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FAQs
Disclaimer
The information and opinions provided in this section are provided in good faith. The opinions are not intended to refer to particular companies or individuals.
The intention is to reflect the current situation that applies in the Australian health industry market place. Overseas clients, individuals and companies should consult their own regulations, laws and circumstance before accepting and/or rejecting this advice.
If you have any questions or would like to add to this list, please email Clarisoft at: support@clarisoft.com.au
Do we need to purchase our grouper software from our main system supplier?
How are grouper standards maintained ?
How do we link the grouper software with the Hospital Information System ?
Do we need to change our patient admission arrangements ?
How important is control over length of stay?
Should one doctor be responsible ?
Why are clinical indicators important, for DRG Management ?
Why are clinical pathways important ?
How will Casemix lead to improvements in quality of care ?
What part does the doctor play in DRG (Casemix) implementation?
What part do nurses play?
Do we need to purchase our grouper software from our main system supplier?
There are two parts to grouper software. The first is the grouper engine and the second is the grouper interface. It is the interface functionality that determines the difference between the software products.
No, you do not need to purchase grouper software from your main system supplier. Interfacing between the products is not technically difficult.
There are NO major main system (HIS) suppliers that build the Australian AR-DRG grouper engine.
In Australia main system suppliers are obliged to allow each Hospital to choose their own grouper software. It is the hospitals right to choose and the Australian Trade Practices Law protects the right of each Hospital to make their own decision. That law is designed to ensure there is competition in the market place and to ensure that any one supplier does not unfairly dominate the market.
The hospital owns the data that is produced by the HIS supplier software. It is not owned by the HIS supplier or consultant company.
Clarisoft will work with any main system supplier to ensure that Hospitals receive the best possible technical support. However, these arrangements must be approved by each individual Hospital.
Similarly, Clarisoft will assist overseas HIS suppliers with the construction of their own software with a view to incorporating the unity features into their main system
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How are grouper standards maintained ?
The Grouper logic for AR-DRG is determined by the Australian Government. This logic is copyright protected by the Commonwealth of Australia.
The correct output from Grouper engines is determined for all approved developers who are contracted to the Australian Government. A certificate of acceptance is provided when 100% compliance with output testing has been achieved.
Hospitals are cautioned to ensure that any interface grouper software application they use is producing output that complies with the Australian acceptance testing requirements.
If the application of the interface to the engine is not performed correctly then incorrect grouping will result, even though the engine is performing in a satisfactory manner.
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How do we link the grouper software with the Hospital Information System ?
The unity Grouper interface allows the hospital to import a data text file from the HIS system and export changes and the DRG assignment code back to the HIS.
The Clarisoft unity interface allows Hospitals to match the Clarisoft data format to their own HIS format. The Clarisoft software automates much of this work and the construction of import and export files can be undertaken by the Hospital IT support personnel.
Similarly, the unity can be used to export data for in hospital analysis and to report to external agencies such as government or health insurers. Much of the expense involved in having HIS suppliers undertake this new DRG software construction work can be avoided or at least delayed until German requirements are adequately specified.
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How important is control over length of stay?
A major budget influence under DRG financing is the effect of patient length of stay. Length of stay CANNOT be controlled after the patient is discharged. The preferred arrangement is to assign the DRG on admission, to enable the ongoing length of stay to be monitored.
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Should one doctor be responsible?
The law requires that each individual patient is admitted under the care and treatment of one single medical practitioner who generally organises attendance or treatment by other medical practitioners.
This doctor is commonly known as the "Responsible" doctor. In some circumstances it becomes necessary to transfer (refer) the care to another "responsible" doctor.
When this occurs the referral should be documented in the medical record with the reasons for the transfer written down. It is the responsible doctor who supervises all medication, patient consent, treatment orders and is responsible for recording a discharge diagnosis and a discharge summary.
To protect patient safety and for legal reasons there can only be one doctor in charge of the total care of the patient at any one point in time.
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Why are clinical indicators important, for DRG Management ?
Clinical indicators are normally applied in association with monitoring of Hospital quality assurance. For DRG Management there is a new emphasis as these indicators can assist in reviewing circumstances that produce bad financial results for Hospitals. An example is Hospital acquired infections that cause extended length of stay or readmissions following surgery.
The Clarisoft unity software provides extensive reporting to allow Hospitals to examine clinical indicators.
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Why are clinical pathways important ?
Clinical or critical pathways are a patient management tool which support continuous quality improvement, efficient resource utilization and quality patient care. This work helps to ensure good patient outcomes.
One significant effect of DRG Financing is to reduce inpatient length of stay. To accommodate this change Hospitals are obliged to examine best practice methods to ensure that quality of care is maintained over a shorter period of inpatient admission. Hospitals normally commence this work by examining their higher volume DRG's in terms of effective and ineffective treatments, diagnostic tests ordering, medication regimes etc. The result is to determine appropriate clinical pathways that are specific to each particular hospital.
Clarisoft provides postal (correspondence) educational assistance for this work.
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How will Casemix lead to improvements in quality of care ?
The information derived from Casemix will help to identify problems in quality so that they can be resolved. This includes information on outcomes such as the average length of stay for a particular DRG.
Hospitals have an incentive to implement clinical pathways based on best practice to ensure that patients receive cost-effective treatment and enjoy good clinical outcomes.
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What part does the doctor play in DRG (Casemix) implementation?
The main role of the doctor remains unchanged. Doctors will continue to practice good medicine as they have always done, for the benefit of their patients.
The doctor must ensure that the clinical practice conforms to best practice in accordance with the needs of the patient within the available resources. Keeping good and accurate clinical records is also very important because this will facilitate accurate coding of the casemix information.
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What part do nurses play?
The nursing care unit becomes the hub of interactive casemix management.
Each ward becomes a "clinical cost center" and the role of the Nurse Unit Manager is expanded to include:
- supervision of the cost center budget;
- co-ordinating information for quality assurance committees;
- ensuring the competence of discharge planning and transfer to alternate levels of care as well as several other Casemix related activities.
Nurses are also aware of the limits of the medical averaging model and are necessary contributors to the development of clinical pathways and assessment to ensure that fluctuations in patient dependency levels are not compromised by the DRG funding model.
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Clarisoft Pty Ltd (ABN: 82 124 437 172) is an Australian-based company providing Health oriented Consultancy and Solutions specifically for ICD-10-AM / AR-DRG implementations.
