New Mothly Activity Collection (MAC) Manual · 2016. 11. 1. · July 2011 . Version 11 : All . Update of controlled document to reflect changes to forms and facilities within the

MONTHLY ACTIVITY COLLECTION Statistical Collections and Integration

Department of Health

Year 2013-

2014

MAC Manual

Document information

Version: v13.1

Published by: Statistical Collections and Integration Health Statistics Unit Department of Health GPO Box 48 Brisbane Q 4001 Email: [email protected]

Approved by: Rod Leeuwendal Manager Statistical Collections and Integration

Date: September 2013

Available From: http://qheps.health.qld.gov.au/hsu/datacollections.htm

Release History: Date Release Pages Details Jul 2009 Version 8 All Removed the Dental collection component and MTHACPS1 report (Public Psychiatric

Hospitals). Updated required definitional changes.

July 2010 Version 9 All Updated to reflect the introduction of MAC Online. Clarification for the term Clinic. Removal of available bed days.

July 2010 Version 10 All Includes updates following the initial to release QHEPS

July 2011 Version 11 All Update of controlled document to reflect changes to forms and facilities within the scope of the collection

July 2012 Version 12 All Updated to reflect the introduction of new Activity Based Funding requirements, the Corporate Clinic Code (CCC) list and updated bed availability categories.

July 2013 Version 13 Numerous Updated Data Collections Unit (DCU) to Statistical Collections and Integration (SCI) and Health Statistics Centre (HSC) to Health Statistics Unit (HSU). Included Delegate of HHS CEO for the approval of the MAC forms. Included information regarding the ABF Emergency Services (ES) form. Added section on ‘Other Outreach’ and refreshed Section 4, Forms Required by Facility by Hospital & Health Service. Included new clinic types for 2013-14.

Sept 2013 Version 13.1 Numerous Updated ‘Home Delivered Procedures’ to clarify business rules and amended the term ‘Continuous Automated Peritoneal Dialysis’ to ‘Continuous Ambulatory Peritoneal Dialysis’ as requested by CARU. Amended 3.1.6 Emergency Services (ES) Form to clarify public ES episodes, and amended form section to reflect amendments to the Emergency Services (MACONES) form. Occasions of Service definition clarified for telehealth /telephone OOS, section. Amended 2.4.2.1 Availability of MAC data on the Decision Support System (DSS) to reflect ABF direction for MAC form approval process..

mailto:[email protected]://qheps.health.qld.gov.au/hsu/datacollections.htm

The Monthly Activity Collection

Contents 1 Introduction .............................................................................................................. 1

1.1 National Health Reform ....................................................................................... 1 1.2 Australian Government Reporting Requirements ........................................... 1

2 The Monthly Activity Collection (MAC) ............................................................... 3 2.1 Scope of the MAC ................................................................................................ 3 2.2 MAC Online ........................................................................................................... 3 2.3 MAC Changes for 2013-14 ................................................................................. 4

2.3.1 Clinic Type Classifications .............................................................................. 4 2.3.2 Column heading changes to OOS forms ...................................................... 7 2.3.3 Overall Form Changes ..................................................................................... 9

2.4 MAC Reporting Requirements & Business Rules ......................................... 10 2.4.1 MAC Monthly & Quarterly Reporting Timeframes ..................................... 10 2.4.2 Chief Executive, HHS Approval.................................................................... 10

2.4.2.1 Availability of MAC data in the Decision Support System (DSS) ..... 11 2.4.3 MAC Forms Required Summary .................................................................. 11 2.4.4 MAC Forms Required by Facility Type ....................................................... 13 2.4.5 MAC Form Structure ...................................................................................... 13 2.4.6 NIL activity report ............................................................................................ 14 2.4.7 Provision of Estimates ................................................................................... 14 2.4.8 Non-admitted Patient & Bed Availability Data Validations ....................... 14 2.4.9 Admitted Patient Data Validations ............................................................... 14 2.4.10 Counting Rules.............................................................................................. 16

3 MAC Form Information ........................................................................................ 17 3.1 Non-admitted Patient Activity Forms ............................................................... 17

3.1.1 Clinic Types and Clinic Definitions ............................................................... 17 3.1.2 Other Definitions ............................................................................................. 17

3.1.2.1 Common data items and definitions ..................................................... 17 General Definitions............................................................................................. 17 Column Definitions ............................................................................................. 18 Row Definitions ................................................................................................... 23

3.1.3 Clinic Form (MACONCLNC) ......................................................................... 23 3.1.3.1 Scope......................................................................................................... 24 3.1.3.2 Form ........................................................................................................... 24 3.1.3.3 Definitions ................................................................................................. 24

3.1.4 Diagnostics and Procedures Form (MACONDGPR) ................................ 24 3.1.4.1 Scope......................................................................................................... 24 3.1.4.2 Form ........................................................................................................... 24 3.1.4.3 Definitions ................................................................................................. 25

Definitions unique to this form .......................................................................... 25 3.1.5 Telehealth Forms (MACONTELP and MACONTELR) ............................. 30

3.1.5.1 Scope......................................................................................................... 31 3.1.5.2 Forms ......................................................................................................... 32 3.1.5.3 Definitions ................................................................................................. 32

3.1.6 Emergency Services Form (MACONES) .................................................... 33 3.1.6.1 Scope......................................................................................................... 33 3.1.6.2 Form ........................................................................................................... 33 3.1.6.3 Definitions ................................................................................................. 34

i


3.1.7 Pathology Form (MTACPATH) ..................................................................... 38 3.1.7.1 Scope......................................................................................................... 38 3.1.7.2 Form ........................................................................................................... 38 3.1.7.3 Definitions ................................................................................................. 38

3.2 Admitted Patient Activity Forms ....................................................................... 39 3.2.1 Bed Availability Form (BED) ......................................................................... 39

3.2.1.1 Scope......................................................................................................... 39 3.2.1.2 Form ........................................................................................................... 39

Reporting bed/bed alternative MAC (BA) flowchart ...................................... 40 3.2.1.3 Definitions ................................................................................................. 41

3.2.2 PH1 Form (MTHACPH1) ............................................................................... 47 3.2.2.1 Scope......................................................................................................... 47 3.2.2.2 Form ........................................................................................................... 47 3.2.2.3 Definitions ................................................................................................. 47

3.2.3 Multi Purpose Health Service Form (MTHACMP1) ................................... 58 3.2.3.1 Scope......................................................................................................... 58 3.2.3.2 Form ........................................................................................................... 58 3.2.3.3 Definitions ................................................................................................. 58

3.2.4 Public Nursing Homes/Hostels/Independent Living Units Form (MTHACNH2) .............................................................................................................. 61

3.2.4.1 Scope......................................................................................................... 61 3.2.4.2 Form ........................................................................................................... 61 3.2.4.3 Definitions ................................................................................................. 61

4 Forms Required by Facility by Hospital & Health Service ............................. 64 5 Mapping between Tier 2, CCC and MAC Clinic Types .................................. 75

ii


Glossary of Terms and Abbreviations

The following terms and abbreviations are used throughout this document. Abbreviation Description ABF Activity Based Funding AIHW Australian Institute of Health and

Welfare CARU Clinical Access Redesign Unit CE Chief Executive CEO Chief Executive Officer COAG Council of Australian Governments DoHA Department of Health and Ageing DSS Data Set Specification DVA Department of Veteran’s Affairs EDIS Emergency Department Information

System HBCIS Hospital Based Corporate Information

System HHS Hospital & Health Service HSU Health Statistics Unit IHPA Independent Hospital Pricing

Authority KPI Key Performance Indicator MAC Monthly Activity Collection MBS Medicare Benefits Schedule MPHS Multi Purpose Health Service NAP Non-admitted Patient NEP National Efficient Price NH Nursing Home NHA National Healthcare Agreement NHIA National Health Information

Agreement NHRA National Health Reform Agreement NMDS National Minimum Data Set ODC Outpatient Data Collection OOS Occasion/s of Service QHAPDC Queensland Hospital Admitted

Patient Data Collection RRMBS Rural and Remote Medicare Benefits

Schedule RSSU Revenue, Strategy and Support Unit SATr Surgical Access Team repository SCI Statistical Collections and Integration UDG Urgency Related Group


1 Introduction This manual provides an overview of the Monthly Activity Collection (MAC). It is a reference for those who complete Monthly Activity forms to report Monthly Activity data to Statistical Collections and Integration (SCI). For users completing, submitting and approving MAC forms, this manual must be read in conjunction with the MAC Online User Manual.

1.1 National Health Reform Commonwealth, State and Territory governments agreed to transform the Australian health system. Since July 2012, Queensland has been working with the reforms resulting from this transformation changing the way public health and hospital services are managed. The National Health Reform Agreement (NHRA) sets out the intention of the Commonwealth, State and Territory governments to work in partnership to improve health outcomes for all Australians. Through this national agreement, there will be enhanced focus on the equitable funding of public hospitals, local access to services, improved efficiency, accountability and transparency across the system, and financial sustainability into the future. The Independent Hospital Pricing Authority (IHPA) established under the NHRA has a pivotal role in the administration of Activity Based Funding (ABF). IHPA also has other key responsibilities as outlined in the NHRA, such as setting the national efficient price (NEP) for public hospital services and the efficient cost of block funding services in regional hospitals. Refer to Health Reform Queensland on QHEPS for further information.

1.2 Australian Government Reporting Requirements Under the NHA, Queensland is required to supply the Commonwealth Department of Health and Ageing with hospital activity data on Queensland’s public health system. As a signatory to the National Health Information Agreement, Queensland is required to provide hospital activity data to the Australian Institute of Health and Welfare (AIHW) according to agreed National Minimum Data Sets (NMDS). Data reported to the MAC is used to meet Public Hospital Establishments NMDS. In addition to the above reporting requirements, MAC is used as a source of hospital activity data supplied on a quarterly basis to IHPA as specified in the:

Health Statistics Unit MAC Manual Version 13.1

Department of Health September 2013 Page 1

http://qheps.health.qld.gov.au/hic/pdf/mac_manual/mac-oum.pdfhttp://www.health.qld.gov.au/health-reform/default.asp

The Monthly Activity Collection • Activity based funding: Non-admitted patient care aggregate DSS

2013-2014. Refer to the IHPA website for details regarding this DSS. In addition to the DSS mentioned above, Queensland must also provide hospital emergency services activity data as specified in the following two data set specifications (DSSs) on a quarterly basis. 1. Activity based funding: Emergency department care DSS 2013-2014

(Patient-Level) “ABF EDC DSS”, and 2. Activity based funding: Emergency service care DSS 2013-2014

(Aggregate Level) “ABF ESC DSS”. Data is reported to the relevant DSS according to IHPA categorisation criteria for the hospital facility’s emergency service. Hospitals with emergency departments categorised as Levels 3B to 6 (by the IHPA) must comply with the ABF EDC DSS with the data source being the EDIS data repository managed by CARU. Hospitals with emergency services categorised as 1 to 3A (by the IHPA) must comply with the ABF ESC DSS. As most facilities in this category do not have ‘corporate’ electronic system/s to record emergency service activity, the ABF Program Office has mandated that non-EDIS sites must complete a MACONES form in MAC Online. The IHPA Three Year Data Plan identifies the overarching jurisdictional requirements, processes and time frames to 2015-16 inclusively.



http://meteor.aihw.gov.au/content/index.phtml/itemId/497537http://meteor.aihw.gov.au/content/index.phtml/itemId/497537http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/non-admitted-carehttp://meteor.aihw.gov.au/content/index.phtml/itemId/497500http://meteor.aihw.gov.au/content/index.phtml/itemId/497500http://meteor.aihw.gov.au/content/index.phtml/itemId/497529http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/IHPA-three-year-data-plan


2 The Monthly Activity Collection (MAC) The Monthly Activity Collection (MAC) collects aggregate (or summary level) data on ‘Admitted’ & ‘Non-admitted’ patient activity and ‘Bed Availability’ from public acute hospital facilities, public residential psychiatric hospitals and public nursing homes/hostels/independent living units and multi-purpose health services each month. There are a number of forms which facilities must complete each month to provide this information to the MAC to comply with State and Commonwealth Government reporting requirements. MAC data is routinely published on the Department of Health Internet and Intranet sites as well as in Australian Government publications such as Report on Government Services (ROGS), Australian Hospital Statistics and the My Hospitals web-site.

2.1 Scope of the MAC All Queensland public facilities must submit the MAC forms that are required for their facility each month1. Refer to Section 4 Forms Required by Facility by Hospital & Health Service for individual facility report requirements. Activity that is required to be reported in the MAC is activity that is operated and managed by the facility and funded from the facility’s operating expenditure.

All outpatient clinic services provided to admitted patients are excluded – as specified in IHPA’s ‘Tier 2 non-admitted services compendium 2013-14’.

2.2 MAC Online MAC Online is a web based application, developed by SCI, which enables facilities to complete and upload a number of spread sheet templates to SCI to report MAC data.

Refer to the MAC Online User Manual for information on this application.

1 This includes the ex-public facilities of the Mater Health Services, South Brisbane and also the Noosa BOOT Hospital due to their contractual arrangements with Department of Health to provide public health services. In the case of Noosa Hospital the activity that is provided under contract must be reported Health Statistics Unit MAC Manual Version 13.1


http://qheps.health.qld.gov.au/hic/pdf/mac_manual/mac-oum.pdf


2.3 MAC Changes for 2013-14

2.3.1 Clinic Type Classifications

The ‘Tier 2 Non-Admitted Services Definitions Manual 2013-2014 v2.0’ defines the clinic classifications (classes) required for jurisdictional reporting of non-admitted services to the IHPA from 2012-13. The Department of Health also use the Tier 2 classification as a source to derive NMDS reporting to the Australian Government as the classification is much more detailed (than those prescribed for NMDS reporting). The MAC, where possible, incorporates the majority of the Tier 2 clinic classifications. However, there are some slight variations to cater for NMDS and State reporting requirements. It should be noted that data reported by facilities to the MAC, according to classifications defined in this manual are mapped to the relevant Tier 2 classes when reported to IHPA and mapped to NMDS clinic classifications when reporting to the AIHW and DoHA. The table below details the 2013-14 Tier 2 clinic class changes, state requirements and the MAC forms which have been updated to incorporate the requirement.

IHPA’s 2013-14 Tier 2 Changes MAC Form Changes

New Clinic Class Action MAC Clinic Type

MAC OOS Form

Comment

Renal Dialysis – Haemodialysis – Home Delivered

New clinic class to be reported to IHPA

Home – Haemodialysis (standard prescription)

Diagnostics and Procedures

Up until 30 June 2013, the activity for Home / Facility – Self Care Dialysis was reported for state purposes as a patient census ie number of patients not number of Occasions of Service (OOS). The categories under which the census was reported on the 2012-13 D&G form were:

Home - Automated PD Home - CAPD Home - Haemodialysis Facility - Self Care Dialysis Services From 2013-14, this data is able to be reported to the IHPA. IHPA’s ‘Tier 2 non-admitted services compendium 2013-2014’ Chapter 13 ‘Counting of home delivered renal dialysis and nutrition procedures’ provides the counting rules and relevant examples and specifies that a patient census approach can be applied using agreed prescribing norms for counting non-admitted patient service events (or OOS). A formula reflective of the ‘prescribing norm’ will be

Home – Haemodialysis (extended hours)


Renal Dialysis – Peritoneal Dialysis – Home Delivered

New clinic class to be reported to IHPA

Home – Automated Peritoneal Dialysis (APD)


Home – Continuous Ambulatory Peritoneal Dialysis (CAPD)




http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/non-admitted-carehttp://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/non-admitted-carehttp://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/non-admitted-carehttp://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/non-admitted-carehttp://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/non-admitted-care




MAC OOS Form

Comment

applied by Department of Health to the census figure for each home delivered procedure clinic class when reporting to IHPA. To enable a formula to be applied for the agreed prescribing norm for ‘Home – Haemodialysis’, a further split into ‘standard’ and ‘extended’ prescriptions was required. In addition, this census data is required to be reported separately for patients who reside within the HHS district and those patients who reside outside of the HHS district. There are now two tables on the D&P form to enable this further delineation.

Total Parenteral Nutrition – Home Delivered

New clinic class to be reported

Home – Parenteral Nutrition


As with the Home Dialysis clinic classes above, counts for these two new clinic classes are to be submitted as a census and a formula will be applied by the Department of Health to report an OOS total to IHPA. This data is also required to be reported separately for patients who reside within the HHS district and those who reside outside of the HHS district.

Enteral Nutrition – Home Delivered

New clinic class to be reported

Home – Enteral Nutrition


Circulatory New allied health/clinical nurse specialist clinic class

Circulatory Clinic To be reported for ‘Other Health Professional’ Provider Type.

Falls Prevention New allied health/clinical nurse specialist clinic class

Falls Prevention Clinic To be reported for ‘Other Health Professional’ Provider Type.

Cognition and Memory

New allied health/clinical nurse specialist clinic class

Cognition and Memory

Clinic To be reported for ‘Other Health Professional’ Provider Type.

Hospital Avoidance Programs

New allied health/clinical nurse specialist clinic class

Hospital Avoidance Programs

Clinic To be reported for ‘Other Health Professional’ Provider Type.

Post Acute Care New allied health/clinical nurse specialist clinic class

Post Acute Care Clinic To be reported for ‘Other Health Professional’ Provider Type.

Geriatric Evaluation and

New allied health/ clinical

Geriatric Evaluation and

Clinic (No Change)

This clinic is now to be reported to IHPA for the allied health/ clinical nurse specialist






MAC OOS Form

Comment

Management nurse specialist sub-acute clinic class

Management (‘Other Health Professional’) provider types. Since the introduction of the 2012-13 Tier 2 Clinic Classification these clinic classes have been reported to IHPA for only ‘Medical Officer’ Provider Type but have been included on the MAC Clinic form for both ‘Medical Officer’ and ‘Other Health Professional’ Provider Types, therefore there is no change.

Palliative Care New allied health/ clinical nurse specialist sub-acute clinic class

Palliative Care Clinic (No Change)

This clinic is now to be reported to IHPA for the allied health/ clinical nurse specialist (‘Other Health Professional’) provider types. Since the introduction of the 2012-13 Tier 2 Clinic Classification these clinic classes have been reported to IHPA for only ‘Medical Officer’ Provider Type but have been included on the MAC Clinic form for both ‘Medical Officer’ and ‘Other Health Professional’ Provider Types, therefore there is no change.

Psychogeriatric New allied health/ clinical nurse specialist sub-acute clinic class

Psychogeriatric Clinic (No Change)

This clinic is now to be reported to IHPA for the allied health/ clinical nurse specialist (‘Other Health Professional’) provider types. Since the introduction of the 2012-13 Tier 2 Clinic Classification these clinic classes have been reported to IHPA for only ‘Medical Officer’ Provider Type but have been included on the MAC Clinic form for both ‘Medical Officer’ and ‘Other Health Professional’ Provider Types, therefore there is no change.

Asthma Clinic class to be retired. Activity to be reported under Respiratory clinic class.

Asthma Clinic Clinic class to remain on MAC Clinic form and Department of Health will report to IHPA as Respiratory.

COPD Clinic class to be retired. Activity to be reported under Respiratory clinic class.

COPD Clinic Clinic class to remain on MAC Clinic form and Department of Health will report to IHPA as Respiratory.

Diabetes Clinic class to be retired. Activity to be reported under Endocrinology clinic class.

Diabetes Clinic Clinic class to remain on MAC Clinic form and Department of Health will report to IHPA as Endocrinology.



The Monthly Activity Collection A diagram detailing the comparison between the MAC Forms of 2012-13 and 2013-14 is:

MAC FORM CHANGES COMPARISON 2012-13 to 2013-14

2012-13 (Non-admitted Patient) MAC Forms

2013-14 (Non-admitted Patient) MAC Forms

CLINICForm

. Consultation Clinics

DIAGNOSTIC & PROCEDURES

Form

. Procedure Clinics


. Emergency Services

. Diagnostic Imaging

. Pharmacy

. Home Dialysis Patients Census

TELEHEALTH Form

. Procedure Clinics




. Pharmacy

TELEHEALTH-Provider Form

. Procedure Clinics




. Pharmacy

1. Additional IHPA ‘Tier2’ clinics

2. Expanded ‘Renal Dialysis’ clinics.3. New IHPA ‘Nutrition’ clinics.4. ‘In’ & ‘Out’ of HHS Tables.

EMERGENCYSERVICES

Form

. Attendances by ‘Triage Category’ & ‘Discharge Deposition’.

5. Additional Telehealth Form

6. Additional classification ‘Type of Visit’ for IHPA.

CLINICForm


DIAGNOSTIC & PROCEDURES

Form

. Procedure Clinics




. Pharmacy

. Home Dialysis Patients Census

. Home Delivered Renal Dialysis and Nutrition Procedures

EMERGENCYSERVICES

Form

. Attendances by ‘Triage Category’ & ‘Discharge Deposition’ & ‘Type of Visit’.

TELEHEALTH-Recipient Form

. Procedure Clinics




. Pharmacy

2.3.2 Column heading changes to OOS forms To comply with IHPA and state reporting requirements, some of the column headings on the OOS forms have been either expanded or clarified. These changes are listed below: Eligible Public

Eligible Public

Other Public 19.2 RRMBS

The ‘Eligible Public’ column of the OOS forms for both ‘1:1 Sessions’ and ‘Group Sessions’ has been divided into ‘Other Public’ and ‘19.2 RRMBS’. This division will enable the separation of OOS billed under the RRMBS (Rural and Remote Medical Benefits Scheme (RRMBS)) and




the Council of Australian Government’s (COAG) s19(2) exemption initiative (Rural and Remote Medical Benefits Scheme (RRMBS)) from those which are ‘public’. This change was requested by the Revenue Strategy and Support Unit (RSSU) in order to meet the Department of Health’s COAG and RRMBS program reporting requirements. For more information on this COAG initiative, refer to RSSU.

Telephone Consultations The column for Telephone Consultations under ‘Eligible Public’ has been removed as there is no longer a requirement to report this type of OOS separately from the other public OOS. The ABF Program Management Office has approved the removal of this column from the MAC forms and now ‘Eligible Public’ telephone consultations are to be reported inclusively with ‘1:1 sessions’ under the ‘Other Public’ column on these MAC forms.

Private (Previously ‘Eligible Other’)

Private

MBS Non MBS

The wording ‘Eligible Other’ has been changed to ‘Private’ to more accurately reflect and clarify the activity to be reported for this category. The RSSU have requested that the ‘Private’ category be further divided into the categories of ‘MBS’ (Medicare Benefit Scheme) and ‘non-MBS’ so that this activity can be separately identified. Group Sessions

GROUP SESSIONS

Eligible Public-

Compensable No. of Patients

Eligible Public Ineligible

Public No. of

Patients

Number of Public Group

Sessions

Private Number of

Group Sessions (exc

Non MBS Group Sessions)

Other Public No. of

Patients

19.2 RRMBS No. of

Patients

MBS No. of

Patients

Non MBS No. of

Patients

In previous years, facilities were only required to report the total number of Group Sessions held and the total number of patients attending those Group Sessions for each reference period.




This year, the Group Sessions section of the OOS forms has been expanded to enable the capture of the number of patients by their eligibility/ compensability including the number of patients who are billed under the RRMBS (refer to Eligible Public section of Column Changes). In addition the number of ‘Private’ patients attending Group Sessions, (both MBS and Non MBS patients) must be reported as required by the RSSU. This will also support Department of Health reporting as per IHPA’s ABF Data Request Specification 2013-14 for MBS and non-MBS reporting.

2.3.3 Overall Form Changes Telehealth Form Two separate ‘Telehealth’ MAC forms have been developed to capture both the provider and recipient ‘ends’ of Telehealth service provision. Two forms are required to meet the Department of Health’s Purchasing Model, which will continue to fund both the provider and recipient ends of Telehealth services, while IHPA only requires a single event to be reported for each Telehealth service. Emergency Services (ES) Form The ABF Program Management Office has mandated that hospitals who do not use the Emergency Department Information System (EDIS) must report their emergency service activity on this form. The Emergency Services (ES) form has been updated to meet the Activity based funding: Emergency service care DSS 2013-2014. This includes a new data element ‘Type of Visit to Emergency Services’ which must be collected for each attendance/ episode and reported against the updated ‘Episode End Status/ Triage Category’ (previously known as the ‘Disposition/ Triage Category’). The collection of this information enables the classification to the relevant UDG for funding purposes. The form has changed quite considerably to enable the collection of this information. Refer to Emergency Services Form (MACONES) for more information. Although some sites may not provide emergency services, it should be noted that the IHPA has classified these facilities in the ‘emergency services’ category in the national ES Funding Model. To ensure no assumptions are made in terms of funding under the IHPA Model, sites that do not have activity are to report a NIL return for the respective period/s.



http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/content/abf-data-request-specifications%232014http://meteor.aihw.gov.au/content/index.phtml/itemId/497529http://qheps.health.qld.gov.au/hsu/datacollections.htm%23mac


2.4 MAC Reporting Requirements & Business Rules

2.4.1 MAC Monthly & Quarterly Reporting Timeframes All final versions of MAC reports must be submitted to SCI by the 14th day2 following the reference month (eg for the reference month of September, MAC reports must be submitted by 14th of October). Non-admitted (aggregate-level) data must be provided on a quarterly basis to the IHPA, as per the IHPA Three Year Data Plan. As this information is used to determine funding and purchasing allocations, data is considered finalised on a quarterly basis, by the submission date following the reporting quarter. Refer to the table below as an example of the quarterly reporting schedule:

Reporting Quarter

Period Due Date Finalisation Date

September July 14 August 14 November August 14 September

September 14 October December October 14 November

14 February November 14 December December 14 January

March January 14 February 14 May February 14 March

March 14 April June April 14 May

14 August May 14 June June 14 July

2.4.2 Chief Executive, HHS Approval As MAC data is used to substantiate funding and purchasing allocations in Department of Health’s ‘purchaser / provider’ model, Chief Executives (or their delegates) must approve the occasion of service MAC forms (Clinic, Diagnostics and Procedures, Telehealth, and Emergency Services) and the Bed form.

HHS CEOs must provide requests to update ‘finalised’ quarterly MAC data in writing to the Healthcare Purchasing Funding and Performance

Management Branch, Department of Health.

2 A preliminary PH1 report is due on the 4th day of each month following the reference month. For most facilities using HBCIS, the PH1 is generated and sent automatically using the ‘Report Monitor’ functionality. A final version is required on the 14th which would contain any amendments to the preliminary version. Health Statistics Unit MAC Manual Version 13.1


http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/content/IHPA-three-year-data-plan


Requests will be tabled at the ‘Relationship Management Group’ meetings for consideration and approval.

Only once this approval is obtained and provided to SCI by the facility,

can the period be unlocked for MAC forms to be changed.

Refer to the MAC Online User Manual to set-up the HHS CEO access level for the Chief Executive (or Delegate) to enable them to approve the above mentioned MAC reports.

2.4.2.1 Availability of MAC data in the Decision Support System (DSS)

Non-admitted activity from MAC forms must have an 'Approved' status for the purposes of providing activity data for WAU reporting in DSS. An 'Approved' status is provided by HHS Chief Executive sign-off (or their nominated delegate/s) in the MAC On-line application. If forms do not have an ‘approved’ status (prior to the weekend processing), activity will not be reported. This includes data in forms that may have been previously approved but then updated after the monthly deadline. It is recommended that if prior month forms require updating, that sites ensure approvals can be processed within the week as the forms status will change back to either ‘Draft’ or ‘Submitted’ and no activity will be reported from that form, for that month. To support the management of MAC form status, HHSs are able check the status of the MAC forms in DSS in the 'MAC Forms' folder. This report is updated in line with the weekend processing of data each Sunday, otherwise for real-time status of forms, registered MAC Online Users can continue to monitor it in the MAC Online Application. As per the Memorandum to HHS CEs dated 13th March 2013 from Executive Director, Healthcare Purchasing, Funding and Performance Management Branch.

2.4.3 MAC Forms Required Summary The MAC forms for reporting of OOS data to SCI (for all public hospital facilities) for 2013-14 are:

• Clinic • Diagnostics and Procedures • Telehealth – Provider • Telehealth – Recipient • Emergency Services (non EDIS facilities only)

The MAC forms for reporting bed availability, (summary-level) admitted patient, nursing home and multi-purpose health services data continue to be:

• Bed • MTACPH1 (PH1)



http://qheps.health.qld.gov.au/hic/pdf/mac_manual/mac-oum.pdf


• Multi-Purpose Health Services (MP1) • Nursing Homes (NH2)

The Bed form categories are aligned with version 3 of the:

Clinical Services Capability Framework.



http://qheps.health.qld.gov.au/chi/AIS/cscf.htm


2.4.4 MAC Forms Required by Facility Type The table below shows which 2013/2014 MAC forms are used to collect data by facility type.

Facility Type

MAC Form Data Collected

Hospital - acute CLINIC (MACONCLNC) One-to-one occasions of service, group sessions and number of group session patients for non-admitted medical officer and other health professional clinic types.

Hospital - acute DIAGNOSTIC & PROCEDURES (MACONDGPR)

One to one occasions of service, group sessions and number of group session patients for hospital funded Community Health, Other Outreach, and Procedure clinics, Diagnostic Imaging and Pharmacy activity and Home Delivered Dialysis and Nutrition Patients census data.

Hospital - acute EMERGENCY SERVICES (MACONES)

One to one occasions of service for Emergency Services (non EDIS sites) by Episode End Status/ Triage category and Type of Visit.

Hospital - acute TELEHEALTH (MACONTELP and MACONTELR)

One-to-one occasions of service and group sessions for non-admitted specialist and allied health clinic types by service provider for which services are delivered by Telehealth.

Hospital - acute BED (BED)

The number of available beds and available bed alternatives for admitted patients.

Hospital - acute PATHOLOGY (MTACPATH)

Pathology occasions of service (Non-Auslab facilities only).

Hospital – acute and psychiatric

PH1 (MTHACPH1)

Admitted patient admissions, separations, and classification changes.

Nursing homes, hostels, independent living units

NH2 (MTHACNH2)

Admitted resident admissions, separations, non-admitted patient occasions of service and allocation of places.

Multi-Purpose Health Services

MP1 (MTHACMP1)

Admitted patient admissions, separations and bed availability.

2.4.5 MAC Form Structure The MAC form templates are in the format of MS Excel spread sheets. Facilities must use MAC form templates to upload their reported activity to MAC Online for submission to SCI. These templates are provided to facilities prior to the beginning of each financial year and are available from the SCI website.

MAC form templates must not be altered in any way as they will not upload to MAC Online and data will not be submitted to SCI.



http://qheps.health.qld.gov.au/hsu/datacollections.htm


2.4.6 NIL activity report Facilities that record no activity during the month are still required to submit the MAC forms that are required for their facility. The cells in which activity is recorded on the form should be left blank.

2.4.7 Provision of Estimates Estimated data should only be provided when events such as major computer system failure, industrial action, natural disasters etc prevent the availability of data. Any data that is an estimate must be denoted as such in the submitted data (using MAC Online comments) and updated with actual data by the date the next reference month is due.

2.4.8 Non-admitted Patient & Bed Availability Data Validations The MAC Online application validates each line of reported patient activity on the MAC forms. Validation exceptions are raised when the reported activity for the reference month is compared to the previous month and fails predetermined acceptance criteria (eg: variance percentage is high, same value both periods, null values etc). Facilities must respond to validation exceptions with relevant and meaningful comments and provide details of the validation exception. Comments provided by facilities are retained within SCI databases and are utilised to respond to queries raised by various business areas in the Department of Health including the Minister’s Office, Office of the Director-General, Divisional Deputy Director Generals, policy officers, data analysts and also the Australian Government. Therefore, it is very important that the comments provided clearly state the reasons for the variations. Where validation comments are not provided when required, SCI will contact the MAC On-line contact at the facility to obtain details for the data anomaly. Facilities may also be contacted by SCI seeking comments on data anomalies that appear following time series trend analysis when required.

2.4.9 Admitted Patient Data Validations SCI validates the (summary-level) admitted patient activity by confirming, where applicable, the total number of separated episodes of care for each reference period. The reconciliation of this data is as follows: • Total Overnight or Longer Separations + Total Same Day

Separations reported on the MTHACPH1 (PH1 report) are reconciled to the total number of separations (episodes of care) for




admitted patients reported to the Queensland Hospital Admitted Patient Data Collection (QHAPDC).

The total number of separations (and their respective modes) reported to each data collection should equal.

• Total Overnight or Longer Separations = grand total statistical +

grand total formal overnight or longer separations from All Admitted Patients.

• Total Same Day Separations = grand total statistical + grand total

formal same day separations from All Admitted Patients. Episodes with a care type of ‘Boarder’ are excluded from this reconciliation. All episodes with a care type of ‘Newborn’ are included, regardless of qualification.




2.4.10 Counting Rules The following diagram outlines the current counting rules for reporting of occasions of service to MAC, as prescribed in national reporting standards. The IHPA ‘Tier 2 non-admitted services compendium 2013-2014’ provides information on counting rules. The Compendium must be read in conjunction with this manual as in some instances there are state reporting requirements at a more local level. Queensland’s MAC reporting of Telehealth OOS and Home Dialysis reporting for 2013-14 are examples of these differences.

Clinician Count MAC Report Classification

Guide

Patient

Scenario 4Many to many

Eg. Persistent Pain

Scenario 3Many to one

Eg. Diabetes

Scenario 2One to many

Eg. Rehabilitation

Scenario 1One to one

Eg. UrologyOne One

One

One

One

One

Many

Many

Many Many

MAC Counting Rules Diagram

1:1 Session

1:1 Session

Group SessionOne

One

SixPatients within the

Group Session

SixPatients within the

Group Session

One Group Session




3 MAC Form Information

3.1 Non-admitted Patient Activity Forms

3.1.1 Clinic Types and Clinic Definitions The clinic types (classes) on the Clinic, Diagnostic and Procedures and Telehealth MAC forms are aligned to IHPA’s Tier 2 Outpatient Clinic Classification so that Queensland can meet ABF reporting requirements. As the Tier 2 non-admitted clinic classifications (Tier 2 Non-admitted Services Definitions Manual 2013-14 v2.0) are reviewed each year, so are the MAC forms to ensure alignment.

3.1.2 Other Definitions Across the MAC OOS forms there are data items collected that are common. These data items are defined in Common data items and definitions. Data items that are unique to a form are defined in the individual form sections of this document.

3.1.2.1 Common data items and definitions

General Definitions

Non-admitted Patients Patients who do not undergo a hospital's formal admission process. Non-admitted patients receive direct care within the emergency department, or as outpatients (including non-admitted day program patients), or through other non-admitted services such as community and outreach services. Occasions of Service Occasions of service include any examination, consultation, treatment or other service provided to a non-admitted patient in each functional unit of a health service facility, on each occasion such service is provided. To meet this definition, an interaction between one or more healthcare provider(s) with one non-admitted patient must occur containing therapeutic/clinical content and result in a dated entry in the patient's medical record. Telephone and other telehealth consultations can be counted as occasions of service if they meet all the criteria included in the definition above. A telephone/telehealth consultation is only counted as one non-admitted patient occasion of service, irrespective of the number of health professionals/locations participating in the consultation.



http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/non-admitted-carehttp://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/non-admitted-care


The MAC still refers to OOS as this is the counting unit defined and specified for Australian Government NMDS reporting. Service Events are referred to as the defined counting unit for IHPA DSS reporting purposes. It should be noted that this counting unit conceptually is an updated version of the OOS data element. Nationally once alignment between both NMDS and DSS are complete it is anticipated that the OOS data element may be superseded by service events. One to One (1:1) Sessions Where one non-admitted patient received services by staff of the facility. Services provided to a 'family unit' at the same time are also to be reported as a single one to one session. Provider Type The discipline of health professional that provides the occasion of service in the clinic. Reference Month The month to which the form refers. Commences from midnight on the first day of the month up to and including 11.59pm of the last day of the month.

Column Definitions

1:1 SESSIONS

Eligible Public - Compensable Eligible Public

Ineligible Public

Private

Work Cover Qld

Work Cover Other

Motor Vehicle

Qld

Motor Vehicle Other

Other Third Party

Other Comp.

Dept Veterans'

Affairs

Other Public

19.2 RRMBS MBS

Non MBS

Eligible Public – Compensable (Patients)

WorkCover Queensland Patients who are entitled to claim damages under the WorkCover Queensland Act.

WorkCover Other

Patients who are entitled to claim damages under a WorkCover Act other than Queensland’s (eg, employees of the Australian Government).




Eligible Motor Vehicle Queensland Eligible patients who are receiving treatment for conditions that resulted from accidents where liability lies with a Queensland registered vehicle. The patients have, or may have, an entitlement to claim damages under Motor Vehicle Third Party Insurance.

Eligible Motor Vehicle Other Eligible patients who are receiving treatment for conditions that resulted from accidents where liability lies with a vehicle registered elsewhere (not Queensland). Other Third Party Patients who have, or may have, an entitlement to claim damages under third party insurance, other than Motor Vehicle Third Party insurance. Other Compensable Patients who have, or may have, an entitlement to claim damages under public liability insurance, other than Motor Vehicle Third Party, WorkCover, or other third party. Department of Veterans’ Affairs Patients for whom the Department of Veterans’ Affairs has accepted responsibility for the payment of any charges relating to their treatment.

Eligible Public (Patients) An eligible patient is one who is eligible for Medicare as specified under the Commonwealth Health Insurance Act 1973. For further information, please refer to http://meteor.aihw.gov.au/content/index.phtml/itemId/481841

Other Public Other Public patients are patients who • elect to be treated as a public patient so cannot choose the

doctor who treats them, or • are receiving treatment in a private hospital under a contract

arrangement with a public hospital or health authority • are not being treated by Medical Officers that are eligible to

claim reimbursement for the service/s provided through Medicare Australia under the Rural & Remote Medical Benefit Scheme (RRMBS) or the Medicare Billing for Primary Care in Small Rural Hospitals arrangements (COAG 19.2).

19.2 RRMBS 19.2 RRMBS patients are patients who are being treated by Medical Officers that are eligible to claim reimbursement for the service/s provided through Medicare Australia under the Rural &



http://meteor.aihw.gov.au/content/index.phtml/itemId/481841


Remote Medical Benefit Scheme (RRMBS) or the Medicare Billing for Primary Care in Small Rural Hospitals arrangements (COAG 19.2).

Ineligible Public (Patients) Patients who are deemed to be not eligible for Medicare services. Corrective Services patients should be reported as ‘ineligible public’ patients. Private (Patients) Patients who have been treated by a doctor exercising a right of private practice at the facility irrespective of the source of funding (eg: Medicare Benefits Scheme, Workcover, third party, self funded etc).

MBS A private patient occasion of service where the principal funding source is the Medicare Benefits Scheme. Non MBS A private patient occasion of service where the principal funding source is other than the Medicare Benefits Scheme.

GROUP SESSIONS

Eligible Public-

Compensable No. of

Patients

Eligible Public Ineligible

Public No. of

Patients

Number of Public

Group Sessions

Private Number of Private Group

Sessions (exc Non

MBS Group Sessions)

Other Public No. of Patients

19.2 RRMBS No. of

Patients

MBS No. of

Patients

Non MBS

No. of Patients

Group Sessions Group Session A group is defined as two or more patients receiving the same services at the same time from the same hospital staff at the same clinics.

The following guides for use apply:

• a group session is counted only for two or more patients attending in the capacity of patients in their own right, even if other non-patient persons are present for the service.

• Spouses, parents or carers attending the session are counted for the group session only if they are also participating in the service as a patient.

• A group session is counted for staff attending clinics only if they are attending as a patient in their own right. Staff training and education is excluded.

• A group session may be delivered by more than one provider. A group session is counted for two or more patients receiving the




same services, even if more than one provider delivers that service simultaneously.

• Patients attending for treatment at a dialysis or a chemotherapy clinic are receiving individual services. Patients attending education sessions at chemotherapy or dialysis clinics are counted as group sessions, if two or more people are receiving the same services at the same time.

Where a patient receives multidisciplinary care within one booked clinic appointment as part of a group, one group session shall be recorded, regardless of the number of providers involved. For example, if a group session is jointly delivered by a physiotherapist and an occupational therapist, one group session is counted for the patients attending that session. Group Session Patients Each patient attending a group session is counted as a non-admitted patient service event, providing that the session included the provision of therapeutic/clinical advice for each patient and that this was recorded using a dated entry in each patient’s medical record. Family members are only counted as attending a group session if they are participating in the non-admitted patient service event as a patient in their own right. Each patient attending a group session is counted as one non-admitted patient service event, regardless of the number of health care providers present. The total number of patients (non-admitted patient service event) attending Group Sessions is to be counted for the reference period for the following compensability/ eligibility categories:

Eligible Public – Compensable No of Patients The sum of patients from the Eligible Public – Compensable categories (ie Work Cover Qld, Work Cover Other, Motor Vehicle Qld, Motor Vehicle Other, Other Third Party, Other Compensable, DVA) who have attended a group session for the reference period should be recorded here. For example, if 3 Work Cover Qld, 1 Other Third Party, and 10 DVA patients who were also public eligible attended a clinic for group sessions for the reference period, then the sum of those patients (14) should be recorded in this column.

Eligible Public (Patients) An eligible patient is one who is eligible for Medicare as specified under the Commonwealth Health Insurance Act 1973. For further information, please refer to http://meteor.aihw.gov.au/content/index.phtml/itemId/481841



http://meteor.aihw.gov.au/content/index.phtml/itemId/481841


Other Public No of Patients Other Public patients attending group sessions are patients who:

• elect to be treated as a public patient so cannot choose the doctor who treats them, or

• are receiving treatment in a private hospital under a contract arrangement with a public hospital or health authority

• are not being treated by Medical Officers that are eligible to claim reimbursement for the service/s provided through Medicare Australia under the Rural & Remote Medical Benefit Scheme (RRMBS) or the Medicare Billing for Primary Care in Small Rural Hospitals arrangements (COAG 19.2).

19.2 RRMBS No of Patients The number of patients attending group sessions who are being treated by Medical Officers that are eligible to claim reimbursement for the service/s provided through Medicare Australia under the Rural & Remote Medical Benefit Scheme (RRMBS) or the Medicare Billing for Primary Care in Small Rural Hospitals arrangements (COAG 19.2).

Ineligible Public No of Patients The number of patients attending a group session who are deemed to be not eligible for Medicare services. Corrective Services patients attending group sessions should be reported as ‘ineligible public’ patients.

Private (Patients) The number of patients attending group sessions who have been treated by a doctor exercising a right of private practice at the facility irrespective of the source of funding (eg: Medicare Benefits Scheme, Workcover, third party, self funded etc).

MBS No of Group Session Patients The number of patients attending group sessions for which the principal funding source is the Medicare Benefits Scheme. Non MBS The number of patients attending group sessions for which the principal funding source is other than the Medicare Benefits Scheme.

Number of Public Group Sessions The total number of public group sessions held for the reference period. This includes both eligible and ineligible patients.




Number of Private Group Sessions (exc Non MBS Group Sessions) The total number of MBS (private) group sessions held for the reference period. This total must not include ‘non MBS’ Group Sessions.

Row Definitions

Clinic Types

Refer to Clinic Types and Clinic Definitions

New Patient (Attendance) An initial occasion of service for a patient at a given clinic (i.e. Corporate Clinic Code) for a condition. Excludes post- discharge review associated with an admitted patient episode. Provider Type Medical Officer Includes all medical officers eg: interns, registrars, specialist consultants. Provider Type Other Health Professional Includes all other non-medical officer health professionals eg: nurses, allied health professionals, technicians, aboriginal and Torres Strait islander health workers. Repeat Patient (Attendance) Any subsequent occasion of service in that given clinic (i.e. Corporate Clinic Code) required for the continuing management/treatment of that condition, up to the stage where the patient is discharged from that given clinic. Includes post-discharge review associated with an admitted patient episode. Where the patient requires ongoing review for the same condition at that given clinic after the referral has expired, an updated referral confirming the need for continued management (refer to Section 5.4 Appointment Management of the Implementation Standard, of the Outpatient Service Implementation Standard) is required and will NOT initiate a new course of treatment, and the next service event will be a REVIEW.

3.1.3 Clinic Form (MACONCLNC) The Clinic form is used to report non-admitted patient activity by provider type (medical officer and other health professional), by clinic type (new or repeat) and also by the compensability/ eligibility of the patient. Health Statistics Unit MAC Manual Version 13.1


http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/45151D40E8573B1CCA25796E0013F415/$File/Tier_1.0.2_28102011.pdf

The Monthly Activity Collection The total number of one to one occasions of service, group sessions and number of group session patients must be recorded on this form.

3.1.3.1 Scope The Clinic form must be completed by all Queensland public facilities. Refer to Forms Required by Facility by Hospital & Health Service for the forms required to be submitted by each facility.

3.1.3.2 Form Clinic Form

3.1.3.3 Definitions Refer to Definitions for the data items collected on this form.

3.1.4 Diagnostics and Procedures Form (MACONDGPR) The Diagnostics and Procedures form is used to report non-admitted patient activity by service provider type (medical officer or other health professional) and compensability/ eligibility for: • community health services (hospital funded only) • procedure clinics (also reported by the appointment type (new or repeat)) • diagnostic imaging and pharmacy activity and • home delivered procedures census (inc renal dialysis and nutrition

patients). Both the number of ‘one to one’ OOS, group sessions and number of group session patients should be recorded on this form.

3.1.4.1 Scope The Diagnostics and Procedures form must be completed by all Queensland public facilities. Refer to Forms Required by Facility by Hospital & Health Service for the forms required to be submitted by each facility.

3.1.4.2 Form Diagnostic and Procedures Form



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3.1.4.3 Definitions Refer to Definitions for the data items collected on this form that are common to the MAC OOS forms.

Definitions unique to this form

The definitions of data items collected that are unique to this form are: OTHER SERVICES DEFINITION Community Health Services - Aged Care Occasions of service provided to non-

admitted patients provided by designated community health units funded from the facility’s operating expenditure that are operated and managed by the facility. Community health units may include well-baby clinics, immunisation units and aged care assessment teams. It is intended that all community health services funded through the facility be reported, regardless of where the services are provided. Separate identification of Community Health Services occasions of service provided to Rehabilitation and Geriatric Evaluation and Maintenance patients is required for national sub and non-acute patient reporting requirements.

Community Health Services - Geriatric Community Health Services - Psychogeriatric Community Health Services - Rehabilitation Community Health Services - Other

Other Outreach Services Occasions of service to non-admitted patients, which involve travel by the service provider, and are not classified as community health services or allied health services. Travel does not include movement within a facility, movement between sites in a multi-campus facility, or between facilities. It is intended that the Other Outreach Services classification excludes medical, surgical, or psychiatric services as these should be reported under the appropriate clinic type on the MACONCLNC form. Other Outreach Services does include activities such as home cleaning, meals on wheels and home maintenance.



The Monthly Activity Collection PROCEDURE CLINICS Refer to Clinic Types and Clinic Definitions NON-ADMITTED PATIENT – DIAGNOSTIC ACTIVITY*

DEFINITION

Diagnostic Imaging All occasions of service provided to non-admitted patients undertaken in radiology (X-ray) departments, as well as in specialised organ imaging clinics that carry out ultrasound, computerised tomography and magnetic resonance imaging. Each diagnostic test, or set of diagnostic tests, for the one patient referred to a radiology department constitutes one occasion of service.

Pharmacy All occasions of service to non-admitted patients from pharmacy departments. When drugs are dispensed or administered in other departments, such as the emergency department or the outpatient department, this is to be reported as an occasion of service against the related clinic type.

* It should be noted that diagnostic activity reported to the MAC (ie Diagnostic Imaging, Pharmacy and Pathology) is required to continue to meet statistical NMDS reporting requirements only. This data is not collected as per IHPA specifications being ‘stand-alone’ clinics. It is our understanding that activity associated with these services does not attract funding (as the costs are bundled together with the associated outpatient clinic). NON-ADMITTED PATIENT – HOME DELIVERED PROCEDURES The Independent Health Pricing Authority (IHPA) has mandated the reporting of activity related to patients receiving home delivered procedures (Home Dialysis and Home Nutrition) in their 2013-14 non-admitted data set specifications (DSS). This is to be reported in terms of the number of treatments undertaken in each reporting period (i.e per quarter). It should be noted that Section 13 of IHPA’s Tier 2 non-admitted services compendium 2013–2014 states that when reporting to the Activity based funding non-admitted patient care data set specification (aggregate) a patient census approach using agreed prescribing norms may be used for counting non-admitted patient service events. Therefore in terms of the MAC reporting, the ‘Home Dialysis Patients - Census’ was further expanded to include:

• all of the IHPA’s requirements to identify ‘Home Delivered Procedures’ for Home Dialysis and Nutrition; and




• Queensland Department of Health’s requirements to identify information on the number of patients who undertake home dialysis in relation to five home-based modalities:

- Home - Home haemodialysis (standard prescription)

- Home - Extended hours home haemodialysis

- Home - Automated Peritoneal Dialysis (APD)

- Home - Continuous Ambulatory Peritoneal Dialysis (CAPD)

- Facility - Self-care haemodialysis

Queensland Department of Health requirements from 1 July 2013 are to support Home Based Renal Dialysis key performance indicators (KPI’s). This KPI requires the monthly census numbers reported to the MAC to be based on whether the patient’s usual place of residence is either ‘Inside’ or ‘Outside’ of the Health & Hospital Service’s catchment area. Separate tables exist on the form to enable this reporting which is also required for Home Nutrition patients. The number of OOS will be derived when the Department of Health reports this information to IHPA. NON-ADMITTED PATIENT – HOME DELIVERED PROCEDURES CENSUS WITHIN THE HOSPITAL & HEALTH SERVICE

DEFINITION

HOME DIALYSIS Home – Home haemodialysis (standard prescription)

Haemodialysis undertaken in a patient’s home independently or with the assistance of a carer. Patients undertaking this modality are assumed to be dialysing for three and a half sessions per week with an average duration of five hours per session.

Home – Extended hours home haemodialysis

Haemodialysis undertaken in a patient’s home independently or with the assistance of a carer for longer duration, or more frequently, than the standard home haemodialysis prescription. Patients undertaking this modality are assumed to be dialysing for four and a half sessions per week with an average duration of eight and a half hours per session.



The Monthly Activity Collection Home - Automated Peritoneal Dialysis (APD)

A form of peritoneal dialysis undertaken daily in the patient’s home either independently or with the assistance of a carer. Patients undertaking this modality use a machine to cleanse their blood through the peritoneal membrane using a system of ‘bag exchanges’ (in many cases overnight). The consumables rather than the duration of the treatment are the primary cost drivers for this modality. Patients undertaking this modality are assumed to be undertaking four to six bag exchanges per day, equating to a maximum of eighteen litres of dialysate fluids in total per day.

Home - Continuous Ambulatory Peritoneal Dialysis (CAPD)

A form of peritoneal dialysis undertaken daily in the patient’s home either independently or with the assistance of a carer. Patients undertaking this modality manually cleanse their blood through the peritoneal membrane using a system of ‘bag exchanges’ and it is the consumables rather than the duration of the treatment that are the primary cost-drivers for this modality. Patients undertaking this modality are assumed to be undertaking four, one and half to three litre bag exchanges per day, equating to a maximum of twelve litres of dialysate fluids in total per day.

Facility – Self-care haemodialysis Haemodialysis undertaken independently or with the assistance of a carer in a purpose-built facility but without the assistance of paid healthcare professionals. Patients who dialyse independently (or with the assistance of a carer) in a facility where other patients are receiving assistance from paid healthcare professionals can be counted as self-care provided that the patient themselves do not receive




assistance from paid healthcare professionals during the session. Patients undertaking this modality are assumed to be dialysing for three and a half sessions per week with an average duration of four and a half hours per session.

NUTRITION Home - Enteral Nutrition The administration of nutrition either

orally or by feeding tube directly into the gastrointestinal tract self-administered by the patient. Refer to the IHPA Tier 2 Non-admitted Services Definitions Manual 2013–2014 25 February 2013 – V2.0

Home - Parenteral Nutrition The administration of nutrition by means of an infusion of an intravenous nutrition formula self-administered by the patient. Total parenteral nutrition is generally only used when it is not possible to meet a patient’s nutrition requirements through an oral or enteral route. Refer to the IHPA Tier 2 Non-admitted Services Definitions Manual 2013–2014 25 February 2013 – V2.0

BUSINESS RULES

The following business rules have been developed and agreed to by CARU in consultation with the Statewide Renal Clinical Network.

1. Patients can be counted as undertaking home dialysis if they are participating in one of the following:

• Home – Home haemodialysis (standard prescription) • Home – Extended hours home haemodialysis • Home - Automated Peritoneal Dialysis (APD) • Home - Continuous Ambulatory Peritoneal Dialysis (CAPD) • Facility - Self-care haemodialysis in a facility without assistance from

paid healthcare professionals

2. Patients in a dedicated home dialysis training pathway in a Queensland Health facility should be admitted for each treatment to HBCIS, and not considered a home patient until established at home permanently.



http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/tier2-non-admit-services-definitions-manual-3013-14http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/tier2-non-admit-services-definitions-manual-3013-14http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/tier2-non-admit-services-definitions-manual-3013-14http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/tier2-non-admit-services-definitions-manual-3013-14http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/tier2-non-admit-services-definitions-manual-3013-14http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/tier2-non-admit-services-definitions-manual-3013-14

The Monthly Activity Collection 3. Patients who are receiving dialysis during a ‘transitory period’ to determine

the most appropriate treatment for end-stage kidney disease are to be included in facility-based dialysis counts, in accordance with the Queensland Health Admitted Patient Data Collection (QHAPDC) business rules, until they meet the definition of participating in home dialysis.

4. To be included in the Monthly Activity Collection for home dialysis, a patient must have been undertaking dialysis for a minimum of two weeks out of the calendar month, which equates to ≥8 sessions of home haemodialysis per month or ≥16 days of peritoneal dialysis. Patients who have undertaken ≤ 7 haemodialysis sessions or ≤ 15 days of peritoneal dialysis in a calendar month cannot be included in the Monthly Activity Collection for home dialysis.

If a patient participates in two different home dialysis modalities in a single calendar month, the patient should be counted against the modality under which they dialysed for the majority of time for the month.

3.1.5 Telehealth Forms (MACONTELP and MACONTELR) The Telehealth forms are used to report non-admitted patient Telehealth activity by service provider type (medical officer or other health professional) and compensability and eligibility for: • specialist and allied health/ clinical nurse specialist clinics (also reported

by the appointment type (new or repeat)) • community health services (hospital funded only) • emergency services attendances • diagnostic and pharmacy activity Telehealth activity is activity that is either provided by, or received by the facility. Both the number of ‘one to one’ OOS, group sessions and number of group session patients must be recorded on this form. Telehealth occasions of service are consultations provided to non-admitted patients using videoconferencing technology. Non-admitted patient Telehealth occasions of service should be reported on the MAC Telehealth report where:

• the service was a substitute for a face-to-face occasion of service; • a clinician (doctor, nurse, or allied health professional) interacted with a

patient or a parent/carer on behalf of the patient; • clinical notes were recorded in the patient’s medical record; and • details of the consultation are captured through an electronic or manual

booking system.



The Monthly Activity Collection Telehealth occasions of service can be reported by a facility when a clinician (medical officer or other health professional) is present during the occasion of service. A Telehealth occasion of service can be reported once by the providing and once by the recipient facility. Each facility should report against the relevant provider type (medical officer or other health professional) and clinic type on the relevant Telehealth form (either the ‘Telehealth – Provider’ or ‘Telehealth – Recipient’ form). For example: A non-admitted patient clinic delivered via video conference. At the providing facility an Anaesthetist has provided the consultation. At the recipient facility the patient and a Registered Nurse are located. In this example:

• the provider would report a Telehealth occasion of service on the MAC ‘Telehealth – Provider’ report. As the Anaesthetist is categorised as a “Medical officer” provider type, the providing facility would report this Telehealth occasion of service against the relevant clinic type under the “Medical Officer” provider type of the MAC Telehealth – Provider report.

• the recipient would report a Telehealth occasion of service on the MAC ‘Telehealth – Recipient’ report. As a Registered Nurse is categorised as “Other Health Professional” provider type, the recipient facility would report this Telehealth occasion of service against the relevant clinic under the “Other Health Professional” provider type of the MAC Telehealth – Recipient report.

All Telehealth occasions of service including group sessions must be reported. Telehealth occasions of service must be reported by compensability and eligibility status for:

• specialist and allied health/ clinical nurse specialist clinics (new or repeat clinic types);

• community health services (hospital funded only); • emergency service attendances (non-EDIS sites); • clinical measurement; and • diagnostic and pharmacy activity.

Videoconferencing for the purposes of making an appointment or providing test results is excluded.

3.1.5.1 Scope The Telehealth form must be completed by all public facilities who provide or receive Telehealth OOS (both one to one and group sessions). Refer to Section 4, Forms Required by Facility by Hospital & Health Service for individual facility report requirements.




3.1.5.2 Forms Telehealth Form - Provider Telehealth Form - Recipient

3.1.5.3 Definitions The Telehealth forms are a combination of the Clinic, Diagnostics and Procedures and Emergency Services MAC forms. For definitions of the data items that are common across all MAC OOS forms and clinic types refer to Definitions. For definitions of OTHER SERVICES refer to Definitions of the Diagnostic and Procedures form. For definitions of the data items for the NON-ADMITTED PATIENT Emergency Services Care section refer to Emergency Services Form (MACONES).



http://qheps.health.qld.gov.au/hsu/datacollections.htmhttp://qheps.health.qld.gov.au/hsu/datacollections.htmhttp://qheps.health.qld.gov.au/hsu/datacollections.htmhttp://qheps.health.qld.gov.au/hsu/datacollections.htmhttp://qheps.health.qld.gov.au/hic/excel/1314-macones.xlshttp://qheps.health.qld.gov.au/hic/excel/1314-macones.xls


3.1.6 Emergency Services Form (MACONES) The Emergency Services form is used to report public non-admitted patient emergency services attendances/ episodes. The number of episodes should be recorded on this form. Under the National Health Reform Agreement only public patients can be treated by a hospital's emergency service / department. Any questions regarding these arrangements should be referred to the Revenue Strategy and Support Unit (RSSU).

3.1.6.1 Scope The Emergency Services form must be completed by all public facilities that do not utilise the EDIS System. Refer to Section 4, Forms Required by Facility by Hospital & Health Service for individual facility report requirements. It is acknowledged that some facilities will be receiving the EDIS application in 2013-14. ‘Non-EDIS’ sites were identified at the time of publishing this manual as having to complete the MACONES form but it is expected that once these sites implement the EDIS System they will cease completing this form. Where EDIS is implemented during a month and activity is only partly captured electronically for that period, the facility must report using the Emergency Services form to ensure that all of their activity (from both EDIS and the legacy recording mechanism) for the month is reported.

3.1.6.2 Form Emergency Services Form The Emergency Services form has changed considerably since last year to enable the reporting of additional information to meet the required DSS. See Overall Form Changes for an overview of these changes. Below are the instructions for the completion of the form.

1. The ES form has been divided into two sections. This division is

necessary to enable the collection of ‘Type of Visit to Emergency Services’ and to continue to report the required compensability/ eligibility categories.



http://qheps.health.qld.gov.au/hsu/datacollections.htmhttp://qheps.health.qld.gov.au/hsu/datacollections.htm


The first section of the form is entitled ‘Type of Visit to Emergency Services’ and the second section is entitled ‘Compensability/ Eligibility of Emergency Services Visit’. Section 1

Section 2

Each emergency service episode must be recorded in both sections against the ‘Episode End Status/ Triage Category #’– once to report the ‘Type of Visit’ and again to report the ‘Compensability/ Eligibility’ of the patient.

2. The column TOTAL VISITS in Section 1 of the form must equal the

‘TOTAL 1:1 SESSIONS (Excluding Private)’ column on the right hand side of Section 2. The same number of episodes must be recorded against the same Episode End Status/ Triage Category #’ in both sections.

If the number of episodes recorded in each section do not match then the difference will be displayed in the ‘Difference’ column on the far right of Section 2.

Any difference must be investigated and amended to ensure that both sections of the form are in balance.

Note: The column Difference is not uploaded with the form. This field is solely to ensure data integrity.

Refer to Definitions section for definitions of data items which must be collected.

3.1.6.3 Definitions Non-admitted patient emergency department service episode The treatment or care between when a patient presents at an emergency department and when the non-admitted patient emergency department clinical care ends.

NON-ADMITTED PATIENT

Public Emergency Services Care T yp e o f Vis it to Eme rg e ncy Se rv ice s TOTALVISITS

Emergency Presentation

Return Visit planned

Pre-arranged admission

Patient in Transit

Dead on Arrival

(must equal 'Total 1:1 Sessions

exc l Priv ate')

TOTAL 1:1 Difference

Elig ib le Pub lic - Co mp e nsa b le Ineligible SESSIONS (between

Work Cover Qld

Work Cover Other

Motor Vehicle Qld

Motor Vehicle Other

Other Third Party

Other Comp.Dept Veterans'

AffairsOther Public 19.2 RRMBS Public MBS

Non MBS

(Excluding Private)

'Total Visits' and 'Total 1:1

Sessions excl Private')

Co mp e nsa b ility / Elig ib il ity o f Eme rg e ncy Se rv ice s Vis it

Elig ib le Pub lic Priva te



http://meteor.aihw.gov.au/content/index.phtml/itemId/327158http://meteor.aihw.gov.au/content/index.phtml/itemId/327158

The Monthly Activity Collection Episode End Status/Triage Category #

The status of the patient at the end of the non-admitted patient emergency department service episode (previously Disposition/ Triage Category #). Episode End Status/Triage Category # Definition

Admitted to this Hospital - Triage 1 Admitted to this hospital (either short stay unit, hospital-in-the-home or non-emergency department hospital ward)

Admitted to this Hospital - Triage 2




Episode Completed Departed - Triage 1 Non-admitted patient emergency department service episode completed - departed without being admitted or referred to another hospital

Episode Completed Departed - Triage 2




Episode Completed Referred to Another Hospital - Triage 1 Non-admitted patient emergency department service episode completed - referred to another hospital for admission

Episode Completed Referred to Another Hospital - Triage 2




Did Not Wait - Triage 1 Did not wait to be attended by a health care professional Did Not Wait - Triage 2

Did Not Wait - Triage 3



Did Not Wait - Triage Not Assigned

Left at Own Risk - Triage 1 Left at own risk after being attended by a health care professional but before the non-admitted patient emergency department service episode was completed

Left at Own Risk - Triage 2




Died in Emergency Department - Triage 1 Died in emergency department as a non-admitted patient Died in Emergency Department - Triage 2

Died in Emergency Department - Triage 3



Dead on Arrival Dead on arrival, emergency department clinician certified the death of the patient



The Monthly Activity Collection Triage Category The urgency of the patient's need for medical and nursing care as assessed at triage. This triage classification is to be used in the emergency departments of hospitals, where patients will be triaged into one of the five categories on the Australasian Triage Scale which are:

Triage Category

Definition

1 Resuscitation: immediate (within seconds) 2 Emergency: within 10 minutes 3 Urgent: within 30 minutes 4 Semi-urgent: within 60 minutes 5 Non-urgent: within 120 minutes

In addition, to report those patients who did not wait and were no

Documents

New Mothly Activity Collection (MAC) Manual · 2016. 11. 1. · July 2011 . Version 11 : All . Update of controlled document to reflect changes to forms and facilities within the