PCSI 2012 Casemix Winter School - “Design and Implementation of Activity Based Funding”, Curriculum Outline – Oct 2nd Version	
Monday	Tuesday	Wednesday	Thursday	Friday	
Student check-in (8:30 to 9:00)

School Opening  (09:00 – 09:30)
•	Course logistics and overview of week
•	Introductions - faculty and students	 Analytical Methods I (09:00 – 10:30)  

Introduction to R software

Probability densities 
•	Cost
•	Length of stay

Goodness of fit measures
•	R2, bias, prediction error, coefficient of variation	Analytical Methods II (09:00 – 12:30)

Statistical tests
•	Statistical significance
•	Materiality of differences

Decision tree modeling
•	CART, CHAID algorithms
•	Applications in DRG development, refinement, and evaluation

Regression Modeling
•	Linear regression (OLS, WLS)
•	Logistic regression
•	Assessment of model assumptions
•	Transformations
•	Applications in ABF design and implementation	Payment System Design Aspects (09:00 – 10:30)  
•	Alignment with health policy objectives
•	Technical and allocative efficiency
•	Setting of prices
o	Average cost; efficient providers
o	Using prices to incent behaviour changes
o	Limiting a provider’s risk due to adverse selection (outlier policy)
•	Exclusions: areas of care, small hospitals
•	Expenditure control and demand  management
o	Two-part tariffs; volume caps
•	Paying for specialized care, teaching, research, and innovation
•	Private versus public provision – ensuring a fair playing field
•	Paying for quality	Hands-on Data Analysis III  (09:00  – 12:15)

Inter-facility comparisons of efficiency

Monitoring and evaluation of ABF

Managing a Hospital Under ABF	
Activity Based Funding - Introduction and Overview (09:30 – 11:00) 
•	Definition and basic mechanics of a ABF system
•	Comparison with other funding mechanisms 
•	Historical background and evolution 					
Casemix Classification Design (11:00 – 12:30)
•	Design principles
•	Age and  complexity/severity adjustments
•	DRG update cycle
•	Clinician and other stakeholder input	Cost Weights (10:45 – 12:30) 
•	Definition and mechanics of cost weight calculation
•	Long and short stay trimming and outlier payments
•	Setting the base rate
•	Payment-rate adjustment factors/market forces factors
•	Adopting cost weights from another country		Implementation Details and Issues (10:45 - 12:30) 
•	Speed of implementation
•	Tracking of volumes and expenditures
•	Scrutiny of prices by, and price negotiations with, providers
•	Setting and updating of market forces factors
•	Update cycle: cost weights, base rates,  rate adjustment factors 
•	Accommodating new technologies and changes in the organization and setting of care 

•	Resources to build and operate an ABF system
o	Data
o	IT infrastructure
o	Expertise
o	Funding	School Closing (12:15 – 12:30)
•	Course evaluation
•	Closing remarks	
Lunch (12:30 – 13:30)	Lunch (12:30 – 13:30)	Lunch (12:30 – 13:30)	Lunch (12:30  – 13:30)	Lunch (12:30 – 13:30)	
Patient-Level Costing (13:30 –17:00) 
•	Bottom-up costing and  top-down costing
•	Cost buckets
•	Workload measurement systems
•	Allocation methods
•	Accuracy, representativeness, and completeness
•	Identifying and handling anomalous cost data
•	Adopting case cost data from another country and other alternatives	Hands-on Data Analysis I (13:30  – 17:00)

Identification and removal of anomalous cost data

Assessment of DRGs
•	Cost homogeneity
•	Clinical homogeneity
•	Stability
•	Transparency and simplicity
	Hands-on Data Analysis II (13:30  – 17:00)

Cost weight calculation
•	Setting trim points
•	Calculating cost weight and outlier payment weight
	Monitoring and Evaluation of ABF (13:30  – 15:15) 
•	Inter-facility comparison of performance and identifying efficient hospitals 
•	Longitudinal methods to monitor effects of ABF
o	Changes in case mix, efficiency, cost, length of stay, quality, readmissions 
o	Changes in medical record documentation Coding accuracy, upcoding, and DRG creep 
o	Quality of care
o	Moral hazard
•	Coding audits
•	Strategies for management	

No classes – school is closed	
			Managing a Hospital Under ABF (15:30 – 17:00)
•	Scrutiny of prices and inequities in payment
•	Patient-level costing
•	Identifying and managing inefficiencies 
•	Negotiating payment for exception cases		

Coffee Breaks at 10:30 and 15:30