Financial Challenges at UTS Hospital

This assignment examines the financial difficulties faced by UTS Hospital. It investigates the impact of case-mix funding using AR-DRGs on hospital finances, highlighting its limitations in capturing the needs of UTS's patient demographic. The analysis suggests a return to per-diem reimbursement strategies as a potential solution, emphasizing the importance of negotiations with insurance companies for sustainable financial operations.

Running head: A CASE STUDY OF UTS HOSPITAL
A Case Study in UTS Hospital
Name of the Student:
Name of the University:
Author Note

1A CASE STUDY OF UTS HOSPITAL
Executive Summary:
This data presents the different factors of the patients over the countries of UTS Hospital,
Australia. Patient’s diagnosis procedure, technological support, management oriented
healthcare are also described in the data. We are interested to analyze the dataset and draw
the necessary conclusions. We took help of MS excel and R to analyze the data. The Purpose
of the case study is to provide an overall scenario of the prescribed dataset of UTS hospital.
The calculations and graphs are used to support our conclusion.

2A CASE STUDY OF UTS HOSPITAL
Table of Contents
Introduction:...............................................................................................................................3
Background:...............................................................................................................................3
Case-Mix and Pre-diem funding models:..............................................................................3
Description and differences of Case-Mix and Per-Diem Funding models:...........................4
Pros and Cons of two models:................................................................................................4
Cons of per-diem models:......................................................................................................5
Case-Mix funding is achieved in Australian Hospitals:.........................................................5
Aim of this report:..................................................................................................................5
Description of Analysis:.........................................................................................................5
Results:.......................................................................................................................................6
Description of analysis:........................................................................................................12
Discussion:...............................................................................................................................12
Appropriate data presentation and Relevant Findings:........................................................12
The advantages and disadvantages of case-mix and per-diem funding and their................12
Potential impact on a hospital:-............................................................................................12
Statement of Recommendation that are linked with UTS hospital:.....................................13
Conclusion:..............................................................................................................................13
References:...............................................................................................................................14

3A CASE STUDY OF UTS HOSPITAL
Introduction:
The data is based on the UTS charitable hospital and their healthcare services that
provide a real picture of its excellent reputation. We would elaborately describe about
hospital’s innovative care towards patients, teaching and medical research and rapid uptake
of new technologies. UTS hospital was guided by the generosity of previous government.
The general situation is that the hospital gets over 90% of the fund from private sector.
The pathological data set is collected from both public and private domain of UTS
hospital, Australia. Most of the factors are here categorical and few are continuous. People
would be conscious of the current heath care services and other facilities provided by the
hospital.
In the next segments of the report, we are going to discuss the relationship between
age and Length of Stay with proper graphs and calculations.
Background:
Case-Mix and Pre-diem funding models:
Case-mix classifications are the structural classifications that underlie many activity–
based funding and healthcare funding schemes. Case mix is a topic fraught with technicality
and vividly relegated to government agencies of private agencies. This report provides an
abridged review of mix classification and its implications for management in healthcare
(Costa,Poss,McKillop, 2015).

4A CASE STUDY OF UTS HOSPITAL
Per-diem funding model means that in the context of each day we assess the funding from the
government, public or private sector (Hwang et al., 2013) to the UTS hospital, Australia. We
can apply models to observe the funding amounts from different sectors.
Description and differences of Case-Mix and Per-Diem Funding models:
Case-Mix model is actually an activity based funding (ABF) model. In the case study
of a particular hospital, a policy intervention is needed to re-shape incentives across health
systems using the diagnosis-related groups. We can assess the effect of ABF on key measures
potentially developing or hampering the patients and health care system of UTS hospital. It
could include several factors like the discharge rate to post-acute care, diagnosis procedure,
readmission rates and indigenous procedure (Palmer et al., 2014).
However, Per-diem funding model mostly focuses on the funding that is coming from
various sectors on day-to-day. It helps management planning and the discussion about
infrastructural and technical development.
Pros and Cons of two models:
Pros of Case-Mix Model:
Firstly, the case-Mix classification provides a means of defining the factor or product
of the hospital. Secondly, a pricing system applied with case-mix framework offers the best
opportunity to apply an administration pricing approach for hospital services.
Cons of Case-mix models:
Firstly, when the information is currently available on the financial and structural
reform, this model does not permit any reasonable prediction. Secondly, the model is found
with apparent convergence of these reforms along a number of critical dimensions.
Pros of Per-diem Model:

5A CASE STUDY OF UTS HOSPITAL
Firstly, this per-diem model has better flexibility than case-mix classification
(Maddan, Marshall and Race, 2013). Many medical professionals like doctors, management
team, decision team work per diem shifts to earn some extra money as the staff-to-patient
ratios are not being mate.
Cons of per-diem models:
This model does not include a long-term case study. Therefore, it is very difficult to
reach to the conclusion at future with the help of per-diem models.
Case-Mix funding is achieved in Australian Hospitals:
Australia is implying the case-mix model to reform their healthcare system. UTS
hospital is going to be one of them. Since 1984, the primary responsibility for the provision
of health services in Australia has rested with a program of universal public insurance under
which public hospital treatment is available to everyone with charge (O’Brien, Dumas, 2013).
Hospitals are funded based on prospectively determined budgets. Now, the changes have
mainly risen from recognition that extensive inter-hospital variation costs must be reassessed
with the adjustment for kinds of patients treated by each hospital (Hof et al.,2017). In
Australian hospitals, the real inter-hospital variations in efficiency are to be estimated and
addressed to have a comparative study.
Aim of this report:
Our objective is to investigate the import of case-mix model in UTS hospital and
identify the better approaches to allocate resources for various hospital services. Much of this
report is has been oriented towards the aim to relate hospital reimbursement to the
widespread experimentation with case-mix classification measures.

6A CASE STUDY OF UTS HOSPITAL
Description of Analysis:
According to the questionnaire, we are intended to provide the comparative relation of
age and Length of Study as an analysis.
Results:
Result A
The age distribution of the data is provided in the following graph-
0 500 1000 1500 2000
boxplot of age

7A CASE STUDY OF UTS HOSPITAL
Figure 1: A box plot of age of the patients clearly signifies the presence of outlier.
0 20 40 60 80 100
boxplot of outliers free age
Figure 2: A box plot of outlier free age of the patients.
Similarly, plotting Length of Stay (LoS), we get-

8A CASE STUDY OF UTS HOSPITAL
0 5 0 1 0 0 1 5 0 2 0 0
boxplot of LoS
Figure 3: A plot of Length of Stay showing the outliers.

9A CASE STUDY OF UTS HOSPITAL
1 2 3 4 5 6 7 8
boxplot of outlier free LoS
Los
f r e q u e n c y
Figure 4: A Box plot of outlier free Length of Stay of the patients.

10A CASE STUDY OF UTS HOSPITAL
0
5000
10000
15000
2 4 6 8
LoS
Frequency
Outler free scatterplot of LoS
Figure 5: A scatter plot of outlier free length of study.

11A CASE STUDY OF UTS HOSPITAL
0 20 40 60 80 100
1 2 3 4 5 6 7 8
age vs LoS dotplot
age of the patients
LoS of the patients
Figure 6: outlier free age vs LoS dotplot.
> summary(new)
age1 LoS1
Min. : 0.00 Min. :1.000
1st Qu.: 20.00 1st Qu.:1.000
Median : 35.00 Median :1.000
Mean : 38.62 Mean :2.362

12A CASE STUDY OF UTS HOSPITAL
3rd Qu.: 60.00 3rd Qu.:3.000
Max. :103.00 Max. :8.000
The summary of outlier free data shows that mean time period of the patients who
stay in Hospital is over 2 days but less than 3 days. The mean age of the patient is 38.62
years.
Result B.
0
1000
2000
3000
4000
0 25 50 75 100
age of the patients
frequency
Histogram of age distribution
Figure 7: A histogram plot shows age distribution.
It shows that the patients whose age is 70 or above are significant in number.

13A CASE STUDY OF UTS HOSPITAL
Description of analysis:
Firstly using software package R, we found some outliers in age of the patients and
Length of Stay of the UTS hospital. Then we used MS excel and R to clean those factors of
the data from outliers. Finally, we have plotted the scatter plot to find the relation between
age and LoS. Finally, we have plotted the scatter plot of the data to find the visualization of a
dataset whose age is above 70.
Discussion:
Appropriate data presentation and Relevant Findings:
Now, counting the number of peoples whose age is over 65 is= 7046. Therefore, we
can conclude that over 40% patients of this hospital are aged persons. It shows that the
majority of patients are older and more complex. These patients need to stay longer than the
average length of stay for each AR-DRG. Therefore, the AR-DRGs are useless for measuring
the hospital’s performance when the LoS of the patients is different to that of the average
hospital.
The advantages and disadvantages of case-mix and per-diem funding and their
Potential impact on a hospital:-
The advantages of case-mix and per-diem funding of this data is that the UTS hospital
would overcome from the crisis. Case-mix classification would develop the infrastructure and
technology whereas per-diem model would increase the salary of employees on day-to-day
basis. However, HIM of the hospital states that case-mix funding using AR-DRGs are not the
best method to record performance because they do not suit the type of patients treated by
UTS hospital. We can find that the UTS hospital should go back to insurance funds and
negotiate a return to the funding of patients on a fixed per-diem basis

14A CASE STUDY OF UTS HOSPITAL
Statement of Recommendation linked with UTS hospital:
The rate of reimbursement from private insurers of UTS hospital is dependent upon
the negotiated rate. Every year, insurance companies negotiate with the hospital rate it pays
with AR-DRGs. These fees are based on Los of each AR-DRG. CEO of UTS arranged
meeting to discuss the issues facing the problem and to plan the action needed to take. The
involvement of Health Information Manager (HIM), the Chief Financial Officer (CFO), Chief
Information Officer (CIO) proves that UTS is involved with information, financial and health
sector.
Conclusion:
As a conclusion, we can say that UTS could overcome the critical situation after
taking proper measures and per-diem strategy. The patients are aged in maximum number;
therefore, UTS would supply proper infrastructure and healthcare with the help of insurance
sector, finance and information sector. They must manage the patients to have minimum
length of stay. Then only this charitable hospital would be able to withstand with his glory.

15A CASE STUDY OF UTS HOSPITAL
References:
Costa, A.P., Poss, J.W. and McKillop, I., 2015, January. Contemplating case mix: A primer
on case mix classification and management. In Healthcare management forum (Vol. 28, No.
1, pp. 12-15). Sage CA: Los Angeles, CA: SAGE Publications.
Hof, S., Fügener, A., Schoenfelder, J. and Brunner, J.O., 2017. Case mix planning in
hospitals: a review and future agenda. Health care management science, 20(2), pp.207-220.
Hwang, S.W., Chambers, C., Chiu, S., Katic, M., Kiss, A., Redelmeier, D.A. and Levinson,
W., 2013. A comprehensive assessment of health care utilization among homeless adults
under a system of universal health insurance. American journal of public health, 103(S2),
pp.S294-S301.
Madden, R., Marshall, R. and Race, S., 2013. ICF and casemix models for healthcare
funding: use of the WHO family of classifications to improve casemix. Disability and
rehabilitation, 35(13), pp.1074-1077.
O'Brien, J.E. and Dumas, H.M., 2013. Hospital length of stay, discharge disposition, and
reimbursement by clinical program group in pediatric post-acute rehabilitation. Journal of
pediatric rehabilitation medicine, 6(1), pp.29-34.
Palmer, K.S., Agoritsas, T., Martin, D., Scott, T., Mulla, S.M., Miller, A.P., Agarwal, A.,
Bresnahan, A., Hazzan, A.A., Jeffery, R.A. and Merglen, A., 2014. Activity-based funding of
hospitals and its impact on mortality, readmission, discharge destination, severity of illness,
and volume of care: a systematic review and meta-analysis. PLoS One, 9(10), p.e109975.