Are Victorian Elective Surgery Cases Still Converting from Overnight to Same Day Cases?

Article excerpt

Abstract

The conversion rate on a diagnosis related group (DRG)-standardised basis of Victorian private overnight (ON) elective surgery cases to same day (SD) cases declined from 4.7% per annum over 1996-97 to 1998-99^sup 6^ to 2.5% per annum over 1998-99 to 2002-03. Similar analysis within the Victorian public sector shows a decline from 3.8% per annum over 1996-97 to 1998-99^sup 6^ to 1.9% over 1998-99 to 2002-03. Comparison on a DRG-standardised basis shows while the public sector continued to show a higher incidence of elective surgery SD cases than the private sector in 2002-03 (by 1.6%). The difference has declined since 1998-99 when it was 2.4%. DRG-based analysis suggests the conversion rate in both sectors and the difference in SD surgery cases between the two sectors will continue to decline. Future savings in recurrent and capital cost due to ON surgery cases becoming SD cases are likely to be much lower than savings in recent years.

Aust Health Rev 2005: 29(2): 178-184

IT HAS BEEN SUGGESTED for a number of years that increasing the proportion of surgical cases performed on a day basis would generate significant financial advantages, and other benefits such as lower rates of hospital acquired infections and less personal and family disruption.1

Same day (SD) separations in Australian hospitals and freestanding day facilities have risen from 2.75 million in 1998-99 to 3.58 million in 200203, an overall increase of about 830 000.2 Much of this increase has been in non-surgical diagnosis related groups (DRGs) that have usually or always been undertaken on a day case basis such as renal dialysis, which accounted for 31% of the total increase in SD cases between 1998-99 and 2002-03,3,4 and chemotherapy.

Some of the increase in day cases has been due to increased SD surgery cases. Both the absolute number and the proportion of cases undertaken as SD cases have been increasing in a number of surgical DRGs. For example, the SD case rate for extracapsular crystalline lens extraction rose from 39.4% of 22972 separations in 1993-94 to 84.1% of 121236 separations in 2000-01. Another example is release of carpal and tarsal tunnel where the SD case rate has risen from 54.3% of 17902 separations in 1993-04 to 84.2% of 25485 in 2000-01.5

It was been shown that from 1996-97 to 1998-99 there was an increase (on an ANDRGv3-standardised basis [Australian national diagnosis related groups]) of 7.7% in Victorian public sector SD elective surgery cases due to conversion (cases previously undertaken on an ON basis converting to SD cases).6 Similar analysis for the Victorian private sector showed an increase of 9.5% over the same period. This was equivalent to an annualised DRG standardised increase in SD cases due to conversion of 3.8% in the public sector and 4.7% in the private sector. No other recent Australian publications quantifying conversion on a DRGstandardised basis have been identified.

In this study, the change in the numbers of cases and rates of conversion in the public and private sectors in Victoria was investigated using DRGstandardised data up to 2002-03. The aims were to determine whether conversion was common to many DRGs; the relative importance of volume change versus conversion in the observed increases; and whether there were different trends in the public and private sectors.

Method

The Victorian Department of Human Services (DHS-Vic) provided unit record (UR) level data for separations in 1998-99. Data elements included ANDRGv3, ARDRGv4 (Australian refined diagnosis related groups), an SD flag, a flag indicating whether the admission was an elective or an emergency case, and a flag to indicate whether the admission was undertaken in the public or private sector. Data for 2002-03 were similar except that the only DRG data available was in ARDRGv4. The data provided by DHS-Vic was totally deidentified in relation to individual patients and individual hospitals. …