PHacts
DEPARTMENT OF VETERANS’ AFFAIRS INFORMATION FOR PRIVATE HOSPITALS
ISSUE 14 NOVEMBER 2014
Introduction
ISSUE #14 FEATURES:
• Remembrance Day
Greetings
• Ambulance Transport
We are rapidly approaching the end of yet
another year in which much significant work
has been achieved and even more looms on the
horizon.
• Femtosecond Laser Assisted Cataract Surgery
Since our last issue in October 2013, the
Department released a National Request For
Tender (RFT) earlier this year for the purchase
of Private Hospital Mental Health Services.
DVA applied new criteria to the purchase of
Mental Health Outpatient Day Programmes
to ensure that services delivered were both
clinically and evidenced based, safe and clearly
outcome focussed with a particular emphasis on
transitioning veterans back into the community.
This proved to be a large exercise with over
200 Programmes submitted for evaluation.
The tender was only finalised last month and I
would like to thank all those involved for their
cooperation and patience.
• DVA “War Codes”
You’ll be aware that the Repatriation
Commission recently endorsed a two year
extension to the current private hospital
contracts to 30 June 2016. In preparation for
future arrangements, the Department is
• Further News on Pay for Performance [P4P]
• High Cost Medical Devices (Item M152)
• White Cards for SRCA clients
John Fely
Assistant Secretary
Hospitals & Defence Homes Services
November 2014
• Perioperative Nursing
• DVA Online In-hospital Claiming (IHC)
• Mental Health Outpatient Day Programmes
• Innovation
• Quality Reporting Time
currently engaged with a number of consultants
to explore opportunities regarding “value based
purchasing”, and conduct research of “palliative
and end of life” care; “minimising adverse
events” and improving the coordination of care.
To put it succinctly, DVA is looking to lay the
groundwork for a stronger focus on the safety
and quality of hospital services provided to the
veteran community.
I look forward to engaging the wider industry in
the lead up to 30 June 2016.
I encourage you to share this edition of DVA
PHacts with other interested staff at your
facility. As always we welcome your feedback
and suggestions for topics for the next issue
of PHacts. Please send your comments to
HospitalContracting@dva.gov.au
On behalf of the department I would like to
take this opportunity to thank you for the
care you provide to the veteran community,
and to reflect on the upcoming anniversary of
Remembrance Day and on that note share with
you the following.
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PHacts
DEPARTMENT OF VETERANS’ AFFAIRS INFORMATION FOR PRIVATE HOSPITALS
ISSUE 14 NOVEMBER 2014
Remembrance Day
Ambulance Transport
Ambulance services are commonly used to transport
DVA patients from private hospitals where the
patient is:
1. discharged and is transported home or
2. transferred to another hospital or
3. is an inpatient and is provided with transport to
another hospital or medical facility to receive
treatment services that are not provided by the
treating hospital and following the treatment is
returned back to the originating private hospital.
Such services include but are not limited to
radiotherapy, dialysis, diagnostics and therapeutic
treatment services.
World War I began in 1914 and lasted for
four years. More than 416 000 Australians
volunteered for service in World War I.
Of those, 324 000 served overseas. More
than 60 000 Australians were killed,
including 45 000 who died on the Western
Front in France and Belgium, and more than
8000 who died on the Gallipoli Peninsula in
Turkey.
As well as Australian soldiers, many nurses in
the Australian Army Nursing Service served
on the Western Front. These nurses worked
in overcrowded hospitals for up to 16 hours
a day, looking after soldiers with shocking
injuries and burns. Those who worked in
hospitals close to the fighting were also in
danger of being shelled by the enemy.
In October 1997, the then Governor-General
issued a Proclamation declaring 11 November
as Remembrance Day – a day to remember
the sacrifice of those who have died for
Australia in wars and conflicts.
As a mark of respect to those who have
died and suffered, people in Australia are
encouraged to stop what they are doing at
11am on Remembrance Day to observe one
minute’s silence, and reflect on the loss and
suffering caused by war.
Lest we forget.
If you would like to receive commemorative
material for this year’s Remembrance Day
commemoration you will need to send your
order [including name and address of facility]
to the DVA PHacts mailbox at:
HospitalContracting@dva.gov.au
In the first two circumstances DVA will usually
accept financial responsibility for the ambulance
transport. Where an air ambulance is required,
discharge planners should contact DVA prior to
arranging an air ambulance. DVA can be contacted
on 133 254 for metropolitan callers or free call on
1800 555 254 for country callers.
DVA will not accept financial responsibility for
ambulance services that are used as described in
the third circumstance. In these circumstances
the private hospital is responsible for the costs of
ambulance services. Where DVA is charged for the
services as described in the third point DVA will
seek to either recover the charges from the private
hospital or refer the invoice for the services to the
private hospital for payment.
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PHacts
DEPARTMENT OF VETERANS’ AFFAIRS INFORMATION FOR PRIVATE HOSPITALS
ISSUE 14 NOVEMBER 2014
Femtosecond Laser Assisted Cataract Surgery
DVA understands that some organisations have
made a significant investment in Femtosecond
Laser technology for cataract removal. In fact,
the Department has received many requests
from providers over recent years to fund this
new procedure with an overwhelming number
being declined.
The use of the Femtosecond Laser for cataract
surgery is not currently available on the
Medicare Benefits Schedule, therefore any
provider wishing to provide this treatment
to DVA clients must continue to seek prior
financial authorisation from DVA.
In determining whether to fund femtosecond
laser services, DVA is guided by the Royal
Australian and New Zealand College of
Ophthalmologists (RANZCO) statement on
cataract surgery on their website which states:
“The public can be reassured to know that
the present technique of cataract removal
through a tiny (microscopic) incision using
phacoemulsification, followed by implantation of
artificial IOL, remains the standard of care and is
extremely efficient and safe. As new technology,
there is no strong evidence that femtosecond laser
surgery will be any safer yet it adds considerably
to the cost of the procedure and prolongs the
procedure.”
DVA also notes the evidence for the efficacy
of femtosecond laser assisted surgery in an
assessment by the Health Policy Advisory
Committee on Technology (HealthPACT)
in February 2012 and the report (WP059)
concluded:
“There appears to be no significant clinical
advantage over the use of the femtosecond lasers
to remove cataracts in comparison to conventional
phacoemulsification, especially when consideration
is given to the high cost of the new technology.
It would appear that the femtosecond laser
technology for the removal of cataracts is rapidly
diffusing in the private sector throughout Australia,
however the technology is unlikely to impact
on the public system in terms of patient flow
and reduced waiting times for cataract surgery.
There is a paucity of comparative evidence, in
the form of randomised controlled trials, with the
reported evidence to date conducted on relatively
small patient groups.” www.health.qld.gov.au/
healthpact/html/tech-briefs.asp
From DVA’s perspective, use of the
femtosecond laser for cataract surgery cannot
be regarded as clinically essential, as substantial
evidence for increased safety and improved
outcomes in cataract surgery is not yet available.
Furthermore, DVA, through its funding
arrangements, does not contribute towards
costs associated with capital investments. We
see the purchase of the femtosecond laser as a
business decision, and as such, we are unable
to contribute towards that cost. This policy
is uniformly applied to all facilities who may
approach the Department from time to time.
Unless there is a strong clinical justification as to
why the conventional procedure is not clinically
appropriate, requests to DVA for prior financial
authorisation for femtosecond laser assisted
surgery will continue to be declined.
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PHacts
DEPARTMENT OF VETERANS’ AFFAIRS INFORMATION FOR PRIVATE HOSPITALS
ISSUE 14 NOVEMBER 2014
Further News on Pay for Performance (P4P)
The October 2013 edition of PHacts included an article
about the DVA Patient Satisfaction Survey questionnaire,
encouraging the distribution of the questionnaire to all
DVA patients who have an overnight acute care, medical or
surgical hospital admission. But wait…. There’s more!
about questionnaire distribution or completion of the
spreadsheet.
ASR email: p4pdva@aussurveys.com
ASR phone: 1800 001 154
ASR Fax: 03 9578 5311
Since its inception in 2009, the survey has been managed
by AC Nielsen Research Pty Ltd. Following a nation-wide
Request for Tender (RFT) process, the Department has
now engaged the services of Australian Survey Research
Group Pty Ltd (ASR) who took over the administration of
the survey effective 17 February 2014.
Hospitals that distribute the questionnaire receive
comprehensive reports, including a breakdown of results
against each question which is compared to the national
average. The survey provides a valuable tool for identifying
how patients feel about many aspects of their admission,
highlighting what is being done well and potential areas for
improvement.
By now any acute, surgical or medical facility should have
received a supply of the questionnaires produced by ASR
and be distributing these. Any stock of Nielsen questionnaires should be destroyed. Hospitals are required to:
• provide all overnight acute care patients receiving
treatment under DVA arrangements with a copy of the
questionnaire, preferably at the time of discharge;
• record on the reporting spreadsheet provided by ASR the
DVA number of the patient receiving the questionnaire,
against the appropriate sequence number;
• encourage veterans to fill in the survey, and return it
within 2-3 weeks of their discharge;
• send to ASR the reporting spreadsheet with the record
of the questionnaires distributed by emailing p4pdva@
aussurveys.com by the 15th of each month; and
• ensure ASR has the contact details of the staff person/s
managing the survey at your hospital.
Please use the ASR contacts below if you require additional
supplies of the questionnaire or have any queries
Additionally, 30% of your overall P4P score is attributed
to the patient satisfaction results. Hospitals with less than
10% questionnaire distribution and return do not receive a
score on the patient satisfaction domain. In the past, some
hospitals have missed out on receiving a bonus payment
because they have not been active in distributing and
recording distribution of the questionnaire.
Hospitals that have been distributing the Patient
Satisfaction Survey recently had the opportunity to
complete a survey to assist DVA in assessing the current
Pay for Performance arrangements and to explore
opportunities for development and improvement to
the programme. The survey was distributed by Health
Outcomes International (HOI). Results are currently being
analysed and recommendations will be delivered to DVA in
the near future.
Feedback to DVA about Pay for Performance is also
welcome at any time.
Email: PayforPerformanceP4P@dva.gov.au
High Cost Medical
Devices (Item M152)
Since the last newsletter there
have been some changes made
to the claiming rules surrounding
Item M152.
DVA will now meet the costs
associated with the use of
High Cost Medical Devices
(HCMD) where it is considered
not reasonably included in the
theatre fees. As a guide, items
valued at $250 or less would not
generally be considered high
cost. M152 should only be used
in exceptional circumstances as
all disposable and consumable
items are considered to be
included in the theatre fee
payable for the procedure.
All claims made under Item
M152 for $250 and below will
be rejected with the following
reason - ‘Item included in
theatre fees’. The effective date
is 1 February 2014.
If you have any queries regarding
this please contact your DVA
Contract Manager.
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PHacts
DEPARTMENT OF VETERANS’ AFFAIRS INFORMATION FOR PRIVATE HOSPITALS
ISSUE 14 NOVEMBER 2014
DVA War Codes
Recent compliance activities undertaken by the Private Hospitals
Contracting team has revealed some confusion amongst hospitals in
identifying veterans from overseas conflicts. To assist you in this regard, a
list of “War Codes” assigned to various conflicts has been provided below.
The “War Code” is a prefix to the veteran’s file number and immediately
follows a state identifier. For example, a British Merchant Seaman 1939
living in Victoria would have the DVA file number: VPSW 12345.
WAR CODE CONFLICT
WAR CODE CONFLICT
WAR CODE CONFLICT
A
AGX
BUR
BW
CGW
CIV
CN
CNK
CNS
CNX
FIJ
GHA
GW
HKS
HKX
IND
IV
KM
KYA
MAL
MAU
MLS
MTX
MWI
N
NF
NG
NGR
NK
NRD
NSM
NSS
NSW
NX
P
PAD
PAM
PCA
PCR
PCV
PK
PMS
PSM
PSW
PWO
PX
Q
RD
RDX
SA
SAX
SL
SM
SR
SS
SUD
SWP
TZA
X
ZZ
Allied Forces
Act of Grace 1939
Burma
Boer War
Commonwealth Gulf War
Civilians
Canadian Forces 1914
Canada Korea/Malaya
Canada Special Overseas Service
Canadian Forces 1939
Fiji
Ghana
Australian Gulf War
Hong Kong (SP Eligibility)
Hong Kong 1939
India
Indigenous Veteran 1939
Korea-Malaya
Kenya
Malaya-Singapore
Mauritius
Malaysia – Singapore SP Eligibility
Malta 1939
Malawi
New Zealand 1914
Newfoundland
New Guinea Civilian War Pension
Nigeria
New Zealand Korea-Malaya
Northern Rhodesia
New Zealand Serving Members
New Zealand Special Overseas Service
New Zealand Merchant Navy
New Zealand 1939
British Pension 1914
British Admiralty Pension
British Air Ministry Pension
Governments and Administration
British Service Department – CRO
British Pension Civilian
British Korea/Malaya
British Merchant Seaman 1914
British Serving Members
British Merchant Seaman 1939
British War Offices Pension
British Pension 1939
Query
Southern Rhodesia 1914
Southern Rhodesia 1939
South African Forces 1914
South African Forces 1939
Sierra Leone
Serving Member
Far East Strategic Reserve
Special Overseas Act
Sudan
Seamans War Pension 1939
Tanganyika (Tanzania)
Australian Forces 1939
Zanzibar
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PHacts
DEPARTMENT OF VETERANS’ AFFAIRS INFORMATION FOR PRIVATE HOSPITALS
White Cards for
SRCA clients
The changes to billing arrangements for clients under DVA’s
Safety Rehabilitation and Compensation Act 1988 (SRCA) are
now in effect.
DVA clients under SRCA with long term treatment needs have
now been issued with a DVA Health Card (White Card).
WHAT DOES THIS MEAN FOR HOSPITALS?
• SRCA clients will use their White Card (or Gold Card if they
already have one) to access hospital treatment in the same
way as other Entitled Persons.
• The hospital service provider must bill DHS (Medicare)
directly for the accepted health care services using the White
Card.
ISSUE 14 NOVEMBER 2014
DVA Online In-hospital
Claiming [IHC]
ARE YOU AWARE YOU CAN MAKE CLAIMS ONLINE W ITH DVA?
Claiming online allows Private Hospitals and Day Procedure Centres to lodge claims
directly with DHS (Medicare). This includes claims for:
• accommodation;
• theatre;
• prosthetics; and
• miscellaneous services.
WHAT ARE THE BENEFITS TO YOUR ORGANIZATION?
• Error free claims processed in seconds and payments lodged into your facility’s
nominated bank account within 3 days
• Electronic remittance advices available as soon as your claim is processed and paid
• Rejected claims can be corrected and resubmitted in real time
Perioperative Nursing
DVA has recently received invoices from private hospitals
seeking payment for the services of perioperative nurses
assisting in theatre. Please note that charges for any inpatient
nursing services are included under the Inpatient Charges
of your Hospital Services Agreement. DVA does not pay
separately for these services. Consequently these charges
should not be levied on veterans under any circumstances.
• Use of an Online Veteran Verification facility that allows you to check immediately
if a patient is known to DVA
LIKE TO FIND OUT MORE?
Just visit: www.humanservices.gov.au/health-professionals/
or telephone DHS - Medicare ebusiness on 1800 700 199
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PHacts
DEPARTMENT OF VETERANS’ AFFAIRS INFORMATION FOR PRIVATE HOSPITALS
ISSUE 14 NOVEMBER 2014
New Purchasing Arrangements for
Mental Health Hospital Services
Mental health is a priority for DVA. The
Department wants to purchase services for
its clients that are accessible, evidence
based and will deliver the best prospects for
recovery from mental illness and for ongoing
good mental health.
In its 2014 Tender for Private Mental
Health Hospital Services, DVA took a new
approach to how it is purchasing mental
health hospital services. Specifically, this
included a focus on purchasing evidence
based outpatient day programmes.
Requirements for these programmes are
set out in the Clinical Guidelines for Mental
Health Outpatient Day Programmes which are
available from DVA on request.
As a result of the tender, DVA has
contracted 18 entities, covering 59 facilities,
to provide a range of quality acute care
services and:
• 86 outpatient day programmes;
• 11 trauma recovery programmes –
Posttraumatic Stress Disorder; and
• 11 ‘innovative’ programmes.
DVA will no longer pay for new hospital
based outpatient day programmes that are
not evidence based, best practice clinical
interventions. Examples of such programmes
include:
• stand alone adjunct therapy such as art
therapy;
• social, recreational or psychosocial
support open ended day programmes; and
• health and fitness programmes.
DVA will continue to fund such programmes
for clients who were still participating as
at 30 June 2014 to ensure no DVA client is
adversely affected. DVA will not, however,
pay for new entrants to these programmes.
For further information, contact your DVA
contract manager.
Innovation
DVA is very keen to explore opportunities for innovation
in the provision of health care to Entitled Persons
that reflect the changing health needs of the veteran
population. Examples could include services related
to in-home palliative care and dedicated hospital
based inpatient treatment/accommodation of patients
suffering from dementia or Alzheimer’s Disease.
Alternatively you may consider an innovative response
to the needs of younger veterans as they navigate the
health system at a time when they are transitioning from
their defence service while rehabilitating from their
service-related injuries.
A particular focus of DVA’s is Palliative and End of
Life Care; Improving the Coordination of Care and
Minimising Adverse Events.
In developing proposals, you should refer to the
Guidelines for proposals for the provision of hospital-based
programs for DVA entitled persons, which are available at:
www.dva.gov.au/service_providers/hospitals/veteran_
partnering/Documents/Guidelines_for_proposals_
for_hospital.pdf
QUALITY REPORTING TIME
Just a gentle reminder that Quality Reports are
required to be submitted to the Department
within four (4) months of the end of each twelve
month period from 1 July to 30 June for the life of
your Agreement. The next report is therefore due
by 31 October 2014.
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