Case Mix and Funding. Health Data Users Day May 12, Greg Zinck Manager, Case Mix

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1 Case Mix and Funding Health Data Users Day May 12, 2014 Greg Zinck Manager, Case Mix 1

2 Overview CMG+ and HIG What s the Difference? Specialized Care Grouping Methodologies Data Sources Used in Grouping 2

3 CMG+ and HIG What's the Difference? Case Mix Groups Plus (CMG+) First released for use with 2007 Discharge Abstract Database (DAD) data. HBAM Inpatient Groups (HIG) First released for use within HBAM in 2011 CMG+ grouper output and clinical information from the DAD are the required inputs 3

4 CMG+ vs HIG Group Assignment The vast majority of Ontario cases are assigned to a HIG cell equivalent to the CMG+ cell HIG Split Type CMG+ Cells HIG Cells Cases Affected Percentage of Cases Unchanged % Refined , % Comorbidity , % Grouping Reassignment % Total 1,135,566 Based on DAD 2012/13 data. 4

5 CMG+ Cell Assignment 5

6 HIG Cell Assignment 6

7 Differences Between Resource Indicators Factor CMG+ HIG Multiplicative Additive Comorbidity Level (CL) Number of Eligible Flagged Interventions Short Stay Adjustments Special Care Unit (SCU) Discharged to Homecare Maternal Age 40 7

8 Non-Acute Grouping Methodologies 8

9 Resource Utilization Groups version 3 (RUG-III) 7 Clinical Categories 44 RUG-III Groups Special Rehabilitation 14 groups Extensive Services Special Care Clinically Complex 3 groups 3 groups 6 groups Decreasing predicted resource utilization Impaired Cognition 4 groups Behaviour Problems 4 groups Reduced Physical Functions 10 groups 9

10 Classification: Future RUG III (44) Changes Apply RUG-IV extensive services rules to existing RUG-III Reverse hierarchy for impaired cognition and behavior groups Resource indicator: STRIVE Study methods and results used to address problematic CMI values CMI derivation changes (anchoring CA1 as 1.000) 10

System for Classification of In Patient Psychiatry (SCIPP) Clinical Categories SCIPP Groups Schizophrenia and Other Psychotic Disorders Cognitive Disorders 18 groups 4 groups Mood Disorders

11 System for Classification of In Patient Psychiatry (SCIPP) Clinical Categories SCIPP Groups Schizophrenia and Other Psychotic Disorders Cognitive Disorders 18 groups 4 groups Mood Disorders Personality Disorders Eating Disorders 12 groups 2 groups 1 groups Decreasing predicted resource utilization Substance Use Disorders 3 groups Other Disorders 7 groups Short Stay 1 group Ungroupable 1 group Not Mental Health 1 group

12 Rehabilitation Patient Groups (RPG) Rehabilitation Group (RG) assigned based on RCG Rehabilitation Patient Group (RPG) assigned within RG 12

13 CIHI s specialized care case mix products Product Audience RPG SCIPP RUG-III (44) RUG-III-HC High Level General Yes Yes Yes No Information Sheet Grouper Technical Yes Yes Yes Yes Methodology Product Weighting/ Technical No Yes Yes No Interpreting Guide FAQ General Yes Yes Yes No Resource Indicator Guide Resource Reports Self study Course Web Conference Course General No No Yes No General NRS ereports OHMRS Operational Reports CCRS ereports HCRS ereports General Yes Yes Yes, several Yes (very high level) General Yes* Yes* Yes* No * Available starting in September 2014.

14 Sources of Data Discharge Abstract Database (DAD) National Ambulatory Care Reporting System (NACRS) National Rehabilitation Reporting System (NRS) Ontario Mental Health Reporting System (OMHRS) Continuing Care Reporting System (CCRS) Home Care Reporting System (HCRS) Data Complexity Single Episode Single Episode Single Episode Longitudinal Episode Longitudinal Episode with Re-entries Longitudinal Multidimensional Data Collection Standard DAD Abstract NACRS Abstract National Rehab Tracking Forms RAI-MH MDS 2.0 MDS-HC Grouping Methodology CMG+ CACS RPG SCIPP RUG-III RUG-III-HC Resource Indicators RIW/ELOS RIW Rehab Cost Weights (Episode and Per-diem) Case Mix Index (Per diem) Case Mix Index (Per diem) n/a Sources of Resource Indicators CIHI Canadian Patient Cost Database (CPCD) CIHI Canadian Patieint Cost Database (CPCD) Ontario MOHLTC Ontario Case Costing Initiative (OCCI) Ontario MOHLTC Staff Time Minutes, Ontario Case Costing Initiative (OCCI) RUG III (44) CIHI Staff Time Minutes, RUG- Weighted Patient Day distribution, OHA Wage Rates RUG III (34) MOHLTC n/a 14

15 Thank You 15

Supporting New Funding Approaches using CIHI s Classification Systems. Health Data Users Day May 27, 2013 Greg Zinck, Manager, Case Mix

Supporting New Funding Approaches using CIHI s Classification Systems. Health Data Users Day May 27, 2013 Greg Zinck, Manager, Case Mix 1 Outline CIHI Groupers and CIHI Data Case Mix, Cost, Case Costing,