Community Nursing Program Classification Review

Project Type - Ageing and aged Care, Funding, Service costing

Description

The Department of Veterans’ Affairs (DVA) appointed Health Outcomes International (HOI) to undertake a review of the Community Nursing Program Classification System and associated Schedule of Item Numbers and Fees. 

The objectives of this review were to assess the appropriateness of the existing Classification System and investigate alternative cost neutral Classification Systems that may more correctly reflect community nursing practices at the time.

 A revised classification system was informed by the following key methodological processes:

  •   An Environmental Analysis informed by:
    • a comprehensive literature review of international and Australian developments in the delivery, classification and payment of community nursing services
    • preliminary stakeholders consultations around the existing system 
    • quantitative analysis of community nursing activity, expenditure and costs data
    • the administration and analysis of two online surveys of community nursing providers to report on the appropriateness of the current Classification System and seek information relating to the key issues to be addressed in undertaking the review and to identify issues impacting on service delivery.
  • An Impact Assessment of the existing Classification System informed by face to face consultations with 15 organisations contracted by DVA to provide community nursing services covering a range of service providers and geographic locations. The sample included for profit and not for profit operators, larger sites and smaller sites, operators of single facilities and operators of multiple facilities, major metropolitan operators and operators in regional areas.
  • Statistical analysis of the CNP Minimum Data Set (MDS) relating to claims made in 2011/12 financial year (analyses included a regression analysis of service provider data, cluster analysis of cost drivers and calculation of community nursing RVUs).
  • Two Delphi Panel meetings with invited community nursing experts, representing a mix of DVA staff and DVA-contracted providers
  • Two national workshops involving contracted service providers and DVA representatives.

HOI submitted a Final Report which presented:

  •  a contextual overview of the Community Nursing Program;
  •  an assessment of contemporary developments in classification and payment of community nursing services;
  •  analysis of DVA minimum dataset including veteran demographics, nursing visit profile, payment analysis, staff mix and exceptional case claims;
  • an assessment of the issues found in relation to the existing classification system; and
  • a summary of classification system options presented to stakeholders and the preferred classification system and payment option.