to non-admitted data. Episodes failing these validations will be

flagged for review by the health services.

16 If the sum of (iCost + dCost) for all records in an episode is > $3,000


17 If the sum of (iCost + dCost) for all records in an episode is < $5




Financial Reconciliation

Health services are required to submit a completed VCDC Financial Reconciliation report with their

VCDC submission. The template to be completed is available at:


Cost Allocations

Health services are required to submit a completed VCDC Cost Allocation QA reports with their VCDC

submission. The templates to be completed is available at:




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