ontario case costing guide: chapter 1 ...ministry of health and long-term care occi - chapter 1...

Ministry of Health and Long-Term Care OCCI - Chapter 1 Introduction to Case Costing Health Data Branch Data Standards Unit

OCCI Version 7.0 of 26 Effective April 2009-March 2010 Updated February 2010

ONTARIO CASE COSTING GUIDE: CHAPTER 1 – INTRODUCTION TO CASE COSTING

TABLE OF CONTENTS 1.1 Brief History ........................................................................................................................................... 2 1.2 Why Invest In Case Costing ................................................................................................................... 3 1.3 Overview of Case Costing Methodology................................................................................................ 4

1.3.1 Overview of OHRS and MIS........................................................................................................... 4 1.3.2 Conceptual Model of Case Costing ................................................................................................. 8 1.3.3 Introduction to the OCCI Case Costing Methodology .................................................................... 9 1.3.4 Four Steps of Case Costing ........................................................................................................... 11 1.3.5 Evolution of the OCCI Case Costing Methodology ...................................................................... 12

1.3.5.1 Program Management Approach............................................................................................ 12 1.3.5.2 Extending the Methodology to Ambulatory, Complex Continuing Care, Mental Health,

Rehabilitation and Community Care Access Centre............................................................ 12 1.3.5.3 A Framework for “Case” Costing .......................................................................................... 13

1.4 Implementing Case Costing .................................................................................................................. 13 1.4.1 Challenges of Implementation....................................................................................................... 14 1.4.2 Implementation TimeFrames......................................................................................................... 15 1.4.3 Implementation Sequence.............................................................................................................. 15 1.4.4 Education/Promotion/Orientation.................................................................................................. 16 1.4.5 Data Flow Models and Methodologies.......................................................................................... 17

1.5 Evaluating Case Costing ....................................................................................................................... 18 1.5.1 The Approach to Evaluation.......................................................................................................... 18

1.5.1.1 MIS OHRS Functional Centre Framework Review............................................................... 19 1.5.1.2 Patient Identification for Linkage........................................................................................... 20 1.5.1.3 Workload Measurement ......................................................................................................... 20 1.5.1.4 General and Patient-Specific Supply Costs............................................................................ 21 1.5.1.5 Labour Hours.......................................................................................................................... 22

1.6 Milestones ............................................................................................................................................. 23 1.7 Uses and Analyses of Case Cost Data .................................................................................................. 24 1.8 Reference materials............................................................................................................................... 25



1.1 BRIEF HISTORY The Ontario case cost initiative was launched with the formation of the Ontario Case Cost Committee under Transitional Funding. This committee called for the development of:

• A more reliable case weight system than the 1985 New York charge-based Resource Intensity Weights (RIWs) (Later, weights based on charge data from Maryland replaced New York charge data)

• More valid standards for the comparison of hospitals • Better information to manage hospitals

Transitional Funding was formed in 1988 to correct for the imbalances and inequities of the global hospital funding system. A case-mix case cost approach within the context of global budgeting was introduced, with RIWs playing a prominent role as a measure of hospitals’ relative resource consumption between different case mix classifications. To meet the above requirements, a case weight system based on Ontario case costs was proposed to enhance or replace the New York-based RIWs. To that end, a Hospital Incentive Fund (HIF) proposal was submitted early in 1992. In March of that same year, the Ministry of Health (MoH) approved $5.6 million in HIF funding for a project which would span three years and be operated jointly by the MoH and the Ontario Hospital Association (OHA). Thus, the Ontario Case Cost Project (OCCP) was born. First Generation An open invitation was presented to all Ontario hospitals interested in joining the OCCP. At the end of the screening process, thirteen hospitals were selected to participate in the OCCP. Each hospital was required to develop and implement the necessary systems and procedures to comply with the OCCP standards and methodology for producing case costs. To assist hospitals in this process, the OCCP created four Milestone Audit Tools. Each hospital was audited at the development, implementation and post-implementation stages of case costing. The Milestone audits were aimed at ensuring compliance with the case costing standards and data quality. Each hospital received payment upon the completion of the requirements for each Milestone audit. Initially, these hospitals began collecting case cost data for acute inpatients on July 1, 1993. Subsequently, data for a one-year period starting October 1, 1993 was submitted to the OCCP to be included in a provincial database. On July 1, 1994, hospitals began collecting case cost data for the day surgery population. Second Generation In August 1995, a second generation of case costing hospitals was added to the OCCP. The second generation was initially comprised of seventeen acute care hospitals and five free standing specialty hospitals. In addition to increasing the number of acute inpatient and day surgery cases being costed, the second generation was intended to expand the scope of case costing to complex continuing care, rehabilitation and ambulatory care patient populations. The OCCP developed costing standards specifically for complex continuing care and ambulatory care based on the existing acute inpatient and day surgery standards. Like the first generation, each second generation hospital received a grant upon passing each of the four Milestone audits. The acute care hospitals of the second generation went live with acute inpatient and day surgery case costing on April 1, 1996. Hospitals began complex continuing care costing on July 1, 1997. Rehabilitation costing was delayed pending development of a minimum data set.



The OCCP Joint Committee managed the OCCP and was responsible for the overall management and operation of the OCCP. This committee had representation from the OHA, the MoH and one OCCP hospital. There were two sub-committees under the OCCP Joint Committee: • Data Reliability and Validity Subcommittee:

Responsible for managing the quality of the data produced by the project representation from the MoH, OHA, Canadian Institute for Health Information and hospitals not participating in the OCCP

• Project Managers (First and Second Generation) Subcommittee: Responsible for the day-to-day operation of the hospital’s participation in the OCCP Representation from each of the Project hospitals

Governance Model The agreement between the MOHLTC and the OHA expired on March 31, 2000. As case costing formed a basis for hospital funding methodologies, the founding partners agreed that the custodianship should be transferred to the MOHLTC. The database and the associated files were relocated to the MOHLTC offices in Toronto. In recognition of the on-going nature of the collection of case costing information, the name was changed to the Ontario Case Costing Initiative (OCCI). OCCI Expansion In 2005, the Information Management Unit of the Ministry of Health and Long-Term Care sent an open invitation to hospitals across Ontario to join the Ontario Case Costing Initiative. The decision to expand OCCI was based on the need to have more representative data for the province of Ontario. Following the open invitation, the Ministry received a positive response, and thirty-seven facilities signed on to join the Ontario Case Costing Initiative. For a full listing of new facilities, please refer to Appendix B – Hospital Profiles.

1.2 WHY INVEST IN CASE COSTING In recent years, case costing has generated considerable interest and enthusiasm. It provides much needed data to inform decision-making at all levels in a hospital. Managers have turned to case costing information when faced with important decisions about the types of services to deliver and how to deliver them. Many hospitals with case costing systems find the information invaluable for strategic and operational planning and management. This is especially true in the current environment of decreasing resources, increasing demand for services, and greater emphasis on quality. Case cost data has also been used to demonstrate good value for resources used, which is increasingly relevant with the current focus on accountability in health care. While hospitals already have financial and management reporting structures in place for tallying costs and reporting by functional centre, it is recommended to implement case costing because this methodology allows for another perspective when analyzing financial information. Case costing provides answers to important management and planning questions that cannot traditionally be answered with departmental management and financial information alone. These questions include:

• What are our top patient businesses (e.g., by program, referral area, funding source, etc.)? • What are our revenues and expenses in each business area? • Is there an opportunity to improve resource utilization for specific patients or groups of patients? • What are the variations in resource use among clinically similar patients? How can these

variations be reduced to increase overall quality and to direct our resources more appropriately?



• What are the cost impacts of realigning programs? • What is a fair price to charge an out-of-country patient for a craniotomy? • How do case costs compare to our peers for similar patients? • What are the differences in costs between treatment options for a particular type of case? • Is it more expensive to provide certain laboratory services in-house or to purchase them from

another facility?

Case costing provides information to support many kinds of analysis and initiatives. Ontario Case Costing Initiative (OCCI) hospitals also report using case cost data for the following activities:

• Evaluation/development of patient care treatment maps/critical care paths • Development of program budgets and variance reporting • Feasibility and impact analysis, e.g., adding a new program, physician, etc. • Productivity analysis/evaluation of program efficiency • Modeling (“what if...”) and forecasting • Evaluation of moving from inpatient to outpatient procedures • Comparison of hospital position (costs) vs. funding

Not only is case cost data important for hospital decision-making, but it can also be used in health care system reform efforts by providing support to hospital funding, research and policy development initiatives. More information on current and expected uses and analyses of case cost data can be found in section 1.2.1. Implementation of case costing does not need to be cumbersome. It takes effort to gather patient-specific cost and workload data, but the overall impact can be managed by carefully designing these systems. The key is to gather patient-specific data as a by-product of care delivery documentation and communications. Chapter one provides some helpful tips for successful implementation of case costing. The case costing approach described in this guide generates case costs by integrating financial, clinical and statistical data. With case costing fully in place, new views can be generated to help answer operational management and planning questions while still providing the necessary departmental management information that the hospital is accustomed to using.

1.3 OVERVIEW OF CASE COSTING METHODOLOGY The first step in developing good cost data is to identify and understand what will be costed. Once a solid understanding of the context in which patient-specific costs are generated is reached, an examination of the methodology that will assist in developing case costs is recommended. The standards for the Ontario Case Costing Initiative are largely based on the Management Information Systems (MIS) and the Ontario Healthcare Reporting Standards (OHRS). The OCCI methodology has been developed to ensure comparability and quality of the data. This chapter presents the conceptual model on which the OCCI case costing methodology is based. Chapter two provides details on the OCCI Standards and chapter three explaining the four steps to the case costing methodology.

1.3.1 OVERVIEW OF OHRS AND MIS This section provides a general overview of the MIS Standards and the Ontario Healthcare Reporting Standards (OHRS). Specifically, it highlights sections of the MIS Standards that are important for case



costing and introduces OHRS. For more information, consult the MIS Standards 2009 and the OHRS Version 7.0 documentation.

Introduction to MIS Standards The MIS Standards are designed to provide a comprehensive framework to organize hospital management information at a national level. The objective of the MIS Standards is to establish standards to:

• Improve the timeliness and comparability of data collected within Canadian health care facilities for management, planning, evaluation, reimbursement and research purposes; and

• Better measure resources and activities by integrating financial, statistical and clinical operational databases.

The Canadian Institute for Health Information (CIHI) manages the ongoing development and maintenance of the MIS Standards, including the production of annual updates. Ontario developed a set of standards called the Ontario Healthcare Reporting Standards based on the MIS Standards in 1994. The Ministry of Health and Long-Term Care updates and revises the OHRS Chart of Accounts based on the current MIS Standards.

Frameworks The MIS Standards use three frameworks to organize information collected in hospitals:

• Functional Centre Reporting: Direct Cost, Full Cost and Service Recipient • The Management Information Systems Application Framework; and • The Functional Centre Framework.

Functional Centre Reporting: Direct Cost, Full Cost and Service Recipient Functional Centre Direct Cost Reporting identifies the direct resources used to provide a specific service within a functional centre. Functional Centre Full Cost Reporting, previously called the Departmental Dimension of reporting, refers to the collection of activity data at the functional centre or departmental level through the identification of direct and indirect resources used to provide patient-specific services. This information allows for the management of resources from a departmental perspective. Service Recipient Reporting, or the patient-centered view (previously called the Global Dimension of reporting), refers to the collection of information to manage specific patient populations. This involves the collection of departmental activity data, such as workload, on a patient-specific basis. Departmental activity under the MIS Standards is measured through the National Workload Measurement Systems (NWMS). Workload measurement systems (WMS) quantify departmental activity in terms of a standardized unit of time. They are used to quantify the staff time spent in patient care (e.g., patient assessment, completion of patient file) and non-patient care (e.g., staff meetings, in-service) activities. WMS tools can be used for the purposes of planning, staffing, budgeting and monitoring performance. Furthermore, comparisons can be made across hospitals since the NWMS standardize the measurement of departmental activity. The standardized unit of time is measured as a “unit of service” or workload unit. Each unit is equal to one minute of time. National unit values are available for selected health disciplines and activities. These national unit values were originally determined using time-motion studies and were averaged across Canada. An NWMS has been developed for each of the disciplines listed in Table 1.1.



Table 1.1: Available National Workload Measurement Systems

Child Life/Recreation Pharmacy Clinical Laboratory Physiotherapy Clinical Nutrition Psychology

Diagnostic Imaging Radiation Oncology Electrodiagnostic, Non-Invasive Cardiology

and Vascular Laboratories Rehabilitation Engineering

Nursing Respiratory Therapy Services Occupational Therapy Social Work

Other Diagnostic Laboratories Speech/Language Pathology Pastoral Care Audiology

OHRS Functional Centre Framework The Functional Centre Framework provides a standardized method of organizing, collecting and reporting financial and statistical information in a hospital. The Framework organizes hospital activity into functional centres. Functional centres are subdivisions of the hospital used in the accounting system to record revenue, expenses and statistics which pertain to a function or activity. Functional centres are also called primary accounts. The Functional Centre Framework features a five-level hierarchy. The hierarchy provides a structured method to collect and aggregate functional centre data. Starting from Level 1, each successive level represents a more detailed breakdown of data from the previous level. The different levels of detail allow hospitals of varying sizes and complexity to use this framework to meet internal and external reporting needs. External comparative reporting can be accomplished through aggregating or ‘rolling-up’ accounts. The primary account code structure consists of five levels, totaling a maximum of nine coding positions.

The first level uses the first two digits to describes the account group and the fund type for primary accounts. All of the operating functional centres are in Broad Group 71 Revenue and Expense - Functional Centres (7) and Operating Fund (1). First and Second Digit (Level 1- Broad Group and Fund Type)

• Operating functional centres are in Broad Group 71

The next level describes the framework: Third Digit (Level 2 - Functional Centre Framework)

1. Administrative and Support 2. Nursing Inpatient/Resident Services 3. Ambulatory Care Services 4. Diagnostic and Therapeutic Services 5. Community Health & Social Services



6. Medical Services 7. Research 8. Education 9. Undistributed (functional centres)

The remaining levels describe the type of service provided or the functional centre: Fourth and Fifth Digits (Level 3 Functional Centre)

• Example: 71 4 15 - Diagnostic Imaging

Sixth and Seventh Digits (Level 4 Functional Centre) • Example: 71 4 15 30 - Diagnostic Ultrasound

Eighth and Ninth Digits (Level 5 Functional Centre) • Example: 71 4 15 30 80 - Neurological Ultrasound

Note that the higher level functional centres are more detailed than the lower level functional centres. A Level 5 functional centre describes more specific functional centres within a Level 4 functional centre. Similarly, a Level 4 functional centre describes more specific functional centres within a Level 3 functional centre. Secondary financial accounts describe the nature of revenues and expenses in the hospital. They are associated with functional centres (primary accounts). The five digits in the secondary account codes for revenue and expenses are organized into three groups. First Digit - Secondary Broad Group

1. Revenue 2. Inactive 3. Compensation 4. Supplies 5. Service Recipient - Specific Supplies 6. Sundry 7. Equipment 8. Contracted-Out Services 9. Buildings and Grounds

Second and Third Digits - Nature of Revenue or Expense • Example: 4 50 - Food Supplies

Fourth and Fifth Digits - Capture Detail • Example: 4 50 26 – Butter

Secondary statistical accounts describe the nature of activities occurring in the hospital. They are also associated with functional centres. Secondary statistical accounts can be joined with information in the secondary financial account of the same functional centre to produce performance indicators. The secondary statistical accounts are organized specifically for statistics and have a maximum of seven digits in the code. First Digit – New Broad Groups of Secondary Statistical Accounts

1. Workload 2. Staff Activity



3. Earned Hours 4. Service Recipient Activity 5. Client Profile 6. Personnel Profile 7. Functional Centre Operations 8. Health Service Organization Operation 9. Specialty and Priority Program Profile

Second and Third Digits - Nature of Statistic Describe the nature of the activity eg • Example: 2 55 Registrations • Example: 4 01 Patient Admissions

Fourth and Fifth Digits and Sixth and Seventh Digits – Capture more Detail

1.3.2 CONCEPTUAL MODEL OF CASE COSTING In order to understand how to distribute the costs of services that a patient receives during a hospital visit, it is important first to discuss the context in which the hospital produces these services. The hospital production function model, shown in Figure 1.1, represents patient-specific costing. The model illustrates how a hospital uses a number of inputs (labour, equipment, etc.) to produce services (x-ray, laboratory tests, nursing services, etc.) that a patient receives from the hospital. The challenge of case costing is to accurately identify the costs of these services and then to distribute the costs to each patient reflecting the cost of the care delivered. The production function model shows that the output of a hospital is a mix of services, or intermediate products, specific for each patient. These intermediate products for patient care are produced by a number of departments (e.g., Nursing, Pharmacy, etc.). Each department produces a range of intermediate products by combining inputs such as labour and capital. For example, an x-ray would be considered an intermediate product of the Diagnostic Imaging department. Figure 1.1: Hospital Production Function Model



The patient-specific mix of intermediate products received is driven by a number of patient characteristics that are unique for each encounter or visit. These characteristics include demographic (e.g., sex, age) and clinical (e.g., diagnoses) information. For instance, the types and quantities of products provided to a stroke patient will differ from those provided to a mother delivering a child. In addition to consuming inputs, these patient care departments also consume services from a number of departments that do not directly produce intermediate products for patient care. These are the traditional overhead, or support and administration, departments such as Finance and Housekeeping. The services produced by these departments are the indirect costs incurred by each of the patient care departments.

1.3.3 INTRODUCTION TO THE OCCI CASE COSTING METHODOLOGY Based on this conceptual model, the goal of the costing methodology is to apportion total hospital costs incurred by both the direct patient care and overhead functional centres to individual patients within a given costing period (Figure 1.2). With reference to Figure 1.2, this means distributing the costs of the inputs to each patient visit based on the mix of intermediate products received. Figure 1.2: The Goal

To accomplish this, the OCCI has developed a case costing methodology based largely on the Canadian Institute for Health Information’s (CIHI) MIS Standards (Standards for Management Information Systems in Canadian Health Service Organizations). The methodology relies on two important features of the MIS Standards: the Functional Centre Framework and the Chart of Accounts.

Ontario Healthcare Reporting MIS Standards (OHRS) and the Case Costing Methodology The OHRS MIS Standards provide a framework to standardize the collection, processing and reporting of financial and statistical information. An important feature of the OHRS MIS Standards is that this standardization allows for comparison of costs across hospitals. The functional centre framework of the OHRS MIS Standards organizes hospital activity into functional centres. Generally, functional centres reflect the various departments normally found in hospitals (e.g., Operating Room, Diagnostic Imaging and Pharmacy). Refer to Figure 1.3 for a diagram showing how costs are tracked by functional centre.



Within each functional centre, the Chart of Accounts standardizes how functional centre expenses and statistics are to be tracked. It goes as far as identifying the detailed individual accounts found in the General Ledger (GL). Based on the information collected through the Chart of Accounts, total expenses for each functional centre can be calculated. Figure 1.3: Total Hospital Costs Tracked by Functional Centre

Allocating Indirect Costs Functional centres are categorized as either transient cost functional centres (TCC TFCs) or absorbing cost functional centres (ACC AFCs). TCC TFCs are generally the support and administrative, or overhead, departments within a hospital. ACC AFCs are generally the patient care departments. After each functional centre is designated as either a TCC TFC or ACC AFC, a methodology is required which allocates a portion of each TCC TFC expenses to each ACC AFC. The resulting allocated expenses are referred to as indirect costs. The original ACC AFC costs are referred to as direct costs. The direct costs and the allocated indirect costs make up the full costs of the ACC AFC. Figure 1.4 illustrates the allocation of transient functional centres to absorbing functional centres. The OCCI uses the Simultaneous Equation Allocation Methodology (SEAM) (see chapter 3) to allocate the indirect costs. Each TCC TFC costs are allocated to each of the ACC AFC based on a system of linear equations. Figure 1.4: Allocation of Transient cost Functional Centres to Absorbing cost Functional Centres

Distributing Costs to Patients Once all the costs are in the appropriate ACC AFC, relative value units (RVUs) are used to determine the appropriate portion of costs to be distributed to each patient. In general, RVUs measure the relative



amounts of resources consumed in producing the specific service/product for patients, and may be specific to each functional centre. These RVUs are tracked on a patient-by-patient basis within each ACC AFC that delivers patient care. Figure 1.5 illustrates how the distribution works. Generally, the OCCI standard offers the choice to use the unit values of CIHI’s National Workload Measurement Systems (NWMS) as RVUs for case costing or Patient Hours. RVUs, workload measurement systems and patient hours are discussed further in Chapter 2. Figure 1.5: Distribute Functional Centre Costs to Patients

Using financial and statistical information from the GL, direct and indirect costs per RVU (relative value unit) are calculated for each ACC AFC. Each patient visit cost is calculated by multiplying the cost per RVU by the total number of RVUs the patient received from that ACC AFC. In the OCCI methodology, patients receive costs from each ACC AFC that delivered services to them. These costs include the direct costs of the ACC AFC and the indirect costs, which are a portion of the TCC TFC costs. The costs for all the ACC AFCs can be added to calculate the total direct and indirect costs for a given patient’s visit.

1.3.4 FOUR STEPS OF CASE COSTING The OCCI has summarized the case costing methodology into four steps:

1. Gathering the data; 2. Allocating indirect costs; 3. Calculating functional centre unit or intermediate product costs; and 4. Distributing costs to patients.

Breaking down the methodology into these four steps simplifies and summarizes the task of patient-specific costing for planning and implementation purposes. The successful achievement of each step is critical, since the results feed into the next step. The four steps of case costing are described in detail in Chapter 3.



1.3.5 EVOLUTION OF THE OCCI CASE COSTING METHODOLOGY The OCCI hospitals have been working to further develop the case costing methodology and have identified numerous opportunities to improve case costing. The following sections are a summary of the current issues and the work of the OCCI. The chapters referenced for each issue contain further details as well as some discussion of the impact that they have on the OCCI case costing methodology.

1.3.5.1 Program Management Approach Ontario hospitals in the past have undergone radical changes in the way they deliver patient care. Traditionally, hospitals are organized in such that the departments that produce the intermediate products are divided along discipline-specific lines, shown in Figure 1.1. Many hospitals have moved towards organizing and managing patient care delivery through the program management approach. This approach involves programs, instead of departments, being directly responsible for delivering direct patient care. The programs displace traditional functional centres as the primary organization unit for the production of intermediate products. Each program may produce a broad range of intermediate products, from nursing care to laboratory tests to social work services. Program management involves more than just re-organizing departments into programs. A key component of program management is the use of multi-skilled workers. Patient care staff, and possibly support staff, within a patient care program would be multi-skilled to provide a variety of services and products. Since any staff can provide a range of intermediate products, systems to accurately capture and cost each activity within the program are required. Hospitals have implemented many aspects of program management to varying degrees. The challenge would be to develop a costing methodology that can be applied to any hospital setting such that the costs produced are relevant for internal decision-making and are externally comparable to other hospitals, including those that are organized departmentally. The lack of a “standardized” approach for program management organization poses challenges when costing The OCCI has examined options to develop case costs in a program management organization. Refer to Chapter 3, Section 3.7 for a description of case costing in a Program Management environment.

1.3.5.2 Extending the Methodology to Ambulatory, Complex Continuing Care, Mental Health, Rehabilitation and Community Care Access Centre The OCCI case costing methodology was originally developed to cost acute inpatients and was then modified for day surgery patients. The methodology has also been extended to cost Ambulatory, Complex Continuing Care, Mental Health, Rehabilitation patients and, most recently, Community Care Access Centres. Many aspects of the methodology for Ambulatory, Complex Continuing Care, Mental Health and Rehabilitation are the same as for acute inpatients. Utilization/workload is captured on a patient-specific basis, financial information is tracked on a standardized basis using the OHRS MIS Standards, and patients are assigned costs based on the total number of intermediate products received. Community Care Access Centres costing methodology is slightly different whereby workload is captured based on their service provider contracts. Costs related to specific supplies can be aligned with each client specifically to each type of referral.



To collect the patient descriptive data for inpatient and ambulatory care, the OCCI has adopted the CIHI Discharge Abstract Database (DAD) and the National Ambulatory Care Reporting System (NACRS). DAD and NACRS are administrative data sets that provide information on patient-specific demographic (e.g., age, sex) and clinical (e.g., diagnosis and procedure codes) information for each discharge/visit. To define the complex continuing care, mental health and rehabilitation encounters, the OCCI standards require the collection of the InterRAI Complex Continuing Care Minimum Data Set (MDS v2), RAI –Mental Health Assessment and the Rehab Minimum Data Set. Descriptive client data for Community Care Access Centres (CCAC) is obtained through the Client Health and Related Information System (CHRIS) database. The OCCI case costing methodology and the case costing standards described in Chapter 3 apply to these patient service types as well as the CCACs with specific standards summarized in Chapter 2.

1.3.5.3 A Framework for “Case” Costing The care provided for a given health condition can involve a variety of different interactions between the patient and the hospital. It would be of great value to be able to measure the cost of treating a patient over their entire episode of illness while in hospital and all services received after the patient has been discharged (home care) For example, many patients now receive follow-up care on an outpatient basis after being admitted to the hospital for a surgical procedure. The outpatient visit is related to the same health condition that required surgery. The ability to link the two visits together would provide a better estimate of the total costs for treating that condition. The OCCI has developed a six-level framework that links the various visits that a patient has across different health care facilities for the treatment of a given health condition. The current information systems in Ontario hospitals allow the costs of the individual visit to be determined. Implementation of the proposed framework, described in Chapter 2 8, will identify the true “case” costs across various health care providers.

1.4 IMPLEMENTING CASE COSTING Case costing utilizes the OHRS reporting for financial and statistical information with a specific target of developing case cost data for management and planning purposes. Refer to the OHRS documentation on the ministry’s website. Although case costing has many benefits for hospital management, the immediate impact on middle management and operating staff will be additional work, both for the implementation and the ongoing data collection. To have a successful implementation, senior management, the Chief Executive Officer in particular, must be active supporters and promoters of the case costing initiative. The hospital must see that the CEO is committed to the project through involvement in the implementation effort, assignment of resources, commitment of necessary investments in information systems, and active participation in identifying executive information needs. The OCCI Project Manager is a key position which will require a full-time commitment for the duration of the implementation. The Project Manager functions as a general contractor with responsibility for the day-to-day management of the project. The general responsibilities of the Project Manager include the following:



• Communication of project mandate • Project organization • Project plan and planning process • Ensure appropriate participation by all required users • Perform audit and change control • Communicate project progress • Ensure that project charges are appropriate

A Steering Committee for the project helps to facilitate acceptance of the case costing project as well as ensures the Project Manager stays on track and provides a forum for timely problem resolution. Since many case costing issues relate to information systems, many hospitals have added case costing to their Information Systems Steering Committee mandate. The OCCI has developed four Milestone Reviews to assist hospitals with the implementation process and data quality verification. Appendix O The OCCI Milestone Process documents describes the Milestones Reviews in greater detail.

1.4.1 CHALLENGES OF IMPLEMENTATION When implementing case costing, there may be issues that arise specific to the brand of information systems being used, however general issues will likely arise also. The following is a list of the main general issues :

Organizational Challenges • Link Admission/Discharge/Transfer (A/D/T) System for patient identification number, encounter number and Patient Hours in each functional centre • Can record patient-specific supplies and other expenses to the patient • Can identify specific procedures and workload to specific functional centres • New technology new way of doing business focus on "learning" • Buy-in from front-line users regarding technical and procedural changes required by the

feeder systems to meet the needs of the corporate system • Developing hospital confidence in cost data • Systems training • Coordinating the collection and entry of data where interfaces do not exist so that information

is entered on a timely and accurate basis (Nursing workload and various episodic area data)

Data Quality and Consistency Challenges • Inconsistencies in data collection from the various feeder systems • Ensuring the crediting of high cost drug returns • Assigning RVUs and grouping products (where these are key features of the system) • Collecting statistical data needed for cost allocation • Obtaining patient-specific laboratory workload data • Determining the most feasible method to capture nursing workload by patient without

involving significant human resources/professional staff • Identifying all patient-specific items that should be tracked, including ongoing identification

of new supplies that meet the criteria (or existing supplies whose value has increased over the threshold)



• Ongoing maintenance of the systems to ensure workload measurement, RVUs, statistical data and patient-specific items are kept up to date

• Data quality checks should occur at the source data level and at the case costing system level • Ensuring clinical data conforms to standards where applicable (eg. CIHI standards). • Ensuring data dictionaries are maintained for all feeder systems, for example, Pharmacy

department and its dictionary of drugs and respective costs.

Information Systems Challenges • Ensuring the system tracks patient-specific workload from the various feeder systems. • The accurate documentation of the patient's movement throughout the hospital is essential to

provide accurate patient hours information that may be used in allocating nursing costs • Developing a system/program to track patient-specific drug costs and pharmacy workload • Automating nursing workload reporting to get patient-specific data • Developing reports to support the accuracy of the data being collected (such as length of stay

report for nursing workload collection) • Archiving data to enable later verification/investigation of data and utilization • Ensuring that registration systems and processes are in place and that the communication of

specific items occur to case costing, for example, deleting or merging of registration accounts • Ensuring reconciliation occurs between clinical and financial data.

1.4.2 IMPLEMENTATION TIMEFRAMES A reasonable time frame for implementing case costing depends significantly on how much of the required system functionality already exists in the hospital. If mature financial systems and the majority of clinical systems are already in place, a time frame of 6 to 8 months would be reasonable to get a working group and assign a dedicated team to focus on each of the following areas:

• Implementing the Case Cost System • Extracting and uploading of files from the various feeder systems. • Developing financial and statistical data to ensure compliance with OHRS requirements • Developing an allocation routine for TCC TFC costs and reviewing the suitability of the

standard allocation bases If any of the major clinical (feeder) systems are missing, or requires overhaul, then it could take up to two years to achieve a solid implementation.

1.4.3 IMPLEMENTATION SEQUENCE The sequence of implementation for the sub-systems that enable case costing can vary significantly depending on the starting point, the condition of already installed systems and the priorities for implementation. Case Cost Project Managers have observed that knowledge of the requirements of case costing and the costing module is important when implementing the clinical feeder systems. In fact, several of the project hospitals have suggested implementing the costing sub-system quite early in the process to facilitate the implementation of the feeder systems. Additional discussion of implementation sequence issues can be found in Appendix 2 of the MIS Standards 2009 2006.



1.4.4 EDUCATION/PROMOTION/ORIENTATION A carefully designed internal promotion plan is an essential ingredient for ensuring case cost project success. It is critical to ‘sell’ case costing to all stakeholders so that they will invest the extra effort both in the short and long term to produce the additional data needed. In planning the promotion, address the following:

Stakeholders in Case Costing • Employees/Unions • Patients • Board • Ministry of Health and Long-Term Care • Management • Medical Staff • Others

Stakeholders’ Concerns • Quality of Care • Loss of power/status • Potential job loss • Change in work style/process • Potential for loss of income • Other

Message for Stakeholders • Potential benefits of case costing (hospital, health care system, individual) • A need to control expectations • A need to address contentious issues • A need to focus on improving existing services versus reducing services

Delivery of Message to Stakeholders • Workshops • Newsletters • Education/orientation sessions • Other

Who Will Deliver the Message to Stakeholders • Hospital Management and Staff • Medical Staff • External Resources



1.4.5 DATA FLOW MODELS AND METHODOLOGIES As case costing is implemented, it is important that the various aspects of the plan come together to produce good case cost data. Data flow models need to be developed internally to define the specific information required for case costing by departments, workload, supplies, etc., Data Flow Model The Data Flow Model provides an overview of the flow of information within a facility which includes the input, processing, storage and output of data. The Data Flow Model is intended to describe only case cost Data that is available within a facility. This includes costs, workload and patient descriptive data elements and those data elements that contribute to the development of case cost data. With a model, it is easier to test whether required source data will be available:

• Where and when it is needed; • In the right form (paper, electronic, verbal) so that required processing can be done; and • That correct output in the right form (paper, electronic, verbal) is produced.

To define your data flow model, use a sketch or point form prose description. The Data Flow Model should be done in sufficient detail to show that cost and/or workload data are linked to specific patients as appropriate, and that an audit trail will exist as needed to verify cost data in later stages of the project and on an ongoing basis.

WMS Methodology The Workload Measurement System (WMS) Methodology shows how to approach the measurement and capture of patient-specific workload. Even though the National WMS is used for an area, document how it was fine-tuned for implementation. Some possible reasons for using different approaches include:

• Features or limitations of the departmental information system; • Features or limitations of the case cost system; • Practical adaptation of the NWMS to patient-specific costing requirements; and • Practical adaptation of NWMS Unit Values to specific operating methods and differences in

clinical technology. It is important to document the methodology used for two reasons:

1. To ensure that the methodology used will generate acceptable patient-specific costs; 2. To identify as early as possible any differences in approach that could impact the reliability or

validity of cost data and its comparability with other hospitals' case costs. The written description of the methodology should provide a point-form description of:

Rationale • Why was this approach chosen? • What other approaches were considered and rejected?

Comparison Data • How do the workload units differ on a procedure by procedure basis from the NWMS? • Provide a list of groups, procedures within groups, and relative value units (RVUs).

RVU Development • Describe a one-time analysis or study that was completed to establish relative values or other

factors. • If grouped, describe how procedures were assigned to their respective groups.



State of Implementation

• Has this methodology been implemented? • If implemented, how long has it been in use? • What follow-up study has been done to validate the approach?

1.5 EVALUATING CASE COSTING The primary objective of the evaluation is to determine how a department's present information and data collection and reporting systems conform to the target environment. The target environment represents the collection and reporting of data in accordance with the standards established by the MIS Standards, OHRS and the OCCI. The goals of this analysis are to:

• Define how the information/data is currently collected and reported; • Identify the specific differences between the current environment (current reality) and the target

environment (preferred future) in terms of missing or inconsistent data; • Assess the reliability and validity of current information; • Identify organizational or procedural constraints to be considered when planning the migration

from the current to the target environments; • Identify information systems constraints or enhancements to be considered when planning the

migration from the current to the target environments; and • Develop a task list.

The output from this evaluation analysis is not an action plan. It is a review and assessment of the current environment relative to the target environment. Further analysis of process flows, information systems applications, data structure and files, technology, etc., may be identified as specific tasks to be undertaken. The outputs from this analysis are used to develop detailed action plans.

1.5.1 THE APPROACH TO EVALUATION The evaluation analysis is conducted together with the Case Costing Project Manager, Department Managers, Information Systems staff and other key staff as necessary. The approach is structured to address each of the major data and information components. The data are categorized into the following major groups. Appendix C – Evaluation Checklist has templates for evaluating detailed items in the groups.

• Functional Centres • Patient Identification for Linkage • Workload Units • General and Patient-Specific Supplies • Labour Hours

The Project team begins with a high-level review of the department's functional centre framework and data relationships. This high-level review represents a "snap-shot" of the current environment in terms of the functional centre structure and the collection of data and is not influenced by current information systems and procedures. The purpose of this starting point is to identify early in the project the relative



magnitude of the effort required to collect and report this data needed for case costing. Further analysis of each of the major data groups will isolate specific issues and concerns within each functional centre. Using the results of this review as a guide, the project team is able to prioritize attention to specific areas of concern and deficiency.

1.5.1.1 MIS OHRS Functional Centre Framework Review The current organization of functional centres in the department is examined for consistency with the Ontario Healthcare Reporting Standards (OHRS). Refer to the OHRS for the functional centre numbers in the department. Use the questions below to help assess the functional centre currently used within the organization/hospital/CCAC. Refer to Appendix C – Evaluation Checklist (worksheet C.1) to obtain a template with review questions for an Overview of Data Collection and Reporting Within Functional Centre Framework to track the documentation. The high-level review questions listed below require a "Yes" or "No" answer.

1. Does each departmental functional centre currently exist? Are there any others? If so, double-check that the MIS and OHRS definitions are understood.

For each existing functional centre: (note that for each existing functional centre within the department, questions 2 through 14 should ultimately be answered with a "Yes")

2. Is the functional centre identified as a separate operating unit within the department (has a unique cost centre code been assigned)?

3. Is the patient's Chart Number (or Health Record Number) collected when an examination or procedure is conducted?

4. Is a unique encounter number (account or register number) assigned for each patient encounter for examination or procedure?

5. Is the patient's date of service collected?

6. Is the patient's specific procedure or examination collected?

7. Are workload units collected?

8. Are workload units collected on a patient-specific basis?

9. Are general supply costs charged to the using functional centre?

10. Are supply items and "supply assemblies" greater than $250 collected on a patient-specific basis?

11. Are the actual labour hours (both worked and benefit) of unit-producing personnel regularly collected within the functional centre where staff are working?

12. Are the actual labour hours (both worked and benefit) of management and operational support personnel regularly collected within the functional centre where they work?

13. Are all physician fee-for-service costs collected on a patient-specific basis or procedure basis?

14. Are the actual labour hours (both worked and benefit) of medical staff on salary collected within the functional centre where they work?



1.5.1.2 Patient Identification for Linkage Use the form in Appendix C – Evaluation Checklist (template C.2) to document the answers to the following questions about patient identification. 1. Are the functional centres collecting the following information:

a) Patient Chart or Health Record Number? b) Patient Register or Account Number? c) Date examination was performed (optional)? d) Name or code of specific exam? e) What constraining factors limit the collection of patient specific procedures/exams in each

functional centre? f) What changes are required to requisitions and reporting forms/documents?

2. Do the functional centres already report the specific procedures or examinations on a patient-specific basis to the accounting office? Is this procedure: a) Manual b) Automated, or c) Combination of both?

3. Are the department's Information Systems:

a) Automated? b) Integrated with the hospital's Central Patient Index and Admission System?

4. If there is no automated Departmental Information System, does the department have access to the

hospital's Main Central Patient Index and Admission / Discharge / Transfer System?

1.5.1.3 Workload Measurement In this section, establish the case cost readiness of the workload measurement systems. Remember that workload measurement is one of the key factors in distributing costs to patients. For each existing functional centre in the department, use Appendix C – Evaluation Checklist (template C.3) to identify a "Yes" or "No" response to each of the following review questions. Record answers to (1), (2), and (10) for each functional centre. 1. Is the NWMS implemented in each functional centre?

a) What, if any, changes have been made to the system (unit values modified, patient-specific workload redefined, etc.)?

b) For those functional centres where an NWMS has not been implemented, what are the constraining factors, if any, to implement workload measurement?

c) What actions, if any, must be completed before workload measurement can be implemented in these functional centres?

2. Where the NWMS is not used, is another system used to measure workload in the functional centre? a) If another system is used, how have the relative values been established?

Workload Measurement Systems typically organize the workload categories into major groups. For example, the Diagnostic Imaging NWMS uses the ‘technical function’ and ‘technical support function’ categories. Template C.3 in Appendix C – Evaluation Checklist is set up to accommodate up to three workload unit categories with the following headings. There should be an answer for each functional centre using the analogous workload unit categories (i.e., replace categories in bold with the categories that are used). 3. Can the WMS identify and collect patient ‘technical function’ workload units?



4. Can the WMS identify and collect patient ‘technical support function’ workload units? 5. Can the WMS identify and collect other workload units? 6. Can the WMS readily produce the total inpatient workload units for each functional centre? 7. Can the WMS readily produce the total outpatient workload units for each functional centre? 8. Can the WMS readily produce the total referred-out workload units for each functional centre? 9. Can the WMS readily produce the total referred-in workload units for each functional centre? 10. Can the WMS readily produce patient-specific workload units for each functional centre?

a) What are the constraining factors, if any, for collecting patient-specific workload in each of the functional centres?

b) Are there any actions that must be completed for this collection to happen? 11. Is there a procedure/mechanism established to ensure products and workload units are accurately

tracked to the patient? a) What are these mechanisms?

12. Are productivity ratios established and monitored for each functional centre?

13. Is the internal collection of workload data: a) Manual? b) Automated?

14. How are workload units transferred to the hospital's Statistical Ledger: a) On manual data collection forms? b) Departmental workload measurement system is interfaced with General Ledger (either through

diskettes, batch, or on-line)? c) Are other feeder systems (e.g., Order Entry/Results Reporting System, Encounter Tracking

System, etc.) utilized to report the necessary information?

1.5.1.4 General and Patient-Specific Supply Costs In this section, use the high-level review (Appendix C – Evaluation Checklist, template C.1 Overview ) and the answers to the following questions to provide further insight into the current capabilities for collecting and reporting general and patient-specific supplies at the functional centre level. Record the answers for each functional centre.

1. Are all supply items currently costed/charged back to the level of the lowest functional centre that exists within the department? a) If supply items are not costed/charged back to the lowest functional level, what are the

constraining factors for costing/charging these items to the lowest level? b) What limitations, if any, of the hospital's central Materials Management System must be

overcome? c) What action must be taken for supplies to be costed/charged back to the lowest level? d) What changes must be taken to requisitions and reporting forms/documents?

2. Are high-cost supply items and supply assemblies over $250 tracked on a patient-specific basis within each functional centre? a) If not, is it possible to identify patient-specific supplies and supply assemblies over $250 for each

functional centre? b) What are the constraining factors for identifying these high cost items? c) What limitations, if any, of the hospital's central Materials Management System must be

overcome? d) What actions must be taken for supplies to be collected and reported as patient-specific supplies

within each functional centre? e) What changes must be made to requisitions and reporting forms/documents?



1.5.1.5 Labour Hours For each functional centre existing in the department, use (Appendix C-Evaluation checklist, template C.4 Labour Hours) to identify a "Yes" or "No" response to each of the following review questions. Note that (2a), (2b), (2c), (2d), (3a), (3b), (3c) and (3d) are open-ended questions.

1. Are the department's staff identified correctly for the broad occupational groups within each functional centre?

Unit Producing Management and Operational Support Nurse Practitioner Medical Personnel

2. Are each employee's actual labour hours (worked and benefit) tracked to account for time spent within each functional centre?

a) If not, what factors are constraining the hospital from tracking actual hours in each functional centre?

b) What limitations, if any, of the hospital's central Payroll System must be overcome? c) What actions must be taken for labour hours to be tracked across each of the functional centres? d) What changes must be made to requisitions and reporting forms/documents?

3. Are unit-producing labour hours and management and operational support labour hours currently distinguished and recorded correctly in the Secondary Chart of Accounts?

a) If not, what are the constraining factors, if any, from distinguishing unitproducing and management and operational support labour hours in each functional centre?

b) What limitations, if any, of the hospital's central Payroll System must be overcome? c) What actions must be taken for unit producing and management and operational support labour

hours to be tracked across each of the functional centres? d) What changes must be made to requisitions and reporting forms/documents?

4. Is the internal collection of labour hour data:

a) Manual? b) Automated?

5. How are labour hours transferred to the hospital's Payroll System:

a) On manual data collection forms? b) Departmental labour tracking system is interfaced with Payroll System Ledger (either through

diskettes, batch, or on-line)? c) Data entry/input is done in the department?

6. Does the Payroll System serve as a feeder system to the hospital's General Ledger system?

Patient Hours Does the hospital capture ADT data electronically for all OCCI mandated functional centres? Is there an audit to compare Patient Hours with length of stay? Other Statistics Case costing relies on other statistics in addition to workload, labour hours and supply costs. These other statistics are used in the cost allocation process. Examples are patient meal days, departmental total costs,



etc. Refer to Chapter 3, Case Costing Reporting Process, for more details of the statistics used for cost allocation. To complete the evaluation of the hospital's case costing ability, review the Chart of Statistics:

• What needs to be collected? • What is currently being collected? • What is the source? • How is it collected?

From the answers to these questions, identify any missing data as well as any data collection problem areas. It is important that the statistics be consistent with the OHRS definitions.

1.6 MILESTONES All hospitals participating in the Ontario Case Cost Initiative undergo four Milestone reviews. The objectives of the reviews are:

• Educating hospital participants • Monitoring hospital progress • Minimizing reliability and validity error • Identifying corrective action if the hospital is not on track • Ensuring compliance with the OCCI costing methodology • Hospital payment

The reviews take place throughout the planning, development and implementation of hospital case costing systems to examine the capture, interface and processing of data. Criteria have been developed to ensure that hospitals adhere to the case costing standards. A variety of techniques are used including site visits, interviews, reconciliation and data analysis. The following presents a brief summary of each Milestone review.

Milestone 1 – Building Blocks The main objective of this initial review is to assess the status of the hospital in terms of planning and development of the required case costing systems. The review takes place at the onset of the planning stages. .

Milestone 2 – Pre-Go-Live Check The review takes place approximately one to two months before the hospital goes live with collecting patient-specific data. The goal of the review is to examine the data capture, data interface and data quality mechanisms to ensure reliable and valid data from each of the components of the case costing system. The review involves a site visit to the hospital by an OCCI representative from the MOHLTC. Interviews are conducted with representatives from Finance, Information Systems, Health Records, Nursing, Laboratories, Diagnostic Imaging, Pharmacy and Allied Health (e.g., Physiotherapy). The OCCI representatives review the status of the existing and planned procedures and mechanisms to capture all necessary data and ensure compliance with case costing standards



Milestone 3 – Three Months Test Data The costing system is analyzed to ensure accuracy, consistency and comprehensiveness of data collection for the three months of data. The hospital is to address all issues identified prior to submitting the data The hospital cost data is brought together with the corresponding discharge abstract from CIHI. The data is analyzed for any irregularities that may indicate systematic problems in the case costing system and/or deviations from the case costing standards. For example, all cases with missing nursing costs are identified. Hospitals are required to resolve all issues identified from both phases before submitting the full year of data.

Milestone 4 – One Full Year of Data The Milestone 4 review consists of an analysis of one year of case cost data. The review methodology is identical to the analysis performed on the three months of data submitted as part of the Milestone 3 . Hospitals are required to resolve all issues identified in the review report. Ad hoc support from the OCCI Team is provided for hospitals unable to resolve the issues identified. Once the hospitals have successfully completed this review, their data is incorporated into the OCCI database. Details of the review methodologies are found in the Milestone Review Tools link.

1.7 USES AND ANALYSES OF CASE COST DATA The principal objective of the Ontario Case Costing Initiative is to produce a made-in-Ontario case cost database from which to develop Ontario Case Weights. Complex Continuing Care, Rehabilitation and Mental Health Weights/Factors Cost data by separated case may be meaningful for some rehabilitation cases with lengths of stay of a few weeks or months, for example. For complex continuing care and mental health activity, however, separation-based data is not meaningful due to the high variations in length of stay among patients (in addition, it would be difficult to analyze such long-term data). An alternate unit of measure is patient days over an assessment period, with differentiation of patients according to their Resource Utilization Groups III (RUG III) or System for Classification of In-Patient Psychiatry (SCIPP) grouping. For complex continuing care and mental health inpatients (as well as for recurring outpatients such as Oncology or Dialysis) the types of analyses that could be done would be similar to those for acute inpatients, but using costs per day or visit rather than costs per stay. From a CCAC perspective, costs can be determined by specific referrals for a client or in turn total costs of all referrals for 1 client. Case cost data from complex continuing care, mental health,and rehabilitation cases are expected from some acute care case costing hospitals as well as from some free-standing specialty facilities, including CCACs in order fully understand and examine specific cost “behaviour” in these speciality facilities. Peer Hospital Factors and Hospital Effects Data from case costing hospitals may provide some insight into differences in specific types of cases among hospitals (analyses of costs and nature of costs within a specific CMG for different hospitals in the sample).



In case costing, there is potential for the skewing of average case costs by an individual hospital within a CMG or patient group if a small or unrepresentative sample of hospitals or facility contributes data to a specific patient or client group or analysis. The proposed approach to dealing with this potential issue is to plot the case cost data for a specific patient group, using different characters to represent individual hospitals contributing to the sample. Also, compute descriptive statistics for each hospital within the patient group (mean/median cost, standard deviation, etc.), and perform tests to determine whether average costs vary by hospital. If there does appear to be a problem related to skewing by an individual hospital within a specific patient group, then different methods of dealing with the issue should be examined. These methods could include transforming the data for each hospital so that effects of variations in input costs are removed, adjusting per the Ontario average length of stay for the patient category, and/or adjusting average costs to treat each hospital's contribution equally (as if they contributed the same number of cases).

Other Potential Uses of Data/Methodology Other potential uses of the costing methodology and Ontario case cost data include:

• The development of a comprehensive weighted case index for each hospital that homogeneously incorporates all relevant patient-related output (Total Weighted Cases = Typical Acute Inpatient Weighted Cases + Atypical Acute Inpatient Weighted Cases + Day Surgery Weighted Cases + Ambulatory Care Weighted Cases (excluding day surgery cases) + Complex continuing Care Equivalent Weighted Cases + Rehabilitation Equivalent Weighted Cases). This would reduce much of the work required in trying to account for costs (e.g. ambulatory and complex continuing care) related to outputs that are not now in the weighted case index.

• Calculation of the Cost of Conservable Days — this is an estimate of projected savings, especially from clinical efficiencies. The proportion of costs that have been identified as Routine and Ancillary (i.e., variable) is expressed as a proportion of total costs.

• The use of costs by category/functional centre and other data to identify factors that affect costs of different cases and cost variations among hospitals.

• The use of procedure detail to examine the intermediate products that constitute the cost of a particular patient group/case (extended standards).

• Identification of CMGs that may have differences in inpatient Nursing costs between sets of hospitals with different Nursing workload measurement, and for which differences in workload that are related to the Nursing WMS could be potentially investigated.

• Examinations of fixed and variable costs for a specific patient group to assist with marginal costing/funding (extended standards).

Research The OCCI has also participated in research activities with the Institute of Clinical Evaluative Sciences, Statistics Canada and various universities.

1.8 REFERENCE MATERIALS The following materials were suggested by the OCCI Project Managers as sources of useful additional information, especially at the outset of the project.

• CIHI MIS Standards 2009 CD-ROM • Ontario Healthcare Reporting Standards (OHRS) version 7.0 via web site: www.mohltcfim.com

[username – healthcare; password – ontario (lower case)]



• CIHI Discharge Abstract Database (DAD) Abstracting Manual (http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=home_e)

• CIHI National Ambulatory Care Reporting System (NACRS) Manual • CIHI Ontario Complex Continuing Care Reporting System (CCRS) Manual • CIHI National Rehabilitation Reporting System (NRS) Manual • Ontario Mental Health Reporting System (OMHRS) Manual • OHIP Fee Schedules • Ontario Medical Association (OMA) Fee Schedule • JPPC Departmental MIS Documents (including Generic Workload Measurement Reporting

Systems documents) • OCCI Milestone Audit Tools (http://www.occp.com/) • OCCI Project Planning Tool • Organizational chart for your hospital • Hospital contact list • OCCI reference material • Costing articles (you may want to do a literature search)

MINISTRY OF HEALTH AND LONGTERM CARE OCCI Chapter 2 Case Costing Standards Health System Information Management and Investment Division Health Data Branch

OCCI Version 7.0 Page 1 of 22 Effective April 2009March 2010 Updated February 2010

ONTARIO CASE COSTING GUIDE: CHAPTER 2 CASE COSTING STANDARDS

TABLE OF CONTENTS

2.1 Overview of Case Costing Standards ................................................................................................. 2 2.2 Hospital Departmental Standards ....................................................................................................... 2 2.2.1 Nursing ...................................................................................................................................... 2 2.2.2 Allied Health .............................................................................................................................. 4 2.2.3 Laboratory.................................................................................................................................. 5 2.2.4 Diagnostic Imaging..................................................................................................................... 7 2.2.5 Pharmacy.................................................................................................................................... 8 2.2.6 Operating Room ....................................................................................................................... 12 2.2.7 Obstetrics: ................................................................................................................................ 12 2.2.8 Emergency Department ............................................................................................................ 12 2.2.9 Financial Services,.................................................................................................................... 13 2.2.10 Health Records ....................................................................................................................... 13 2.2.11 Information Systems ............................................................................................................... 14

2.3 Hospital Patient Service Type Standards .......................................................................................... 15 2.3.1 Standards for Hospital Ambulatory Care................................................................................... 15 2.3.2 Mental Health and Chronic Complex Continuing Care.............................................................. 16 2.3.3 Standards for Hospital Rehabilitation........................................................................................ 19 2.3.4 Standards for Hospital Complex Continuing Care ..................................................................... 20

2.4 Community Care Access Centre Standards ...................................................................................... 21 2.5 Community Care Access Centre Client Type Standards ................................................................... 22



2.1 OVERVIEW OF CASE COSTING STANDARDS This chapter addresses some of the costing standards that are the foundation required for the effective development of case costing methodology. Each area/department within a facility has been identified in the following and each specific standard identified.

2.2 HOSPITAL DEPARTMENTAL STANDARDS

The OCCI Standards require the following hospital departments are provided in this section: • Nursing • Allied Health • Laboratory • Diagnostic Imaging • Pharmacy • Operating Room • Obstetrics • Emergency Room • Financial Services • Human Resources • Information Systems

2.2.1 NURSING

The costs from Nursing Inpatient functional centres can be distributed using either nursing workload or patient hours as a proxy for nursing workload. Other unitproducing nursing staff such as Clinical Nurse Specialists, Enterostomal Therapists, and Patient Educators often provide services to patients on several inpatient units and ideally, labour and benefit costs for these positions would be distributed to the responsible Nursing units on the basis of the proportion of time spent on each unit.

Nursing Workload Data Methodology Data reliability and validity are significant and important aspects of the costing process. Since nursing costs represent a major component of the cost of care, guidelines for the monitoring of nursing workload measurement or patient hours need to be followed closely to provide assurance of the reliability and validity of nursing data. For nursing workload, there are two very different aspects to monitor the data quality for case costing. The first aspect addresses the application of the workload measurement tool by the nursing staff. The second relates to ensuring that all patients are reported, that workload is assigned consistently among nurses (interrater reliability) and that patient and unit specific nursing workload data is transferred to the costing system without loss or error. For workload measurement systems that are based on patient types, 90% reliability is expected, while for proxy type workload the goal is 85% reliability.

Patient Hours Data Methodology: The second type of cost distribution is based on patient hours. This method is used primarily for nursing cost allocations. For acute inpatient functional centres, a patient's hospital stay is measured in hours and



is used to calculate unit costs. The patient hours are captured in the ADT system (Admission, Discharge, Transfer) and based on the length of time that a patient receives care in each functional centre.

When using patient hours to calculate Functional Centre Unit Cost, the unit cost is per patient hour.

Functional Centre Unit Direct Cost =

Functional Centre Direct Cost (Less PatientSpecific Supplies, Drugs and Other NonWorkload Distributed Costs)

÷ Total Patient Hours of the Functional Centre

Functional Centre Unit Indirect Cost = Functional Centre Indirect Cost ÷ Total Patient Hours

of Functional Centre

The Patient Hours unit cost calculation is illustrated in the example below. • On the General Medicine Nursing Unit there are a total of 133,400 Patient Hours Inpatient

Actual YearToDate. • The total actual direct costs for the General Medicine Nursing Unit for the fiscal year are

$4,500,000. • The total indirect costs are $2,145,165.

The total direct costs are divided by the total patient hours to determine the direct cost per patient hour: Direct Cost per Patient Hour = $4,500,000 ÷ 133,350 = $33.75

To determine the indirect cost per patient hour, the indirect costs allocated to this functional centre (determined in section 3.3 step 2 of Case Costing Reporting Process) are divided by the total patient hours in this functional centre:

Indirect Cost per Patient Hour = $2,145,165 ÷ 133,350 = $16.09

Note that nonworkloaddistributed costs, such as physician feeforservice, are removed from functional centre direct costs before the calculation of functional centre unit direct costs. A separate unit direct cost is calculated for nonworkloaddistributed costs by dividing these costs by the total functional centre RVUs that are used to distribute these costs.

The functional centre unit costs are then applied to each patient.

Patient Hours Methdology and ADT system: For patient hours, the ADT system must be monitored and audited. One audit that is highly recommended is to compare patient hours with length of stay and to check that they are equal. This ensures that patient hours have not been missed during the patient's stay and ensures that the patient hours used to allocate costs to patients is of high quality. An important factor is to monitor interrater reliability with the registration staff. All registration staff should follow the same process for admitting, discharging and transferring patients. Ongoing education sessions are encouraged. The registration staff should be aware that the way a patient is admitted, discharged or transferred could have impacts to case costing.



2.2.2 ALLIED HEALTH

In Ontario, hospitals are required to report allied health workload using the generic workload reporting framework as stipulated in the OHRS. The development of multidisciplinary teams reporting to a single manager has created the need for comparable workload data across professions. A series of documents to assist the professions required to report under the Functional Centre Reporting Framework is described in Chapter 1. Chapter 1 provides an overview of the Framework. The Framework for nursing workload can also be used for workload measurement in the Allied Health departments.

Allied Health typically includes the following departments: • Audiology • Child Life • Chiropody • Clinical Nutrition • Occupational Therapy • Pastoral Care • Physiotherapy • Psychology • Rehabilitation Engineering • Social Work • Speech Language Pathology • Therapeutic Recreation • Respiratory Therapy

Key issues for implementing case costing in these areas include the following: • Capturing both departmental and patientspecific workload; • Capturing general and patientspecific supplies charges; • Capturing labour hours in the functional centre where the work is done; and • Setting up an audit program to ensure the reliability and validity of data produced.

National workload measurement systems (NWMS) have been developed for all of the allied health departments. A complete listing of National Workload Measurement Systems can be found in the MIS Standards 2009, Chapter 4. The original purpose of workload measurement was to get a picture of the full range of departmental activity. Statistics such as ‘total units produced’ and ‘ratio of service recipient to nonservice recipient workload units’ are important for departmental management. The challenge in implementing case costing is to work out how to organize data collection to produce both the statistics and the number of service recipient workload units for each patient. The recording forms (refer to Appendix C with 4 templates) may already give a head start, so only reorganization is needed to summarize the units for reporting.

Most of the NWMS provide sample forms for patientspecific recording. Patientspecific data recording can become cumbersome, as in the example that requires one record sheet per patient compared to several patients per record sheet in the basic patient care record. If workload statistics are accumulated and reported using a software package, it is important that the program can provide service recipient units by patient.

If the hospital opts to distribute patientspecific clinical nutrition costs, Clinical Nutrition must be set up in its own functional centre (functional centre 71445). Prior to April 1, 2004, Patient Food Services



(OHRS Functional Centre 71195) costs were allocated as indirect costs using patient meal days as an allocation base. Effective April 1, 2004, Patient Food Services (functional centre 71195) costs are to be distributed as direct costs.

2.2.3 LABORATORY

The NWMS should be used to generate workload units for the Clinical Laboratory. In the past, Ontario hospitals have had experience with the OHIP LMS (Labour Material and Supervision) codes and units. This system exists to support laboratory licensing and, with unit values attached, supports billing/payments for private medical laboratories. This is a gross coding system that uses the same code for a test regardless of the specimen. For some tests there is a significant difference in workload between testing serum and testing plasma. Historically, the LMS unit values have not been representative of true workload and are thus not useful for case costing and should not be used.

The conceptual model for Clinical Laboratory services workload measurement is shown in Table 2.1 below. The workload measurement system groups workload into the major categories of Patient Care and NonPatient Care, as follows:

Table 2.1 Clinical Laboratory Workload Measurement Patient Care NonPatient Care Preanalytical Analytical Postanalytical Specimen Collection Specimen Testing Technical Support

Functional Centre Activities Organizational/Community/Professional Activities Teaching/Inservice Research

Accumulating PatientSpecific Workload One of the first challenges in the laboratory is to determine the best way (given the system limitations) to gather workload by patient. Will the hospital's laboratory information system accumulate workload units by patient for transfer to the case costing system? Or will the laboratory information system transfer numbers of tests to the case costing system with the case costing system applying unit values from a master reference file? Both methods are effective; each requires different setup and maintenance.

Average Workload Units When the course of a lab test sequence depends on the result of the initial screen, there is potentially a wide range for the resultant workload. Ideally, the information systems and procedures can handle different workload for a negative result than for a positive result. If the systems cannot do this, an average unit value, taking into account the unit value for both a negative and positive result and their associated frequencies, should be developed. The ratio of positives to negatives should be verified periodically and in turn the average unit value should be adjusted accordingly.

Grouping Tests as Intermediate Products Beyond averaging unit values for individual tests, some hospitals have grouped tests with similar workload unit values under one intermediate product. This approach reduces the number of different products that the costing system must track. The options for creating costs for the products in the case costing system include:



• Individual Costs Only: Actual costs for each test. • Combination Individual and Grouping: Actual costs for high volume/cost tests and tests with

similar costs grouped and charged at an average cost for the group. • Full Grouping: Tests with similar costs grouped and charged at an average cost for the group.

If tests are grouped for costing, a record should be kept of this methodology for future reference when costs or groups must be updated in the system. There should be a routine mechanism in place to maintain the test costs in the system (whether using individual costs or cost groups). The number of workload units assigned to a group should be calculated using a weighted average (by volume) of the workload units of each lab test within the group.

One or Many Functional Centres The MIS Standards OHRS provide a range of functional centre numbers for the Laboratory. Setting up separate functional centres for each laboratory section will generate better case costs, but at the penalty of added coding and management reporting. Some of the advantages of separate functional centres by laboratory section include:

• Patients receiving testing from sections with higher equipment or supply costs will also receive those higher costs; and

• Patients receiving testing from sections with higher quality control or calibration standards requirements will also receive the associated higher costs.

In terms of disadvantages, there will be a need to track all categories of workload units, labour hours, supply and equipment costs to each functional centre.

Alternative Distribution of Equipment and Supply Costs Some hospitals have found that labour workload is not representative of equipment or supply costs for particular tests, procedures or functional centres. The case costing methodology recommends using workload as the distribution base for functional centre costs to cases, as this approach provides reasonably good case costs with simplicity. The hospital may want to use a more refined approach, developing an RVU for equipment and supply costs, described in Chapter 3, sections 3.4 and 3.5.

Patient Care and NonPatient Care Workload Some Clinical Laboratory patient care workload cannot be linked to specific patients. This patient care workload is then related to quality control or calibration standards. These activities generate valid workload, but not workload that can be readily assigned to each patient. Only patientspecific patient care units are used in case costing to calculate functional centre unit costs and to distribute costs to patients.

The general approach for calculating unit costs is to use only patientspecific workload units, as described in section 3.4. Note: Include inpatients, outpatients, and referredin when calculating the total workload units for the unit cost calculation.

Referred Contracted Out Tests For most hospitals, referredcontracted out tests represent a small proportion of their clinical laboratory costs. The average cost for a referredcontracted out test is established based on actual charges from invoices and charged to the case as an expense. Although there is no workload associated with performing the test, the specimen handling workload units must still be assigned to the case.

New Tests/Intermediate Products As discussed in section 3.4, the clinical laboratory functional centres may periodically introduce new tests that need to be added to the list of intermediate products. Refer to section 3.4 for more details on how to



develop costs for new products. Some OCCI hospitals have found that their laboratory information systems could not readily add new tests, so they accepted that the units for doing those added tests would simply be handled as other patient care workload that cannot be linked to specific patients.

Physician Fees and Salaries Hospital laboratories may have pathologists on staff, either dedicated to several laboratory functional centres or performing administrative duties in addition to unitproducing activities. Medical pathologist salary expenses are often a significant portion of the costs for the functional centres to which they provide services. First, the hospital must charge the pathologist expenses to those specific laboratory functional centres for which the pathologist provides services.

For case costing purposes, the standards allow for two methods of distributing the costs to patients. The costs may either be distributed through the patientspecific workload associated with the laboratory tests or the hospital may develop RVUs, based on the Ontario Medical Association (OMA) fee schedule. Section 3.5 provides a more detailed explanation of how to distribute these expenses.

2.2.4 DIAGNOSTIC IMAGING

The conceptual model for Diagnostic Imaging services workload measurement is shown below. The workload measurement system groups workload into the major categories of patient care and nonpatient care as shown in Table 2.2:

Table 2.2 Diagnostic Imaging Workload Patient Care NonPatient Care

Diagnostic/ Therapeutic Intervention Technical Function Technical Support Function

Functional Centre Activities Organizational/Community/ Professional Activities Teaching/Inservice Research

Technical function workload includes all technical activities required to perform an examination, procedure or other care for a patient. Technical support function workload includes all of the support activities that precede or follow the technical functions required to support patientspecific examinations or procedures, including patient reception, report typing and filing, and technical supervision.

As described in the MIS Standards 2009 documentation, diagnostic intervention refers to an activity carried out/service provided that is often individually designed for a specific service recipient or group of service recipients associated with assessing the presence, absence or status of a disease process or health condition. Therapeutic intervention refers to an activity carried out/service provided that is often individually designed for a specific service recipient or group of service recipients aimed at health promotion and disease prevention, improving/maintaining health status, or minimizing the impact of deterioration on function and quality of life.

Grouping Exams as Intermediate Products Some hospitals have grouped exams with similar workload unit values under one intermediate product to reduce the number of different products that must be tracked by the costing system. As with Clinical Laboratory, the options for setting exam products in the case costing system include using individual costs only, a combination of individual and grouping, or full grouping.



New Procedures/Intermediate Products Refer to Section 9.3 (Clinical Laboratory) and Chapter 5 Section 3.4 has details on how to handle costing of new intermediate products.

Physician Fees and Salaries Radiologist costs are often a significant portion of the costs in the Diagnostic Imaging functional centres. Hospitals may have salaried radiologists on staff, or (as in most hospitals) radiologists may be paid by the hospital on a feeforservice basis. First, the hospital must identify and charge the radiologist salaries or feeforservice expenses to those specific Diagnostic Imaging functional centres for which the radiologist performs work. Hospitals are required to use the professional component of the OHIP fee schedule as RVUs to distribute the feeforservice costs or salary expenses to patients. Chapter 6 (Section 6.3) Section 3.5 provides details on the methodology to distribute these expenses.

2.2.5 PHARMACY

Pharmacy and drug costs are distributed to patients through a combination of direct charge capture and distribution by formula. This approach to patient costing uses the Medication Profile (Pharmacy’s record of patient medication) not the Medication Administration Record (MAR): Nursing’s record of actual medication administration. Although the MAR could provide an exact record for drug cost development, it is not a practical source document. The recommended approach produces useful costing based on orders, returns and standard cost distribution. It requires the following functionality in pharmacy information systems: the automated medication profile system is merged with the inventory (cost) system to attach costs to the medication dispensed; and that there is another "field" in the medication profile system to allow the capture of an associated labour component based on dosage form. The best drug cost distribution data are achieved with a computerized unit dose drug distribution system

Drug Costs There are two broad categories of drugs for case costing purposes:

• Individually dispensed drugs, including PRN medication that is not kept as ward stock; and • Ward stock

Hospitals that use a high proportion of ward stock will not be able to produce good drug cost data because of practical limitations. This occurs because distribution of ward stock costs requires the assumption that the daily ward stock drug cost for all patients on a nursing unit be the same in order to avoid onerous data capture. This assumption is acceptable where ward stock is a small portion of the patient's total drug cost (unit dose system) or where there is consistency in ward stock drug usage by patient (such as a short stay unit).

Even automated information systems can be overloaded by too much detail. With thousands of drug/dosage forms, some OCCI hospitals found they had too much cost detail. They chose to group drugs for costing purposes, establishing average costs for groups of drugs.

Options for setting drug costs in the system for case costing include: • Individual Costs Only: Actual costs for each drug dosage form. • Combination of Individual and Grouping: Actual costs for high volume/cost drug dosage

forms; drug dosage forms with similar costs grouped and charged at an average cost for the group.



• Full Grouping: Drug dosage forms with similar costs grouped and charged at an average cost for the group.

Whatever method is used, it should produce representative drug costing. If drugs are grouped for costing, keep a record of the methodology for future reference when costs must be updated in the system. Also, put a routine mechanism in place to maintain the unit drug costs in the system (whether using individual costs or cost groups).

Individually Dispensed Drugs Tracking the costs of individually dispensed drugs is relatively straightforward, but does require the use of an automated Medication Profile. Hospital size does not affect this requirement. Since the automated information systems used in Pharmacies are able to apply unit costs to each drug dispensed (and credit specific returns), a patient's detailed drug cost can be produced at discharge. Hospitals should distribute costs of individually dispensed drugs based on actual drug costs and quantities dispensed for the patient.

‘As needed’ medication orders, coded as PRN, for individually dispensed drugs are also entered into the Pharmacy information system. A PRN medication order presents a special challenge for costing since the patient may not want or need the PRN medication, or may continue to use it throughout their stay. Since PRN medication is typically low unit cost, the standard procedure is to enter the PRN medication order only once into the Pharmacy information system (unless it changes). To achieve a fair cost distribution with reasonable effort, the OCCI hospitals used the following approach for PRN medication orders:

• When dispensed PRN medication orders are entered, a hospitaldeveloped estimate of patient usage is entered (the estimate could range from one day for a patient on a shortterm unit to more than 30 days for a longterm care patient).

The overall cost impact of drug returns is considered to be small (typically 5% or less). Some pharmacy information systems have an autocrediting feature that automatically credits drugs on discharge or death of the patient. This feature is helpful as long as the system does not credit drugs that cannot be reused. Ensure that one category of returns is being credited:

• High cost reusable IV returns need be credited for costing purposes. The hospital must, of course, first satisfy itself of the appropriateness of reusing a particular returned IV medication based on current practice standards

Ward Stock It is not practical to track ward stock on an individual case basis. The recommended approach is to use standard costs to provide an approximation. The first step is to establish an average ward stock cost per patient day for each nursing unit. This average cost must be updated at least annually, although a more frequent cost adjustment, such as quarterly, is preferred. As an alternative to calculating and merging a drug cost with a patient day, the drug costs could become part of the direct operating costs of the nursing unit and be distributed to the patients on the basis of patientspecific nursing workload units. The record of drug cost details would then be captured with the secondary financial expense accounts for the nursing unit.

Ward stock returns are unlikely to exceed $250 per occurrence or even per patient. However, if a nursing unit does return a batch of reusable ward stock worth $250 or more, it should be credited against the nursing unit ward stock drug cost for that period.

Drugs Administered Through Other Departments Some drugs are administered through departments other than Pharmacy. Traditionally, the costs of such drugs have remained with the pharmacy and in the general ledger as drug costs, even though Pharmacy has little to do with them.



The following approaches for tracing the cost of drugs administered through other departments have been designed to ensure accurate case cost data:

• Nonmedicated IV solution costs are distributed along with other material and supply costs incurred through the nursing unit.

• Anesthetic agents and other drug items administered through the OR are tracked through the OR clinical record.

• Medical gas costs are tracked through the administering department.

Depending on the capability of the financial information system, it should be possible for each functional centre to establish accounts for the drugs administered. This allows drug costs to be tracked to the responsible functional centre. The next step is to select an approach to tracking patientspecific usage that provides acceptably accurate case cost data. Potential approaches could range from distributing these drug costs along with other functional centre supply costs (e.g., for nonmedicated IV solutions) to keeping detailed records and distributing costs based on consumption by patient.

Drug Costs for Inpatient and Outpatient Pharmacy Operations As with other functional centres, outpatient labour and supply (and drug) costs must be separated so that the cost distribution formulas distribute inpatient costs to inpatients and outpatient costs to outpatients.

Implications of Decentralized Drug Costs Some hospitals have already adopted a decentralized approach to tracking drug costs in an effort to improve responsibility and accountability for drug usage. The traditional (centralized) approach is to charge all drugs to pharmacy. With the decentralized approach, drug costs are distributed to inpatient units based on drug usage by patients on the unit. If the hospital distributes drug costs in this manner, the financial system's features (and limitations) must be reviewed so that drug costs can be matched with the patient drug distribution data.

Pharmacy Labour For costing purposes, pharmacy labour falls into four main categories:

• Drug Distribution Labour • Clinical Pharmacy Labour • Management and Operational Support Labour • InHouse Manufacturing (IV Admixture and TPN Preparation)

Drug Distribution Labour The hospital should use the Pharmacy National Workload Measurement System (NWMS) to determine appropriate labour/workload units for each of the Pharmacy's labour categories. It is important to document how workload categories and unit values are defined for later verification, if needed. The conceptual model of the NWMS for pharmacy is shown in Table 2.3. Table 2.3 Pharmacy Workload

Patient Care NonPatient Care

Clinical Pharmacy • Assessment • Therapeutic Intervention • Consultation/Collaboration

Drug Distribution • NonSterile Products • Sterile Products

Functional Centre Activities Organizational/Community/Professional Activities Teaching/Inservice Research



The accuracy of drug distribution workload measurement depends to a great extent on the approaches used by the hospital to distribute drugs. Drug distribution by unit dose provides the most accurate workload, when workload is produced as a byproduct of pharmacy processing using an automated medication profile. Drug distribution by ward stock does not facilitate data capture for labour costing. Typically, a hospital uses a combination of approaches, including ward stock for relatively inexpensive, generalpurpose items. For most OCCI hospitals, ward stock does not represent a significant portion of drug distribution labour. Thus, the documented workload units associated with drug distribution from the automated medication profile could be used as relative values to distribute drug distribution labour cost to patients. If ward stock is a significant portion of the hospital's drug distribution labour, consider using the ward stock workload measurement capabilities incorporated in the Pharmacy NWMS.

Distribution of drug distribution labour cost to patients requires the use of an automated medication profile with the ability to assign labour category attributes to each drug item in inventory. Drug distribution labour for a case would then be calculated as the product of the number of doses of each drug dispensed times the number of labour units established for the dispensing of one dose of that drug, summed for all drugs dispensed to the patient (Where a hospital is partially converted to a unit dose system, two attributes for each dosage form would be needed, one for workload associated with unit dose drug distribution, and one for traditional drug distribution).

Clinical Pharmacy Labour As much as half of Pharmacy labour cost is clinical pharmacy activity. Clinical pharmacy activity workload is not directly related to drug distribution labour––for example, the drugs required by patients in ICU may generate relatively few labour units for distribution while pharmacist clinical activity could be quite concentrated. Conversely, chemotherapy patients whose treatment plan has already been established receive high labour cost drugs with little concurrent clinical pharmacist activity.

If the hospital's clinical pharmacy is a separate functional centre, use the pharmacy NWMS so that clinical workload can be distributed more precisely to patients for case costing purposes. If clinical pharmacy activity represents a small proportion of the total pharmacy workload, use drug distribution labour as the basis for distribution of clinical activity labour costs to cases. Hospitals using a clinical workload measurement system must ensure that the workload units produced are compatible with distribution workload units. Ideally, total pharmacy labour cost would be distributed to each patient based on the sum of the distribution and clinical workload units that the patient received.

Management and Operational Support Labour As in other functional centres, only patientspecific units can be used to distribute costs to patients. The denominator in the unit cost calculation formula is the total number of patientspecific units produced by the functional centre during the period. Costs for management and operational support, clinical labour, general supplies, and so on are all distributed to patients as direct costs in proportion to measured patient specific unit producing labour.

InHouse Manufacturing (IV Admixture and TPN Preparation) The MIS Standards (Section 3.3, Recording of Supplies Expenses) specify that where inhouse manufacturing or compounding (such as sterile products from the Pharmacy, including TPN and IV additives) is done, the costs of manufacturing should be transformed into supply costs through the use of inventory accounting. Ideally, such manufacturing would be done in a separate functional centre with the manufactured products then "sold" to Pharmacy inventory. In this way, the labour, drug and material costs are converted to a drug cost in the Pharmacy inventory and charges are distributed to patients through the normal systems.



2.2.6 OPERATING ROOM

The OCCI standard for distributing operating room costs, other than patientspecific supplies, is door to door time, which is the time captured when the patient enters and exits the operating room to undergo the surgical procedure. Compared to skin to skin time, it better measures the total time to perform the procedure including patient preparation time. This information can be captured through the OR booking system or schedule.

2.2.7 OBSTETRICS:

To better reflect the type of care mothers and neonates receive in Obstetrics (functional centres 7125020** to 7125090**), the patient hour unit cost for neonates requires adjustment. The neonate patient hours are scaled. The scaling factor is based on the birth weight of the neonates. The scaling factors are outlined in Table 2.4 below.

Table 2.4 Scaling Factors for Neonates Cost of Neonates greater than 2500g = (2/3) * patient hours * hourly unit cost Cost of Neonates between 2000g to 2500 g = (3/4) * patient hours * hourly unit cost Cost of Neonates less than 2000g (not scaled) = patient hours * hourly unit cost Cost of Mother (not scaled) = patient hours * hourly unit cost

2.2.8 EMERGENCY DEPARTMENT

Emergency Room (ER) costs for outpatients can be based on standardized RVUs for each triage level. The Canadian Triage Acuity Scale (CTAS) defines 5 levels of triage according to the perceived need for physician assessment. Many hospitals have developed standardized workload values for each triage level and these can be used as RVUs. A formula for inpatient cost in ER has been developed. The RVU for an inpatient would be 1.4 times the RVU for the patient’s outpatient encounter.

Cost of ER patient Unit = ER Triage Units/24 hours * 1.4 cost factor ER Patient Cost = Cost of ER patient Unit * Patient Hours

This formula was developed based on a small group of data and will be reviewed when more data is available.

For scheduled emergency visits use the CTAS level of 5 to determine the nursing workload associated with scheduled ER visits. Emergency visits are identified as prescheduled type of outpatient clinic or day surgery visits taking place in the emergency department and reported under the emergency functional centres. This usually occurs with small facilities.

Note: All Emergency unscheduled visits must have triage levels 1 to 5 in order to determine costs.



2.2.9 FINANCIAL SERVICES,

Financial Services must be involved in the collection of both financial and statistical information. An understanding of the MIS Standards and the OHRS Chart of Accounts is crucial to avoid many case cost development problems. Key concerns for Financial Services in implementing case costing are discussed in Sections 3.2 and 3.3 and include the following:

• Converting Using the OHRS Chart of Accounts • Categorizing costs correctly; • Auditing data for validity and reliability; and • Implementing cost allocation.

Refer to the document, OCCI Milestone Process, Appendix M for the questions used in the OCCI Milestone 1 and 2 Review. These questions are designed to help check the progress so that there are no surprises later in the implementation!

Cost Allocation Implementation All functional centres must be included in the cost allocation, whether they provide patient services or not. The fair cost of administration to a nursing unit is produced by charging all functional centres that benefit, including those that are undistributed or that are nonpatientcare. The cost allocation process can be summarized as follows:

• Identify Transient Cost Functional Centres (TCC TFCs) and Absorbing Cost Functional Centres (ACC AFCs);

• Determine the allocation base for each TCC TFC; • Develop and maintain simultaneous equations (this step may take the form of entering

information from the first two steps into the cost allocation software); • Allocate total expenses of the TCC TFC (as indirect costs) to:

o each other (reciprocal services) and o each ACC AFC using these services;

• Validate allocation of costs.

2.2.10 HEALTH RECORDS

Many of the important Health Records issues are covered in section 3.2.3. There is some additional material to help plan and manage implementation. References to other sections are included where the material has been previously covered.

Health Records ensures that patient descriptive data are gathered in support of case costing. Although Health Record Department staff typically handles final coding and abstracting, there is considerable organizational effort required so that care providers provide timely and accurate documentation of the patient's care.

There are two primary issues that Health Records must focus on: • Ensuring the quality of patient descriptive data; and • Coding of the basic and optional data items needed for case costing.



Ensuring Quality of Patient Descriptive Data All Health Records coding staff and other areas completing assessment type information must be up to date on current standards with each service type. One of the major responsibilities within a facility is to ensure the reliability of the data abstracted. This can be tested through interrater reliability audits in which all staff abstract the same cases and compare any differences. If any discrepancies are found, the hospital may need to look at current policies and practices to improve the data quality. Mechanisms must be in place to ensure that the abstracted/assessment data is complete and that there are no missing or invalid data elements. The various software vendors may have edits or error reports that identify any invalid or incomplete data fields. The hospital may have other mechanisms in place to ensure that patient charts are completed, with policies to contact physicians for queries about the diagnoses or procedures.

The value of case costing is the availability of timely data that will assist the hospital in decision making. At the end of the costing period, the OCCI receives the patient abstract/assessment data from CIHI. Any delays in closing the period due to incomplete data or problems in coding cause a lag in the time that the cost data can be matched with the patient descriptive data. In addition, errors may result where patients are assigned to the wrong classification group, overestimating or underestimating the costs for that group.

CIHI Mandatory Data Additional clarification of certain CIHI mandatory data elements for Inpatients, NACRS, Mental Health, Rehabilitation and Complex Continuing Care can be found in the respective 2009 CIHI manuals

2.2.11 INFORMATION SYSTEMS

The various departmental requirements discussed in this chapter are the ‘building blocks’ for case costing, and information systems represent the ‘mortar’ holding case costing together. Case costing implementation is a team process, and the Information Systems department plays an important role in helping the organization implement the required information systems.

It is important to ensure that the hospital's Information Systems Strategic Plan reflects the hospital's business plan to implement and use case costing. The Information Systems Department's priorities must be clear and compatible with the hospital's overall priorities.

Since information systems are a factor in almost all aspects of case costing implementation, it is next to impossible to pull all significant information systems material from the various departments for presentation in this chapter. The reality is that information systems staff must be familiar with all aspects of case costing to provide the level of support needed.

The MIS Standards 2009, Appendix 2 (Implementing the MIS Standards) provides a wealth of technical information with regard to selection and acquisition of information systems. In addition, section 1.6 Chapter 12 of this Guide provides further information on project organization and management.

The approaches that hospitals have used to develop a case costing system can be categorized into four groups:

1. SingleVendor Approach: This involves utilizing a single comprehensive solution for patient and financial information systems. 2. MainframeBased Approach: This involves utilizing a mainframebased cost accounting system with data feeds from mainframebased patient care and financial systems.



3. MultiVendor PC/MicroBased Approach: There are several vendors who provide cost accounting systems adapted for PC or microcomputer platforms. There are similarly adapted patient care systems. 4. InHouse Developed Systems Approach: Some hospitals have gone the route of designing their own cost accounting system based on a minicomputer. Patientcare and other financial systems are obtained from various vendors. 5. OCCI (Ontario Case Costing Initiative) Approach: A standardized case costing system that is not proprietary where changes/edits/updates can easily be done. Structured standard tables are provided by the MOHLTC for specific report writing capabilities. Other additional data elements that facilities may want to cost can be easily added, for example, Health Outcomes for Better Information and Care (HOBIC), or Injury Severity Scoring (ISS) used in classifying trauma cases, etc. The benefits for a standard case costing software system include all the technical requirements, report generation capabilities and all maintenance. Updates would be done for all facilities participating, etc.

The OCCI Approach would be the ideal standard Case costing system.

2.3 HOSPITALPATIENT SERVICE TYPE STANDARDS

The OCCI case costing methodology was originally developed to cost acute inpatients and have moved forward in costing methodologies for Ambulatory, Mental Health, Complex Continuing Care and Rehabilitation patients.

It is crucial to keep in mind that most aspects of the methodology apply to all cases. Utilization is captured on a patientspecific basis, standardized financial information is tracked using the MIS Standards, and costs are distributed to patients based on the total number of services/intermediate products received from each functional centre.

The most difficult issue when adapting the standards to Ambulatory (NACRS), Mental Health, Complex Continuing Care and Rehabilitation is to define the encounter. The acute inpatient encounter is defined as the time between admission and discharge dates. However, an ambulatory care encounter can be only ten minutes long while a mental health or complex continuing chronic care encounter can be more than one year long. The challenge has been to maintain the standards while recognizing the differences in the encounter for different populations. Most of the differences in the methodology for mental health, complex continuing care chronic, and ambulatory care are due to the nature of the visit or encounter. For rehabilitation patients an encounter number is not identified for OCCI. Linkages are only made by discharge and admit dates.

This chapter summarizes the costing standards and issues specific to ambulatory care, mental health, complex continuing chronic care and rehabilitation. All of the general and departmental standards presented in this Guide apply to the costing of these patient groups. Details of the costing standards are found in Chapters 3.

2.3.1 STANDARDS FOR HOSPITAL AMBULATORY CARE The general and departmental standards apply to ambulatory care cases. Minor modifications to the acute inpatient standards have been made to accommodate ambulatory care costing.



The NACRS have recording guidelines that define when an ambulatory care data set is to be collected (refer to the CIHI Ambulatory Care Minimum Data Set). The current guidelines specify that one data set is recorded when services are provided by one or more staff within the same functional centre.

From a case costing perspective, the key issue is to ensure that the appropriate costs are distributed to the appropriate encounters. The hospital must generate the required data sets for each patient visit and then track the costs to each functional centre that provided the services/intermediate products.

For the purposes of costing, an ambulatory care encounter (an encounter includes visits, diagnostic procedures, attendance days and telephone contacts—see Methodology for Costing Ambulatory Care— Version 2 for details) will be recognized in each of the following situations (based on the CIHI/MIS definitions): 1. Services provided to a registered hospital outpatient by an ambulatory care functional centre

(Emergency, Day/Night Care and Clinics) as defined by the OHRS • Only one visit is recorded for each patient per ambulatory care functional centre in a given 24

hour period. A second visit is only reported if: the visit is for a different medical problem in the same 24hour period, the patient is treated by a different physician or service in the same 24hour period, or care is provided by a different shift of care providers.

• If a registered outpatient receives services from more than one OHRS ambulatory care functional centre, each set of services from an individual functional centre will be recognized as a separate encounter.

• Patient care services (e.g., consultations, therapy, etc.) provided through phone contacts to, or on behalf of, a registered outpatient will be recognized as an ambulatory care encounter. The ‘Mode of Visit’ field must be used to indicate that the encounter was a phone contact.

2. Services provided to a registered outpatient by an Allied Health (Therapeutic) functional centre. Outpatient attendancedays for the following services will be recognized as encounters for costing: • Physiotherapy, Occupational Therapy, Speech/Language Pathology, Audiology, Psychology,

Social Work, Clinical Nutrition, Recreation Therapy, Child Life • Radiation Oncology • Therapeutic Services of Respiratory Therapy (e.g., hyperbaric chamber)

Additional services, provided to a patient in conjunction with an ambulatory care encounter, will be captured and costed as part of that ambulatory care encounter. In most cases, these services would be ordered through the ambulatory care functional centre:

• Laboratory • Diagnostic Imaging • Other Diagnostic Laboratories (EEG, Echocardiography, etc.) • Pharmacy

2.3.2 MENTAL HEALTH AND CHRONIC COMPLEX CONTINUING CARE A mental health or complex continuing chronic care encounter is identified by the patient’s admission and discharge dates. Due to the length of stay of a mental health or complex continuing chronic care visit (sometimes greater than one year), a mental health or complex continuing chronic care encounter can be divided into a set of subencounters for the purposes of costing. A subencounter is defined as the time period between any two consecutive assessment periods, as described below.

Each subencounter is identified by a mental health or complex continuing chronic care MDS assessment period (usually 90 days) which is defined as the time from the beginning day of an MDS assessment



period to the day before the next assessment period. The beginning of a new assessment period triggers the beginning of a new subencounter except when a significant change in status occurs. In this case, the new subencounter is triggered on the day the change in status has been identified.

All services and products delivered to each patient are to be tracked for each assessment period. Figure 2.1 shows an example of the MDS assessment process:

Figure 2.1: MDS Assessment Process

Conceptual View of MDS Assessment Process Upon admission, the patient is assigned a registration number by the ADT system, which identifies the encounter. For the purpose of case costing, each encounter is then divided into a number of sub encounters. Assessment reference date is the last day of the MDS observation period referring to the specific end point in the MDS process and is captured as part of the MDS. This date triggers the start of a new assessment period, unless there is a significant change in status. Date of entry refers to the date upon which the patient was admitted into the facility and is captured as part of the MDS. Date signed as complete refers to the date upon which the RN Coordinator certifies that the assessment is complete and is captured as part of the MDS. Significant change in status refers to the date upon which a significant change in the patient’s condition is recognized. This is not captured as part of the MDS.

The following example, illustrated in Figure 2.1, clarifies the standards for case costing.

SubEncounter # 1 (Assessment Period #1)

• The costing standards require that all services and products delivered to the patient from the day of admission to the last day (day 90) before the next MDS assessment period will be tracked to the patient as part of assessment period #1. Therefore, the beginning date of the first assessment period is day 0, the day of admission.

• All services and products received between the admission date and the initial assessment are associated with the first assessment period. It is critical to attach these first few days of stay to the first assessment period since a significant amount of care, and therefore costs, will be incurred in the first few days of stay.



SubEncounter #2 (Assessment Period #2)

• The second assessment period, subencounter #2, begins on the day following the assessment reference date, usually day 91.

• All services and products delivered to the patient from the 91st day of stay to the last day (day 180) before the third MDS assessment will be tracked to the patient as part of assessment period #2. The care provided to patients (the products and services received) will reflect results of the quarterly assessment.

Other SubEncounters (Assessment Period #3, #4)

• Similar to subencounter #2, the third assessment period, subencounter #3, begins on the day following the assessment reference date, around day 181.

• All services and products delivered to the patient from the 181st day of stay to the last day (day 189 in this example) before assessment period # 4 will be tracked to the patient as part of assessment period #3.

• However, ten days into the third assessment period, the patient in our example has a significant change in status. Due to the change in the patient’s condition, attending care providers observe the patient as the patient stabilizes and complete a full assessment. The period then continues for 90 days, after which a quarterly assessment will be taken similar to previous quarterly assessments.

• In this case, encounter #4 is triggered on the day the significant change takes place (day 190) as opposed to when the assessment is completed, which can be several days after the change. All services and products delivered to the patient from the 190th day of stay to the last day (day 280) before assessment period #5 will be tracked to the patient as part of assessment period #4.

Tracking Costs for Readmissions There may be occasions where a patient is discharged from a mental health or complex continuing chronic care facility and is expected to be readmitted to the facility. For example, the patient may be temporarily admitted to another health care facility to receive a surgical or diagnostic procedure or the patient may be temporarily discharged home. As long as there is no significant change in the patient’s status after readmission, the same MDS assessment covers that subencounter until the next assessment.

It is important that the costing of the encounter continue even while the patient is temporarily absent from the facility. If the entire assessment period is 90 days long and a patient was absent for four of those days, the costing period should represent the entire 90 days and all costs accumulated during the period. In the case where the patient’s status has changed, a new MDS assessment would initiate a new assessment period.

When reporting case costs to the OCCI, each subencounter is submitted as part of the cost submission and is identified through each patient’s:

1. Master Number 2. Chart number 3. Admission date 4. Registration number (as assigned by the ADT)

• for Complex Continuing chronic Care – the Unique Registration Identifier is used • for Mental Health – the Case Record number is used

5. Discharge date (if applicable)



To calculate the Mental Health workload the patient hours methodology should be used as previously described.

Hospital Data Submission Requirements Currently, hospitals internally are able to track utilization based on the register account number. For mental health, complex continuing chronic care and rehabilitation case costing, the main challenge will be to track the utilization of products and services to each subencounter. Hospitals are required to develop mechanisms to uniquely identify each assessment period/subencounter.

PatientSpecific Supplies: Generally, there will be few high cost patientspecific supplies (greater than $250) that will be costed directly to mental health or complex continuing chronic care patients. The hospital may find that some supply items with a low unit cost are used in high volumes by certain patients and thereby account for a significant proportion of the total supply costs. For example, complex continuing chronic care patients frequently use incontinence products, which are a large portion of the Nursing unit’s supply costs. These supply costs are usually spread to all patients based on workload, rather than being distributed directly to the patients who use them.

The hospital can identify these high volume items and distribute the costs to those patients who use these supply items. Alternatively, the hospital may decide to lower the overall threshold for distributing patient specific supplies.

2.3.3 STANDARDS FOR HOSPITAL REHABILITATION

Rehabilitation assessments consist of three types of assessments: 1) Admission assessment (completed within 72 hours of admission to the rehabilitation facility/unit 2) Discharge assessment (completed within 72 hours prior to discharge from rehabilitation

facility/unit 3) Followup assessment (completed within 80180 days following discharge from the rehabilitation

facility/unit

Service Interruption: A Service Interruption Status of 1 in the Discharge assessment is indicated according to the standards set by CIHI. When the Service Interruption Status of 1 is indicated the patient has been discharged and admitted to another facility and may be readmitted back to the rehabilitation facility to continue with rehabilitation treatment.

For those rehabilitation patients staying between 4 and 10 days and discharged, only the admission assessment will be completed. Only those cases staying longer than the 10 days will also have the Discharge assessment completed. The Discharge assessment contains both the admission date and discharge dates for that rehabilitation case and is considered a “complete” case, whereas the Admission assessment only indicates the admission date for LOS between 4 & 10 days.

For rehabilitation patients staying less than 4 days (0 to 3 days) then a discharge date is indicated on the Admission assessment.

For Rehabilitation: The admission/discharge information is also submitted as part of the cost submission and is identified through each patient’s:

1. Master Number



2. Chart number 3. Admission date

These data elements are to be submitted in the OCCI case cost data submission (see the OCCI technical specifications guide)

Nursing Workload Measurement Systems: For those facilities not able to capture patient specific workload, a proxy has been developed for each RPG (Rehabilitation Patient Group). The model uses a grouping methodology where groups are split based on Functional Independence Measure (FIM) scores, as noted in Table 2.5 below. For a comprehensive list of the Rehabilitation Group, please refer to Appendix D Q.

Table 2.5 – Rehabilitation Classification for Patient Hour Nursing Weight Rehabilitation Group RPG Patient Hour Nursing Weight Stroke 1110 0.9759 Stroke 1120 0.8506 NonTraumatic Brain Injury 1310 0.9839 NonTraumatic Brain Injury 1320 0.7915 Neurological 1410 1.0971 Neurological 1420 0.9525 NonTraumatic Spinal Cord Injury 1610 1.5235 NonTraumatic Spinal Cord Injury 1620 1.5235

The formulas for calculating the rehabilitation workload costs are the following;

Weighted Unit Cost = Total Nursing Cost $ ÷ Total Weighted Units

Patient Specific Weight = Patient Hour Nursing Weight * Patient Hours

Rehab Patient Cost = Weighted Unit Cost * Patient Specific Weight

PatientSpecific Supplies: Generally, there will be few high cost patientspecific supplies (greater than $250) that will be costed directly to rehabilitation patients. The hospital may find that some supply items with a low unit cost are used in high volumes by certain patients and thereby account for a significant proportion of the total supply costs.

2.3.4 STANDARDS FOR HOSPITAL COMPLEX CONTINUING CARE

The costing of Complex Continuing Care patients is very similar to the Rehabilitation patients. The RUG III Group is adopted instead of the RPG Grouping.

Nursing Workload Measurement Systems: For those facilities not able to capture patient specific workload, a proxy has been developed for each RUGIII Group. A sample list is shown in Table 2.6. For a comprehensive list of weights for the RUG III Group, please refer to Appendix D Q.



Table 2.6: Resident Utilization Group Classification – Patient Hour Nursing Weight RUGIII Group Patient Hour Nursing Weight RUC 1.1537 RUB 0.9492 RUA 0.9492 RVB 0.9492 RVA 0.9492 RHC 0.9155 RHB 0.8560 RMC 0.8371

The formulas for calculating the complex continuing care workload costs are the following;

Weighted Unit Cost = Total Nursing Cost $ ÷ Total Weighted Units

Patient Specific Weight = Patient Hour Nursing Weight * Patient Hours

Complex Continuing Care Patient Cost = Weighted Unit Cost * Patient Specific Weight

Note: Facilities need to ensure that all assessments have the appropriate RUG (Resident Utilization Group) assigned. With some external vendors BC1 & BC2 are not valid RUGs. These are indications of data quality issues and will impact the calculations for determining workload, for example RUG “ZZZ” = 0.8277.

Different RUGs can be assigned for one resident stay. Caution must be made when this is encountered as it will have an impact on the proxy workload assigned..

PatientSpecific Supplies: Generally, there will be few high cost patientspecific supplies (greater than $250) that will be costed directly to rehabilitation patients. The hospital may find that some supply items with a low unit cost are used in high volumes by certain patients and thereby account for a significant proportion of the total supply costs.

2.4 COMMUNITY CARE ACCESS CENTRE STANDARDS

In the Community Care Access Centres (CCACs), costing is done by each specific referral approved for each client. One client can have multiple referrals, where costing by referral start and end dates can be done. Costs by client can also be done from their initial “admission date” to actual “close date” of the client. The closed date of the client would reflect all services provided by each referral that have been completed.

Costing for workload can occur by hour or by visit. Contract service providers provide the cost and add their associated overhead costs. For case costing purposes this item cannot be separated. Therefore CCACs would use the costs/workload knowing that contracted service provider overhead exists in the cost/workload and will be allocated to each client.



2.5 COMMUNITY CARE ACCESS CENTRE CLIENT TYPE STANDARDS

Each approved referral for a CCAC client is assigned a Billing Reference Number (BRN) and all costs attributed to that particular referral for a client are recorded in the Client Health and Related Information System (CHRIS).

Client Specific Supplies:

In CHRIS all specific supply costs can be associated with each BRN and referral.

MINISTRY OF HEALTH AND LONGTERM CARE OCCI Chapter 3 Case Costing Reporting Process Health System Information Management and Investment Division Health Data Branch


ONTARIO CASE COSTING GUIDE CHAPTER 3: CASE COSTING PROCESS

REQUIREMENTS

TABLE OF CONTENTS

3.1 Case Costing System Requirements ................................................................................................... 3 3.2 Step 1: Gathering the Data ................................................................................................................. 4 3.2.1 Financial Data ............................................................................................................................ 4 3.2.1.1 Functional Centre Cost Assignment ..................................................................................... 5 3.2.1.2 Allowable Recoveries and Revenues in Case Costing......................................................... 11 3.2.1.3 Separating Inpatient, Outpatient and NonPatient Operating Costs and Revenues ............... 12 3.2.1.4 Other Hospital Costs.......................................................................................................... 13

3.2.2 Cost Distribution Bases............................................................................................................. 15 3.2.2.1 Workload .......................................................................................................................... 16

3.2.3 Patient/CLIENT Descriptive Data............................................................................................. 20 3.2.3.1 CIHI and OCCI Coding Requirements ............................................................................... 20 3.2.3.2 Linkage of Patient Descriptive Data with Cost Data........................................................... 22

3.3 Step 2: Allocating Indirect Costs...................................................................................................... 23 3.3.1 Indirect Cost Allocation Using SEAM ...................................................................................... 23 3.3.2 Indirect Cost Allocation Bases .................................................................................................. 25 3.3.3 TCC TFC Costs that can be Allocated as Indirect Costs ............................................................ 26

3.4 Step 3: Calculating Functional Centre Unit Costs or Intermediate Product Costs .............................. 28 3.4.1 The General Ledger, Accounting Guidelines, and Variable and Fixed Costs.............................. 28 3.4.2 Functional Centre Unit Costs .................................................................................................... 29 3.4.2.1 Information Needed to Calculate Functional Centre Unit Costs .......................................... 30 3.4.2.2 Functional Centre Unit Cost Calculation ............................................................................ 30

3.4.3 New Tests/Intermediate Products .............................................................................................. 35 3.4.4 Relative Value Units................................................................................................................. 35

3.5 Step 4: Distributing Costs to Patients ............................................................................................... 36 3.5.1 Distributing Functional Centre Unit Cost to Patients based on Workload................................... 36 3.5.2 Distributing Functional Centre Unit Cost to Patients based on Patient Hours ............................. 38 3.5.3 Intermediate Product Costing.................................................................................................... 39 3.5.4 Patient Cost Distribution Bases ................................................................................................. 39

3.6 Step 5: Bringing It All Together....................................................................................................... 40 3.6.1 Interfacing Departmental Data with the Case Costing System ................................................... 40 3.6.2 Options for Reporting Case Costs ............................................................................................. 41 3.6.2.1 Costs by Day of Stay ......................................................................................................... 42 3.6.2.2 Variable/Fixed Detail......................................................................................................... 42 3.6.2.3 ServiceSpecific Data Elements ......................................................................................... 43 3.6.2.4 Procedure Detail ................................................................................................................ 43

3.6.3 A Framework for “Case” Costing ............................................................................................. 44 3.7 Costing in a Program Management Hospital .................................................................................... 45 3.7.1 Gathering Data ......................................................................................................................... 46 3.7.2 Allocating Indirect Costs .......................................................................................................... 46 3.7.3 Calculating and Distributing Product Costs ............................................................................... 47



3.7.4 Product Line Costing ................................................................................................................ 47 3.8 Example of Case Costing Methodology in Action ............................................................................ 48 3.8.1 Example: Step 1 Gather The Data........................................................................................... 48 3.8.2 Example: Step 2 Allocate Indirect Costs ................................................................................. 49 3.8.3 Example: Step 3 Calculate Functional Centre Unit/ Intermediate Product Costs ...................... 51 3.8.3.1 Example: Method 1 Calculate Functional Centre Unit Costs (MIS OHRS Workload Costing) ........................................................................................................................................ 51 3.8.3.2 Example: Method 2 Calculate Intermediate Product Costs (Intermediate Product Costing) 51

3.8.4 Example: Step 4 Distribute Costs to Patients........................................................................... 54



3.1 CASE COSTING SYSTEM REQUIREMENTS

Information systems make case costing possible, practical and effective. Information systems and information systems staff play a key role in the implementation and sustained operation of a case costing system. Included here is an example of some features and capabilities that are important in a departmental system for case costing.

Input to Departmental Systems and Case Costing System • Linked with Admission/Discharge/Transfer (ADT) System for patient identification number,

encounter number and Patient Hours in each functional centre confirming valid account numbers. • Can record procedure and workload for patient • Can record patientspecific supplies and other expenses to the patient • Can identify specific procedures and workload to specific functional centres

Output from Departmental Systems • The format of the source data (e.g., Nursing, Operating Room, Health Records) should be

examined to determine the optimal method of transferring data to the case costing system

Output from Case Costing Systems • The capability for summary analysis of costs associated with patients • The capability to list patientspecific utilization and costs

Tracking • The ability to track patients from admission to discharge • The ability to track patient demographics, clinical and resource utilization and case costs for

patients

Querying Tools • Data querying tools should be based on a relational database in which information is stored in

tables that relate to each other by userdefined queries, allowing efficient and accurate storage and retrieval

Audit Reports • To ensure that what is passing to the costing system is the desired information • Should enhance the validation process and improve data integrity checks • Data quality checks should occur at the source data level and at the case costing system level

Stand Alone System • Ensure that patientspecific information can be entered and retrieved

Batch/real time • Ensure that patient information is available on system when required • Ensure that data can be archived, rather than purged, to free up space

Other • Patient billings • Check requirements (if any) of Case Costing System operating system • Have users assess user friendliness



• Table driven system (relational) with usermaintained tables for workload values

Vendors • Follow Request for Proposal (RFP) procedures • Be specific in questions • Usability, functionality and supplier capabilities are critical • Insist on demonstration and documented proof of performance • Selection team should be balanced with ‘technology enthusiasts’ and ‘healthy skeptics’ • Obtain references

3.2 STEP 1: GATHERING THE DATA

A standardized methodology has been developed with the goal of producing high quality case cost data. Reliable and valid data— financial, statistical and patient descriptive data—are necessary to produce high quality case costs. To obtain the data, follow data preparation and collection rules, audit the processes that generate the data and ensure that a particular case’s costs can be traced.

In sections 3.2 to 3.5 there is a focus on what must be done to produce high quality cost data, by categorizing, allocating, and distributing costs. These standards were originally developed for acute inpatient and day surgery costing and now include rehabilitation, mental health, complex continuing care and community clients.

Gathering data is the first step in the case costing process. The OCCI data standards for gathering financial and statistical data are based largely on the Ontario Healthcare Reporting Standards (OHRS), which provide the framework for collection and organization of hospital statistical and financial data. Standards are necessary to ensure the comparability of data. In this chapter, the OCCI standards for the collection of financial, statistical and patient descriptive data (health records data) are presented.

3.2.1 FINANCIAL DATA

The Ontario Healthcare Reporting Standards (OHRS) define a framework for the compilation and comparison of financial and statistical data. Since the OHRS are the starting point for case costing, hospitals wishing to implement case costing must be familiar with OHRS. The standards presented here expand or clarify accounting issues and their treatment, as well as any additions to, or modifications of, the existing OHRS accounts needed for case costing purposes. The complete set of OHRS documentation is available on the ministry’s website, www.mohltcfim.com, which includes account numbers, account definitions and key accounting terms.

Hospitals must adhere to the account structure presented in the OHRS Chart of Accounts. Note that there is a “rollup” built into the OHRS Chart of Accounts numbering system. To safeguard the “rollup”, be

Data Reliability and Validity Reliability is the degree of consistency with which an instrument measures the attribute it is supposed to be measuring. Validity is the degree to which an instrument measures what it is supposed to measure.

Pollit and Humgler, 1983

http://www.mohltcfim.com/



sure to define the functional centres at the lowest level needed to break out costs internally, and be sure that all of a lower level account rolls up to one account at the next level up.

Functional Centres for High Cost Equipment One way to isolate high equipment costs and distribute them to the patients who receive their benefit is to establish additional functional centres specifically for such high cost equipment. This approach is especially appropriate if the nonlabour cost per service exceeds $250. Note that a suitable relative value unit system is needed to distribute costs to patients. This mechanism of establishing separate functional centres for high cost equipment enables hospitals to develop more accurate patient case costs. Hospitals can still compare their costs with those of hospitals that do not have these functional centres by rolling up to a common level, such as Level 3, and comparing at that level. Several specific functional centres that isolate high cost equipment have already been defined in OHRS and are listed in table 3.1.

Table 3.1 Functional Centres with High Cost Equipment OHRS Functional Centre Number OHRS Functional Centre Name Cost Item

71 3 40 25 ** 71 3 60

Day/Night Care, Surgical/Procedural Day Surgery Operating Room Equipment/Supplies

71 3 62 Day Surgery Combined OR & PARR Equipment/Supplies 71 3 65 Day Surgery PostAnesthetic Recovery Room Equipment/Supplies 71 3 67 Day Surgery Pre and Post Operative Care Equipment/Supplies 71 3 69 Day Surgery Combined OR, PARR & Pre and Post Care Equipment/Supplies 71 4 10 25 ** Clinical Chemistry Equipment 71 4 15 ** XRay Equipment/Supplies 71 4 15 25 Computed Tomography Equipment 71 4 15 30 ** Diagnostic Ultrasound Equipment 71 4 15 40 71 4 15 35

Nuclear Medicine Nuclear Medicine – Gamma Cameras Equipment/Supplies

71 4 15 44* Cardiac Catheterization Laboratory Supplies 71 4 15 70 Magnetic Resonance Imaging Equipment

Functional Centres for Patient Care Administration and Support Patient care departments with several functional centres and a large administrative and support staff may find it beneficial to set up a specific administrative and support functional centre for the department. The OHRS provide a suggested account structure for functional centres such as Laboratory, Diagnostic Imaging, Pharmacy and Nursing. It is easier to achieve a representative distribution of these administrative and support costs to patients using this approach. Some further considerations on the use of functional centres for departmental administration and support are discussed in section 3.1.2.1, Functional Centre Cost Assignment. Note that patient care administration and support functional centre costs are assigned to the patient care functional centres as a direct cost.

3.2.1.1 Functional Centre Cost Assignment The Functional Centre Reporting sections of the MIS Standards and OHRS specify how financial and statistical data should be collected and organized for case costing. Assigning expenses to the proper functional centres is crucial to achieve accurate case costs. In this section, the OCCI standards are described, which are based on the OHRS for assigning hospital expenses to functional centres. There is



also a detailed explanation of the OCCI standards associated with the following expenses: salaries and benefits, physician compensation, patient care administration and support, supplies, drugs, amortization and leasing of equipment, and maintenance of major clinical equipment.

Salaries and Benefits Salaries and benefits are usually the largest component of a functional centre’s costs. The OHRS secondary account codes for salaries and benefits are as follows: 310** 3 ** 10 Worked Salaries 330** 3 ** 30 Benefit Salaries 340** 3 ** 40 Benefit Contributions 390** 3 ** 90 Purchased Service Salary 3 90 9* MD – Purchase Service including FeeforService

Worked salaries, benefit salaries and purchased service salaries represent the three categories of salaries.. The OCCI standards require that salaries and benefits of personnel be assigned to the functional centres in which they work. This standard applies to all unitproducing personnel (those capturing workload), medical personnel, and management and operational support personnel. More information on labour costs related to these broad occupational groups is provided below.

Education and research staff salaries are assigned differently from the salaries of other hospital personnel. If education or research staff performs unitproducing work instead of the usual functional centre staff, these hours spent performing unitproducing work and the associated salaries are assigned to the functional centre receiving the service. Otherwise, their hours and salaries are assigned to the appropriate Education (7* 8) or Research (7* 7) functional centre.

Students receiving compensation should have their costs distributed to the appropriate functional centres at the actual rate of compensation. Students who are not compensated by the hospital have no labour expenses assigned to functional centres. An employee’s uncompensated overtime hours are also assigned no value. Although worked hours are not reported for unpaid students and unpaid overtime hours, workload is still collected, effectively reducing the cost per Relative Value Unit (RVU).

Mechanisms need to be in place to distribute benefits to the appropriate functional centres. Depending on the accounting system, it may be necessary to post benefits into one account, and then distribute benefit costs to each functional centre in proportion to salaries. To maintain comparability of reporting among hospitals, costs such as benefit contribution expense must not be treated as overhead (indirect costs). Hospitals must ensure that yearend payroll accruals are distributed to the functional centres. Both salaries and benefit contributions need to be accrued. Accruals are necessary in order to match salary and benefit contributions with workload statistics to provide a more accurate cost per workload unit.

Labour Hours Labour costs account for about threequarters of a hospital's operating costs. Since labour is such a large cost component, incorrectly assigned labour costs can lead to distorted case costs, even at the summary reporting level used for developing Ontario case costs. Most hospitals face a major challenge in documenting staff assignments, especially in Nursing where many temporary, casual, agency and float pool staff may work their shifts on different units each day. Developing correct labour costs for each functional centre requires good information on shifts worked in each functional centre. It is expected that a hospital's recording system will have the ability to assign an employee’s hours to the functional centre in which they worked, to the nearest hour. This will ensure precise labour charges to each functional centre.



For case cost development, it is also important that labour costs (hours), in each functional centre, are assigned to the proper OHRS financial secondary account. Remember that staff involved in both unit producing and management and support activities to a significant extent, must have their hours (and benefits) split between the Management and Operational Support (3 10 **), and UnitProducing (3 50 **) secondary accounts.

Accurate recording of labour hour data provides meaningful information for managing workload and staffing levels, and for monitoring productivity and cost effectiveness. The division of labour hours into unitproducing and management and operational support hours is also important for Step 3 of the case costing process, when labour costs are designated as variable or fixed (refer to section 3.4).

Medical personnel labour hours are treated differently than unit producing, and management and operational support labour hours. Medical personnel are compensated for their professional medical services, either on a feeforservice or salary basis. Physicians do not collect workload, and their labour hours and expenses are assigned to the Medical Personnel (3 90 **) secondary accounts. The section entitled Physician Salaries and Fees provides greater detail on how to handle physician activity.

The hospital's central payroll time and attendance system will most likely be the feeder system which contributes the labour hours to the General Ledger Chart of Accounts and Statistics on an ongoing basis. Functional centres are responsible for accurately recording the time being inputted into the payroll system (either manually or electronically). As an alternative to using the payroll system, hours could be entered through a separate entry module linked to the workload management measurement or costing system. The payroll system has the advantage that the labour cost output to the costing system module can come directly from the hospital's financial systems, so that existing management reports will reflect the more accurate labour distribution immediately. Any other approach could mean double data entry and create the potential for data reconciliation problems.

Departmentspecific labour data requirements are noted in Chapter 2, Case Costing Standards.

Physician Salaries and Fees Most hospitals have some physicians who are remunerated by the hospital through a contractual arrangement. Typically, physician remuneration consists of feeforservice (e.g., radiologists) or salary (e.g., pathologists). Compensation expenses for physicians, as with other hospital workers, should be charged as a direct cost to the functional centre in which the individual works.

Physicians who cannot be identified clearly with one functional centre prior to service provision should have their expenses charged to the appropriate Medical Resources functional centre (71207, 71307, or 71507). These costs must be eventually cleared by assigning them to patient care functional centres, as direct costs, based on an estimate of time the physicians spent providing services to each of the functional centres. These costs should be distributed to patients based on workload collected in the functional centre.

Sometimes physicians perform management functions in addition to patient care work. In this case, remember that hours spent performing management functions must be assigned to the appropriate patient care administration functional centre, if this is a separate functional centre in the hospital. For example, a physician who is also the head of the Diagnostic Imaging department would have to record the hours spent performing management functions in the Diagnostic Imaging—Administration functional centre (7141510).

Note that for case costing only physician compensation when the physician is remunerated by the hospital is important. Many physicians (e.g., surgeons) working in the hospital are not compensated by the



hospital but rather are directly compensated through the Ministry of Health and LongTerm Care via OHIP billings.

Patient Care Administration and Support Particularly in larger hospitals, patient care administration and support functional centres have been established to isolate general management and support function staff and supply costs from those of the nursing, diagnostic or treatment areas. In smaller hospitals, these management and support functions are simply another activity of unitproducers and are already part of the functional centre’s costs. All costs contained in separate support and administration functional centres must be cleared through distribution to the functional centres that they support. These costs should be assigned as a direct cost to the patient care centres they support. Total functional centre workload, total department cost or estimates of the time staff spend providing services to functional centres can be used as the basis for the assignment. Patient care administration and support functional centres include the following:

Inpatient Nursing: 7120510 – Inpatient Nursing Administration 7120520 Clinical Resources (centralized)

712052020 IV Therapy 712052040 Enterostomal Therapy 712052092 Transplant Coordination/Organ Procurement 712052094 Palliative Care Team

7120600 Program Management Administration

Ambulatory Care: 7130500 Ambulatory Care Administration 7130600 Program Management Administration

Clinics: 7135005 Clinic Administration

Diagnostic and Therapeutic Services: 7140600 Program Management Administration

Laboratory: 7141010 Lab Administration 7141015 Clinical Laboratory Support Services 7141020 Specimen Procurement and Dispatch 7141021 – Lab Pre/Post Analysis

714102110 Lab Specimen Procurement 714102120 – Lab Specimen Receipt & Dispatch

Diagnostic Imaging 7141510 Diagnostic Imaging Administration 7141512 – Diagnostic Imaging Administration – Picture Archiving and Communication System (PACS)

Respiratory Therapy 7143510 Respiratory Therapy Administration

Pharmacy 7144010 Pharmacy Administration



Rehabilitation Services 7144900 Rehabilitation Services Administration

Community Services 7150500 Community Services Clinical Management

Supplies For case costing purposes, it is necessary to distinguish between general and patientspecific supplies since these costs are distributed to patients differently. In the section that follows, general and patient specific supplies are defined as well as how these costs are assigned to functional centres.

General Supplies General Supplies include all stationery, medical supplies, surgical supplies, ward stock drugs, laundry and other miscellaneous supply items. General supply items are charged to the functional centre using the supplies. The costs for general supplies are a component of each functional centre's total direct operating costs and are included when the functional centre's cost per unit is determined.

PatientSpecific Supplies It is not practical to “charge” all supplies to patients when doing case costing because it would mean accounting for each dressing, each tongue depressor, etc. However, if the costs of highcost supplies are averaged, individual case costs could be distorted. To address this issue, a dollar limit has been established by the OCCI for tracking supplies or supply assemblies of $250 or greater to the patient. Therefore, any item or related grouping of supplies, or "supply assemblies" with a unit or assembly cost of $250 or more should be tracked to the patient as a patientspecific supply. A set of separate OHRS accounts in broad group 5 is used to record patientspecific supplies. Note that the MIS Standards have eliminated the $250 threshold for tracking patientspecific supplies as of April 1, 1999. The OHRS require hospitals to track certain expensive supplies, which are “traceable” to patients. The OCCI does not require hospitals to capture supply or supply assemblies less than $250. However, it is important to track items or assemblies that cost less than the $250 limit if those items are for a large percentage of the functional centre's total supply cost. Typically, there are high cost supplies in the Operating Room and Diagnostic Imaging.

A supply assembly is a group of supply items that is used together in a patientspecific procedure. For example, a supply assembly for an orthopedic procedure may consist of one $100 prosthesis and six $50 screws. The patientspecific supply cost of this assembly totals $400.

The requirement to identify patientspecific supply costs could have a significant impact upon the hospital's current manual and automated supply management practices and systems. Examples of some of the issues that are likely to arise in many functional centres include:

• Are patientspecific supply items identified on an ongoing basis? • Are the patientspecific supplies tracked that may account for a high proportion of the functional centre's supply budget but cost less than $250?

• Can the current materials management system track both inventory and noninventory items? • Will direct purchase items need to be catalogued for ongoing tracking? • If supplies are charged back to the functional centres prior to usage (e.g., through the use of exchange carts or departmental (unofficial inventories), how are actual usage identified?

• Can the current materials management system support the tracking of patientspecific cost items (i.e., either stand alone or integrated with the order entry/results reporting system and/or other ancillary systems)?



• Is a departmental materials management system or other specific programs required for the support of these functional centre specific requirements?

• Can the current systems support maintaining supply assembly lists and costs through a "bill of materials" or other methodology?

Drugs Drugs are also classified as supplies. For case costing, it is necessary to distinguish between individually dispensed drugs and ward stock drugs. All individually dispensed drugs, regardless of their cost, are tracked and assigned directly to the patient. PRN (as needed) medication that is not kept as ward stock is also captured on a patientspecific basis. These patientspecific costs are excluded from the functional centre unit cost/intermediate product cost calculation. Ward stock drugs are general supplies and therefore are not captured on a patientspecific basis.

The OHRS specify that all drug costs (patientspecific and ward stock) must be distributed to the consuming functional centre. The OCCI case costing methodology differs from the MIS Standards OHRS. Individually dispensed drugs are charged to Pharmacy. However, ward stock drugs must be assigned to the appropriate Nursing functional centre. There are also some specific drugs and related items, administered through other functional centres, that must be charged to those functional centres. For example: • Anaesthetic agents and other drug items administered through the Operating Room are assigned to the Operating Room.

• Nonmedicated IV solution costs are charged to the appropriate Nursing functional centres. • Medical gas costs are charged to the administering department.

Amortization and Leasing Expenses Historically, amortization and leasing expenses were simply charged to Administration. For case costing, amortization and leasing costs must be assigned to functional centres using the equipment. The patient cost distribution process distributes these costs correctly to the patients receiving service from the functional centre as direct costs of the functional centre. Hospitals must comply with the OHRS requirements for amortization rates. In Ontario, the threshold for capitalization is a minimum of $1,000. Each corporation will be allowed to establish their threshold amount at $1,000 or higher.

Maintenance Maintenance of major clinical equipment performed by the hospital's maintenance and/or biomedical department should be charged to the department receiving the service. The maintenance department should have a mechanism to document the service provided (i.e., work order system) and provide an input document for the accounting posting. At the end of the accounting period, when the cost allocation is performed, the maintenance department's costs would be reduced by the dollars charged directly to the departments served. The remainder would be allocated as indirect costs according to the cost allocation formula.

Major clinical equipment maintenance may also be provided through an external maintenance contract. Like maintenance provided by the hospital's maintenance and/or biomedical department, these charges must be assigned directly to the functional centres whose equipment is receiving the maintenance.

Note that building and building equipment maintenance should be allocated as an indirect cost using the allocation statistics presented in this Guide, as there is little value in charging these costs to the absorbing cost centres directly.



3.2.1.2 Allowable Recoveries and Revenues in Case Costing Interdepartmental recoveries (F122**)/expenses (F 697**) should be excluded from case costing. The sum of F 122* equals to that of F 697** so the exclusion ensures zero impact.

Key Notes OHRS standards require

o Cash discount (F 12090) should be reported in Finance (FC 7*115), with the exception of Research (FC 7*7) and Marketed Services (FC 7* 920);

o Recovery Entity Internal Laundering Process (F 12196) should be reported in Laundry and Linen (FC 7*150);

o Recovery Entity – Major Clinical Equipment Maintenance (F 12195) should be reported in Bio – Medical Engineering /Medical Physics (FC 7*1175);

o Recovery Entity Food Services Outpatient (F 12197) should be reported in Patient Food Services (FC 7*195).

Services Referred In recovery (F 12030) and associated workload/patient activity, which are reported in home patient care functional centers, need to be handled as follows:

Referred In workload/patient activity/expenses need to be included in case costing. However, the related recovery (F 12030) cannot be used to net with departmental gross expenses.

If Research (FC 7*7**), Education (FC 7*8**) and Undistributed Functional Centers (FC 7*9**) share corporate administrative and supportive services, they should absorb a part of administrative and supportive expenses using the Simultaneous Equation Allocation Method (SEAM). Allowable recoveries/revenues in these departments are indicated in the Table 3.2 below.

Net surplus (allowable revenues/recoveries greater than gross expenses) in Research (FC 7*7**) or Education (FC 7*8**) or Undistributed Functional Centers (FC 7*9**) cannot be used to reduce expenses in other departments in the SEAM allocation. Also, the maximum for net cost in these departments is zero.

Net Expenses in selected Undistributed Accounting Centers (AC 8*9**) listed below will be allocated to patients.

Table 3.2 Allowable Recoveries and Revenues for Functional Centre Frameworks Functional Centre (FC) Recoveries Included

(Financial Accounts) Revenues Included (Financial Accounts)

7*1** Administration & Support 120*, 121* None

7*2** Nursing Inpatient 120* (except 12030), 121*

11015 and 11016 for FC 7120710 and FC 71270; 11016 for other FC 712*

7*3** Ambulatory Care 120* (except 12030), 121*

11016 for FC 71305* & FC 71306*; 11015 & 11016 for FC 7130730 and FC 7130735; 11016 for FC 7131022; 11030 for FC 71330*; 11016 for FC 71367, 71369



Functional Centre (FC) Recoveries Included (Financial Accounts)

Revenues Included (Financial Accounts)

7*4* * Diagnostic & Therapeutic 120* (except 12030), 121*

11015 & 11016 for FC 7141041*; 11016 for all other FC 714* except FC 71406 and FC 71490

7*5** Community Services 120* (except 12030), 121*

None

7*7** Research 120*, 121* 13***, 14***,15***, 160**, 170**, 190**

7*8** Education 120*, 121* None

7*9** Undistributed Functional Centers 7*910 NonService Recipient Food Services

7*920* Marketed Services

7*940

120*, 121*

120*, 121*

120*, 121*

None

13***, 14***, 15***, 16***, 17***, 19***

13***, 14***, 15***, 16***, 17***, 19***

8*9** Selected Undistributed Accounting Centers included in case costing

Municipal Taxes (AC 81960) Other Undistributed Expenses Operating (AC 81990) Employee Benefits Debit Clearing Account (AC 81995) Employee Benefits Credit Clearing Account (AC 81996) NEER Penalties (AC 81990) NEER Rebate (AC 81945) Employee Future Benefits (AC 81965)

120*, 121* None

3.2.1.3 Separating Inpatient, Outpatient and NonPatient Operating Costs and Revenues Patient case costs should not be distorted by a hospital's other business activities. Our use of case cost data is best served when inpatient, outpatient, referredin and ancillary operations are clearly and correctly separated.

Hospitals are constantly seeking new ways to generate revenue. One approach is to take advantage of a hospital's strength in its support services (such as printing or food services) to provide products or services for nonhospital clients. Patient case costs should not be affected (understated or overstated) by the expenses or revenues associated with these revenuegenerating activities.



Wherever possible, isolate nonpatient costs and revenues by establishing a separate functional centre for nonpatient operations and using direct charge billing for ancillary operations that provide services both within the hospital and to outside customers. Whatever approach is used, it should support both case costing and the monitoring of the profitability and financial performance of the nonpatient ancillary operations.

In some instances, it may be difficult to separate patient and nonpatient costs when the hospital has one functional centre containing expenses for both patient and nonpatient operations. To estimate patient costs, nonpatient revenue is used as a proxy for nonpatient costs in this functional centre. This means that there is a need to establish a mechanism to capture nonpatient operating revenue, and net the same amount from the operating costs of the functional centre prior to reporting.

Patient Revenue Some hospitals distribute patient revenue to functional centre accounts for management reporting purposes to show departmental managers a more complete and balanced picture of their operations. If the hospital uses this approach, remember that revenue for providing care to the patients must not be netted when determining costs for distribution to patients. This approach applies to all patient revenue: LHIN funding, Ministry of Health and LongTerm Care Allocation, OHIP, WCB, crutches, etc.

3.2.1.4 Other Hospital Costs Hospitals may decide not to cost functional centres whose expenses are only a very small percentage of the total hospital costs. It may not provide much added benefit to set up systems to cost functional centres that contribute insignificantly to case costs. Nevertheless, aim to distribute a large portion of the operating costs. The OCCI has established standards for the functional centres that must be costed for certain patient populations:

Acute Inpatient For the first year of costing, hospitals must distribute at least 80% of acute inpatient operating costs to patients using approved workload measurement systems. The following core functional centres must be included as part of the 80% minimum:

712**** to 7127*** Nursing Inpatient Services 71410** Clinical Laboratory 71415** Diagnostic Imaging 71440** Pharmacy

Additional functional centres must be costed so that by the beginning of the third year of costing at least 95% of inpatient costs are distributed to patients.

NACRS Hospitals must distribute at least 80% of ambulatory operating costs to patients using approved workload measurement systems. The following core functional centres must be included as part of the 80% minimum:

Functional Centre Number

Functional Centre Name

7126* Operating Room 71310** Emergency



Functional Centre Number

Functional Centre Name

7136* Day Surgery Operating Room, Recovery Room, Pre and PostCare 7134055 Day/Night Care Endoscopy 7141544 Cardiac Catheterization Lab 71410** Clinical Laboratory 71348610 Day/Night Care Hemodialysis 713408650 Day/Night Care – Peritoneal Dialysis 7153086 Dialysis Home Care 71415** Diagnostic Imaging 71430** Other Diagnostic Laboratories Non Invasive Cardiology and Vascular Laboratories 71435 Respiratory Services 71440** Pharmacy 71450 Physiotherapy 71455** Occupational Therapy 71470** Social Work

If 80% of total outpatient costs cannot be distributed to patients by costing the above functional centres, a hospitalspecific mix of additional ambulatory care functional centres must be costed to achieve the 80% minimum. Hospitals have the option to cost additional functional centres beyond the 80% minimum.

Chronic Complex Continuing Care Hospitals must distribute at least 80% of chronic complex continuing care operating costs to patients using approved workload measurement systems. The following core functional centres must be included as part of the 80% minimum:

71295** Long Term Care IP 71450 Physiotherapy 71455** Occupational Therapy 71470** Social Work

Mental Health Hospitals must distribute at least 80% of mental health operating costs to patients using approved workload measurement systems. The following core functional centres must be included as part of the 80% minimum:

71276** Mental Health Inpatient 71410** Clinical Laboratory 71415** Diagnostic Imaging 71430** Other Diagnostic Laboratories Non Invasive Cardiology and Vascular Laboratories 71440** Pharmacy 71470** Social Work 71475** Psychology



Rehabilitation Hospitals must distribute at least 80% of rehabilitation operating costs to patients using approved workload measurement systems. The following core functional centres must be included as part of the 80% minimum:

71281** Rehabilitation Inpatient 71450 Physiotherapy 71455** Occupational Therapy 71470** Social Work

If costing the above functional centres cannot satisfy the 80% requirement, then a hospitalspecific mix of functional centres with chronic care rehabilitation activity must also be costed to satisfy the minimum. Hospitals have the option to cost additional functional centres beyond the 80% minimum.

Appendix E, Patient Specific Cost Distribution, is a helpful tool to assess the impact of including or excluding particular functional centres. This form organizes the functional centre costs distributed to patients; the total inpatient, chronic complex continuing care, mental health, rehabilitation and outpatient costs for the reporting period; and the total functional centre costs not distributed to patients. To ensure that a consistent approach has been taken to the apportionment of costs between acute inpatient, chronic complex continuing care, mental health, rehabilitation and outpatient activity, use the information reported by the hospital’s OHRS Trial Balance submission to the Ministry of Health and LongTerm Care.

NonDistributed Absorbing Cost Centre (ACC) Functional Centre (AFC) Costs Hospitals will vary in the percentage of costs they distribute to patients. Some OCCI hospitals are distributing 100% of acute inpatient costs by costing all inpatient functional centres. Others, however, are including only some or none of the optional functional centres and are capturing closer to 85% of inpatient costs. Because of this variation, the OCCI employs a methodology that distributes acute inpatient costs of nondistributed patient care functional centres to patients.

This methodology, to standardize the acute inpatient case cost data from OCCI hospitals, is required so that comparisons can be made between hospitals. It is only expected to be an interim measure, however, since hospitals are required to distribute 95% of total inpatient costs by the beginning of the third year of costing. Since the OCCI employs a methodology that distributes undistributed functional centre costs to patients, hospitals should ensure that they do not distribute or allocate these costs to patient care functional centres.

3.2.2 COST DISTRIBUTION BASES

Two data types can be used as cost distribution bases. The first type of cost distribution is based on workload. The workload cost distribution is described in the following section. The second type of data involves the collection of patient hours and is described in Section 3.2.2.2 and further discussed in Section 3.4. Either workload or patient hours can be used to distribute nursing costs. Hospitals should select a system that meets their needs and is compatible with the appropriate OHRS methodology.



3.2.2.1 Workload Workload data serve as the cost distribution base for most functional centre costing purposes. Through order entry/results reporting, cost accounting or departmental information systems and intermediate products (such as exams, procedures and other services) are translated into workload units by functional centre for each patient. This information is linked to the specific patient through a unique encounter identifier.

There are three time recording methodologies for workload measurement: average, standard and actual. The average time reflects the national average time to conduct the task, as identified by the National Workload Measurement System (NWMS). The Diagnostic workload measurement systems use average time methodologies, while the Nursing and most therapeutic workload measurement systems support both actual and standard time recording.

The workload recording method should follow the NWMS that applies to the work done by the functional centre (see MIS Standards 2009, Chapter 4, for a complete list). These systems provide a standardized means of measuring the activities or outputs of each functional centre. Workload units are broadly divided into Service Recipient/Patient Care and NonService Recipient/NonPatient Care workload.

Linking Workload Data to Other Case Cost Data Ideally, workload measurement can be done as a byproduct of existing departmental functions. For diagnostic departments, an order entry/results reporting system can be used to minimize the impact of data collection and reporting. Case costing requires the collection and reporting of financial and statistical data on a patientspecific basis. This means that a functional centre must be able to track and report workload units and services with the patient unique identifier. There is more information on linking patient and cost data in Chapter 8 2 Case Costing Standards.

Monitoring The Workload Measurement System If realistic productivity ratios cannot be produced with the NWMS units, reengineer the units to more appropriately reflect the workload required for various activities. Any changes should strictly follow the NWMS methodology outlined in the MIS Standards 2009. Notify CIHI of significant differences so that an evaluation can be done about the need for revision to the NWMS. If the units are reengineered, re evaluate their continued use whenever the NWMS units are adjusted and whenever there is a change in technology or procedures.

Developing A Customized Workload Measurement System Some hospitals choose to develop a customized workload measurement system for functional centres where no NWMS exists. To ensure data comparability, OCCI hospitals have identified those functional centres and explained the approach used. The selection of a workload measurement methodology should ultimately rest upon the results of the methodology to reflect accurate and comprehensive outputs of the functional centre.

The development of a workload measurement system must adhere to generally accepted workload measurement principles. Some of the desirable characteristics of a workload measurement system are the following:

• Activities (procedures or intermediate products) are capable of being patientspecific. • Activities (procedures or intermediate products) are well defined, are recognizable, and are

elements of a functional centre’s function that can be considered separate outputs. • A workable number of activities (procedures or intermediate products), normally less than 15, is

used, but enough to represent the largest portion (at least 80%) of a functional centre's worked hours.



• Relative values represent the ratios among average times necessary under average conditions to complete all aspects of measured work.

• Each activity (procedures or intermediate products) represents homogeneous elements of resource use.

• Activities (procedures or intermediate products) should be clinically and financially homogeneous.

To maintain data quality, productivity ratios for reported workload with each workload measurement system should be monitored. Productivity ratios must be maintained within an acceptable range to ensure that workload recording is complete. In particular, Allied Health workload measurement systems that record activity time are susceptible to recording problems if not monitored routinely. If the reported time units are significantly more or less than the number of minutes of therapy staff time, then the cause of the discrepancy should be investigated and corrective action taken.

There is a generic sixstep approach to developing, implementing, and maintaining a standard time workload measurement system and is described below. The standard time methodology uses facility specific set values for high volume activities that demonstrate minimal variability.

1: Review of Current Work Methods Start with a review of current work methods and processes to ensure that the time values or relative values assigned to activities are reflective of the lowestcost, most efficient processes that yield acceptable quality.

Conduct this review by breaking the work method/process into its component parts or elements. Analyze each component part or element separately so that the review of the work method/process becomes a series of fairly simple steps.

The review may be aided by applying the concept of flow process analysis and charting. Flow process charting is a graphic representation of the sequence of all operations, transportation, inspections, and delays occurring during a process or procedure. By using these charts, hidden inefficiencies are located easily, such as bottlenecks, duplication of effort, etc.

Here are some examples of checklist questions used to review the current process: • Can it be eliminated? • Can it be changed or rearranged? • Can it be combined? • Can it be simplified? • Can it be improved?

The level of detail required for reviewing current work methods is unique to each hospital and department. The review of current processes should be a continuous effort, recognizing that further improvement is always possible.

2: Identify Workload Elements Select workload elements or activities (procedures or intermediate products) which reflect the variability and complexity of the department's patient care workload. A group workshop session may be used to identify and reach consensus on workload activities that are well defined, recognizable, and considered distinct department outputs.

Patient Care Workload activities should be identified and categorized as follows:



• Service Recipient (diagnostic, evaluative or therapeutic and support activities that are provided to, or on behalf of, specific patients)

• NonService Recipient (activities that are part of the departmental activities but which do not involve the care of specific patients or cannot be linked to specific patients)

A workable number of activities (procedures or intermediate products) is normally considered to be less than 15. The largest portion of the functional centre's worked hours (at least 80%) should be represented.

3: Assign Time/Relative Unit Values Establish an allowed time or relative value unit for each of the workload activities identified in 2: Identify Workload Elements. Relative values represent the ratios among average times necessary under normal conditions to complete all aspects of measured work. Potential techniques that may be used to measure the work content of the activities include the following:

• Time Study (The actual time spent on each workload activity is measured using logs, time ladders or other methods. This process is repeated until there is confidence that the time is reflective of the activity)

• Work Sampling (Work sampling is used to determine the actual percent of time spent on the observed activity. Observations are regularly or randomly spaced over the total observation period or over several time periods.)

• Estimates (Using historical data, the relative work content value among the activities, procedures or intermediate products, may be estimated in a group workshop session or by the department manager.)

4: Ongoing Data Collection Develop and implement data collection methods to collect the workload elements and labour hours on an ongoing basis. Case costing also requires that the time units or relative value units of the patient care activities be collected and reported on a patientspecific basis.

Ideally, the collection of workload units and labour hours should occur as a byproduct of departmental systems or hospital information systems. However, manual data collection forms may be developed as a shortterm measure until further investments can be made in additional automated information systems.

5: Establish Productivity Target The MIS Standards define productivity as a measure of efficiency shown through the ratio of outputs: the extent to which output is maximized with minimum input. Productivity targets should be established for each workload measurement system. Depending on the context, productivity may be stated as workload units per hour or hours per workload unit. For example, the MIS Standards use workload units per worked hour as an indicator of productivity.

Whether using weighted units (based on adjustment of the total activity volume based on the relative value unit of each activity) or unweighted workload units, productivity targets must reflect a realistic balance between labour hours (input) and workload activities (output). Productivity can be calculated using only service recipient (patient care) workload or using total workload. Productivity targets can be initially established based upon preliminary data collection activities or estimates, but should ultimately be refined over time to more accurately reflect achievable levels of performance.

6: Monitor Key Relationships Monitoring productivity and other key relationships is an ongoing process that ensures productivity ratios are maintained within an acceptable range and that workload recording is complete. Productivity targets should be reflective of the current scope of services in the functional centre.



Some key relationships to monitor include: • Actual productivity to target productivity (units per hour); • Actual to budgeted workload volumes; • Percentage patient care hours to nonpatient care hours; and • Comparisons of productivity among functional centres that use the same methodology to measure

workload.

Distributing Functional Centre Unit Cost to Patients based on Patient Hours This process is similar to the workload costing method. It requires the following information:

• Patient hours acquired by the patient from the functional centre during the period. • Functional centre unit direct cost and unit indirect cost for the period. • Total cost of patientspecific supplies, including drugs and other microcosted items, provided to

the patient from the functional centre during the period. • Total cost of other nonworkload distributed products and services delivered to patients.

To determine the direct and indirect patient cost for each functional centre providing patient care services (ACC AFC), the service cost must be calculated. The service cost is obtained by multiplying the patient hours received by the patient by the cost per hour. To calculate the direct patient cost per functional centre, the costs for any high cost supplies, drugs and nonworkload distributed products received by the patient must be added to the service cost. The calculations are presented below:

Patient Direct Cost by Functional Centre

= Patient Hours ×

Functional Centre Unit Direct Cost

+ Functional Centre PatientSpecific Supplies, Drugs and Non workload Distributed Costs

Patient Indirect Cost by Functional Centre

= Patient Hours × Functional Centre Unit Indirect Cost

Example: For the General Medicine Nursing Unit, the following information is given about Patient A:

Patient Hours in General Medicine Nursing Unit = 2 Hours

The direct cost of this service for Patient A can be calculated as follows: 2 (Patient Hours) X $ 50 (direct cost per workload unit calculated in step 3) = $ 100

The indirect cost of this service can be calculated as: 2 (Patient Hours) X $ 20 (indirect cost per patient hour calculated in step 3) = $40

Total Cost = Direct Cost + Indirect Cost Patient A Total Cost = $ 100 + 40

These steps are then repeated to determine the full (direct and indirect) cost for each patient provided by the functional centre.



3.2.3 PATIENT/CLIENT DESCRIPTIVE DATA

Once costs have been established, the cost data must be linked to information about the patient and the course of diagnosis and treatment while in hospital. For acute inpatients, patient costs are identified for all cases that are discharged within the costing period. This includes any patients who are admitted before the beginning of the period and discharged during the period.

This section describes the specific patient descriptive data requirements. For inpatients, emergency, day surgery, ambulatory, rehabilitation, mental health and complex continuing care information is gathered either through the Health Records department or other areas using the CIHI abstract or assessment tools. Data quality is as important as the range and completeness of patient descriptive data elements collected. The Canadian Institute for Health Information provides the reference standard for all patient type data coding and abstracting. It is important that standards are in place and adhered to. All hospitals in Ontario use the same standards governing rules and data requirements, which form the reference standard for patient descriptive data collection.

For CCAC clients, the client descriptive data are outlined in the Client Health and Related Information System (CHRIS). Specific standards for completing the required data fields are in place.

Many OCCI hospitals have obtained a grouper. This software product is used to analyze abstracted patient records. It is useful for checking abstracted patient information for accuracy before submission to CIHI. Groupers assign:

1) Acute inpatient cases to Case Mix Groups (CMGs), 2) Ambulatory to CACS, 3) Rehabilitation to RPG, 4) Complex Continuing Care to RUG, and 5) Mental Health to SCIPP

Note: CCAC Client descriptive data set in CHRIS does not have a grouper.

Chapter 2 provides more information about the requirements for the Health Records department.

Data Quality The ultimate acceptance of case cost data hinges on the quality of the data used to calculate case costs. The CIHI coding manual, definitions, and rules must be observed to ensure consistent application and interpretation of the minimum data standards. It is critical that Health Records, clinical staff and physicians be included in educational programs designed to make sure that there is up to date information with coding standards and data requirements and the necessary data quality processes are in place for each service type prior to submission to CIHI. Conformance to OHRS standards indicated for clinical data sets is a requirement.

All adjustments to Registrations/ADT systems must be communicated to staff. For example, if there are any deletions or merges of accounts they need to be communicated to the area responsible for case costing.

3.2.3.1 CIHI and OCCI Coding Requirements Requirements for coding and submission of patient descriptive data are dependent upon the patient populations for which the hospital is submitting costs.



Acute Inpatient and NACRS Abstracting CIHI has specified a mandatory set of data elements on the inpatient and NACRS abstract. The list of these mandatory abstract items is given in the respective CIHI manuals. Health Records staff must be familiar with these mandatory abstracting requirements.

Chronic Complex Continuing Care and Mental Health Minimum Data Set CIHI has derived a minimum data set from the Minimum Data Set (MDS) version 2009 Chronic Care Assessment Tool to capture patient descriptive data for chronic complex continuing care patients (residents) and Minimum Data Set (MDS) version 2 OMHRS (MDS) to capture patient descriptive data for mental health patients. The OCCI standards require the collection of the MDS to define the chronic complex continuing care or mental health encounter. The data elements are collected through periodic assessments by clinical staff involved in the treatment of the chronic complex continuing care or mental health patient. The purpose of the data collection is to gather information to address the needs and strengths of the patient in an individualized care plan.

Assessment data is collected approximately every 90 days. However, assessment data can be collected in periods less than 90 days if there is a “significant change” in patient status.

Certain situations may occur in which the question arises of whether or not an assessment should be done on a patient. For example, due to a lack of appropriate beds in the facility, a chronic complex continuing care patient may be assigned to a rehabilitation or longterm care bed, or a rehabilitation patient may be admitted to a chronic complex continuing care bed. How is it decided which patient receives an MDS assessment? The bed designation, and not the patient type, determines whether or not to do an assessment. Therefore, an MDS assessment is done for patients in a designated mental health or chronic complex continuing care bed.

Due to the lengthy nature of the mental health or chronic complex continuing care visit, patients may have more than one MDS assessment throughout their hospital stay. The unique identifier for each assessment is the MDS assessment reference date. This date is the last day of the MDS observation period. The assessment period (usually 90 days) is defined as the time from the beginning day of an MDS assessment period to the day before the next assessment period. Each assessment defines a costing period in which all services and products delivered to the patient are to be tracked to that assessment period.

The list of required MDS data elements for chronic complex continuing care can be found in the CIHI Ontario Chronic Care Patient System (MDS) Manual. More details about the assessment tool itself are presented in the MDS v2 Resident Assessment User’s Manual. A list of required MDS data elements for mental health as well as more detail about the assessment tool it can be found in the OMHRS Minimum Data Set Manual

Rehabilitation Minimum Data Set The minimum data set for rehabilitation is recorded at admission and at discharge for each rehabilitation visit, with the option of a follow up assessment record.

Assessments include: a) The Functional Independence Measure (FIM instrument) b) CIHI cognitive assessment c) CIHI Instrumental Activities of Daily Living (IADL) (optional) The Admission Functional Independence Measure (FIM instrument) and CIHI cognitive assessment must be completed within 72 hours after admission. Specific guidelines governing Service Interruption are outlined by CIHI.



3.2.3.2 Linkage of Patient Descriptive Data with Cost Data For case cost analysis purposes, it is necessary to keep all activities related to a particular inpatient grouped together. The OCCI determined that for its analysis of data from multiple hospitals, a unique linkage between patient abstract data and cost data requires four data elements:

• Institution number to identify the hospital; • Health record or chart number to identify the patient; • Register number to identify the admission; and • Admission date to provide clear identification (since register number is often reset at the beginning of each fiscal year).

In table 3.1 below some of the data elements are somewhat modified for the other patient types.

Table 3.1 summarizes the key elements by patient population. It is vital that the key elements submitted to CIHI match those key elements in the case cost submission.

Table 3.1 Key Patient Descriptive Data for each Patient Type

Acute Inpatient Complex Continuing Care

Ambulatory Care/ NACRS Mental Health Rehabilitation

Master number 5 characters





Patient chart number 10 characters





Registration/account number 7 characters

Resident code (URI) 20 characters

Registration/account number 12 characters

Case Record number (registration number) 12 characters

N/A

Admission date YYYYMMDD 8 characters

Date of entry YYYYMMDD 8 characters

Date of visit YYYYMMDD 8 characters



MIS OHRS Functional Centre

NOTE: To date, CCACs will only be providing costing information.

Additional Patient Descriptive Data An additional patient descriptive data element has been considered optional for Ontario Case Cost development, but may be of interest to the hospital.

Health (OHIP) Card Number As more hospitals join the OCCI, it may become more feasible to track patient stays across hospitals. This would allow for more complete patient episode (across system) costing. The Health Card Number is a common patientspecific identifier that would allow for episode costing.



3.3 STEP 2: ALLOCATING INDIRECT COSTS

Allocation of Indirect Costs vs. Distribution of Direct Costs As described in section 1.3, overview of methodology, cost allocation involves allocating the costs of transient cost functional centres (TCC TFCs) to the absorbing cost functional centres (ACC AFCs) to establish the full costs of operating patient care functional centres. Generally, ACC AFCs are associated with the patient care functional centres, whereas TCC TFCs are associated with the administrative and support, or overhead, functional centres. Later in the costing process, the functional centre’s relative value units will be used to calculate a cost per unit of service. This cost can then be multiplied by the number of relative value units received by a patient to calculate the case cost.

For case costing, refer to direct costs as those costs that were directly assigned to the ACC AFC according to the rules discussed in section 3.2. Establish the full operating costs of the ACC AFC through cost allocation, the process by which the costs of the TCC TFC are assigned to the ACC AFC. These allocated costs are referred to as indirect costs. A formula is used to allocate these TCC TFC costs to the ACC AFC as indirect costs, based on an estimate of costs incurred by the ACC AFC to provide particular services.

3.3.1 INDIRECT COST ALLOCATION USING SEAM

The Simultaneous Equation Allocation Method (SEAM) is the OCCI standard method to compute the indirect cost allocation. This algorithm allows us to determine the relative use of administrative and support services by each patient care functional centre.

In essence, SEAM allocates a portion of the TCC TFC costs as indirect costs to other TCC TFCs as well as ACC AFCs, then simultaneously allocates out all the TCC TFC direct and indirect costs to all the ACC AFCs as indirect costs. Details of SEAM are provided below with an example.

SEAM uses a series of linear algebraic equations to allocate the costs of the Administrative and Support functional centres to the patient care functional centres. These overhead functional centres, or transient cost functional centres (TCC TFC), do not contribute directly to the “product,” but they provide essential auxiliary support to the patient care or absorbing cost functional centres (ACC AFCs). To calculate the percentage of indirect costs that go to each patient care functional centre, SEAM uses the allocation bases listed in Appendix A/3

SEAM has been shown to be the best available method for case cost development. It is one of several approaches that have been developed to solve what is known as the “reciprocal service allocation problem.” This problem exists because the Administrative and Support functional centres provide services to each other. SEAM resolves this problem by allocating a portion of the TCC TFC costs to other TCC TFCs as well as to the ACC AFCs, and then allocating all the TCC TFC direct and indirect costs to all the ACC AFCs as indirect costs simultaneously.

Example of SEAM calculation To illustrate the SEAM calculations with a simplified example, assume that a hospital has two transient cost functional centres, T1 and T2, providing services to each other and to the hospital’s two absorbing cost functional centres, A1 and A2, with the following percentages:



Services provided from Services provided to Total T1 T2 A1 A2

T1 10% 40% 50% 100% T2 20% 50% 30% 100%

The total costs charged to each functional centre are as follows: T1 $ 30,000 T2 $ 20,000 A1 $200,000 A2 $100,000

The algebraic expression developed to represent the total costs for each cost functional centre: T1 = 30,000 + 0.20 T2 T2 = 20,000 + 0.10 T1 A1 = 200,000 + 0.40 T1 + 0.50 T2 A2 = 100,000 + 0.50 T1 + 0.30 T2

Using substitution to solve the equation for each cost functional centre, we start by substituting the equation of T2 into T1:

T1 = 30,000 + 0.20(20,000 + 0.10 T1) T1 = 30,000 + 4,000 + 0.02 T1

0.98 T1 = 34,000 T1 = 34,694

Substituting the solution of T1 into the equation for T2: T2 = 20,000 + 0.10(34,694) T2 = 20,000 + 3,469 T2 = 23,469

Finally substituting the solutions of T1 and T2 into A1: A1 = 200,000 + 0.40(34,694) + 0.50(23,469) A1 = 200,000 + 13,878 + 11,735 A1 = 225,612

And substituting the solutions of T1 and T2 into A2: A2 = 100,000 + 0.50(34,694) + 0.30(23,469) A2 = 100,000 + 17,347 + 7,041 A2 = 124,388

The final amounts in the ACC AFCs represent the functional centre’s direct costs plus the proportion of indirect costs allocated from each TCC TFC. The following table summarizes the resulting cost reassignments of the cost functional centres:

T1 T2 A1 A2 Total Costs before allocation $30,000 $20,000 $200,000 $100,000 $350,000 T1 allocation (34,694) 3,469 13,878 17,347 T2 allocation 4,694 (23,469) 11,735 7,041

Costs after allocation $225,612 $124,388 $350,000

Other Methods for Reassigning Overhead Costs Two other methods for reassigning overhead costs are the direct method and the step approach. A brief description of each method is provided here to illustrate the benefits of SEAM. A significant advantage to



using SEAM over these methods is that SEAM takes into account the interaction of the TCC TFCs with each other.

The direct method allocates overhead costs directly to the ACC AFCs without consideration of the interdependence between TCC TFCs. The exclusion of interdepartmental allocation is acceptable only if each overhead cost functional centre is providing approximately the same level of services to all the ACC AFCs.

The step method reassigns TCC TFC costs with some recognition of interdepartmental services. This method requires that management determine which TCC TFCs provides the most interdepartmental services. The costs of this TCC TFC are then reassigned to the other TCC TFCs and ACC AFCs. This first TCC TFC to be allocated does not receive any other TCC TFC costs. The costs of the second TCC TFC are reassigned in the same manner, having received indirect costs from only the first TCC TFC. The TCC TFCs reassigned last has costs reassigned to it from all the other TCC TFCs and will be allocated only to the ACC AFCs. The reassignment of costs is based on the allocation statistics for only those cost functional centres to which that TCC TFC costs are allocated.

There is no generally accepted rule for determining the order for reassigning the TCC TFC in the step method. The first TCC TFC is chosen as the one that provides the most services to the other TCC TFCs. The other TCC TFCs follow in order based on their relative levels of interdepartmental services.

SEAM has proven to be the best available way to deal with the interrelationships between Administrative and Support functional centres. One potential advantage over the other methods is that the source and amount of administrative and support functional centre costs allocated to patient care functional centres can be identified. In addition, the cost results have much greater reliability since the method does not depend on a consistent order used to process records in the computation from hospital to hospital, and can be adjusted as a hospital’s activities change.

3.3.2 INDIRECT COST ALLOCATION BASES Each TCC TFC is associated with a specific measure, termed the “allocation base,” that is used by SEAM to allocate the TCC TFC costs to other functional centres. The allocation base provides a means of estimating the amount of TCC TFC costs consumed by the ACC AFCs in providing patient care. To ensure comparability of results, standard cost allocation bases are used by OCCI hospitals for case cost reporting.

The allocation bases should be measured for the entire fiscal year and the bases should be updated annually. For example, if proportion of department cost is the basis for cost allocation, the cost figures should be the totals for the entire fiscal year. Cost allocation may be done at any MIS OHRS account level (3, 4 or 5), depending on the functional centre. Many of these cost allocation bases are listed in Appendix K A.

Actual YearEnd Costs are used for the Cost Allocation Calculation Actual costs are the most appropriate calculation for Ontario case cost development. Hospitals that allocate and report indirect costs as part of their monthly management reporting typically use budget costs to establish the proportion of actual costs to allocate. OCCI hospitals recalculate the allocation at yearend to produce case costs based on actual costs for the period.



3.3.3 TCC TFC COSTS THAT CAN BE ALLOCATED AS INDIRECT COSTS

The costs of functional centres that are traditionally classified as hospital support and administration or overhead are considered to be indirect costs. For example, Finance, Health Records and Information Systems are departments that do not provide direct patient care, but are necessary in order for the ACC AFC to provide services to patients.

Hospital departments and managed support functions have been organized in many different ways. As a result, different hospitals documenting and accounting for operations correctly could produce similar total case costs but with quite different ratios of direct and indirect costs.

In addition, the hospital may not be costing some patient care functional centres, such as Allied Health. These functional centres should receive the appropriate indirect costs, but the costs of the Allied Health functional centres should remain undistributed.

The OCCI standards on the types of expenses or functional centre costs that should be allocated as indirect costs or distributed as direct costs are as follows:

Laundry Hospitals with a Laundry and Linen Department or using contract laundry services have moved to charge departments for their usage of laundry services.

OCCI hospitals should ensure that all laundry and linen costs are assigned to ACC AFCs as direct costs. Note that hospitals with their own laundry and linen service may choose to use the Laundry and Linen functional centre throughout the year and then quarterly distribute the costs to the absorbing cost functional centre using a distribution base.

Hospital Library, Audiovisual, Medical Illustration and InService Education For case costing, the provision of Hospital Library, Audiovisual, Medical Illustration and Inservice Education should be allocated as indirect costs to functional centres receiving these services as noted in Appendix K A. Costs associated with receiving inservice education are allocated to the receiving employee’s cost functional centre.

OCCI hospitals should also ensure that the expenses of "Special Functional Centres" are excluded from the cost allocation process and left undistributed. These Special Functional Centres are the Level 2 Framework Sections of Research (7), Education – Formal (8) and Undistributed Functional Centres (9). It was reasoned that the services of these functional centres are not associated with specific patients or programs and are outside the scope of a hospital’s patient care business.

Maintenance (General and Biomedical) The MIS Standards OHRS recommend the use of a work order system and the posting of maintenance activities as direct costs to each functional centre receiving service. Any residual maintenance cost not covered by the work order charges should be allocated as an indirect cost using net square metres or department total costs. Hospitals that do not have a work order system in place may allocate general maintenance costs. Biomedical maintenance must be distributed as direct costs through a work order system. Note that maintenance covered by maintenance contracts is charged as a direct expense to the functional centres receiving the service.



Patient Care Administration and Support Functional Centres The costs of separate support and administration functional centres should be assigned as a direct cost to the patient care centres they support. More detail about patient care departmental support and administration cost distribution can be found in section 3.2.1.1.

Nursing Administration All nursing administration costs should be distributed as direct costs to nursing functional centres based on each nursing functional centre’s total costs as a proportion of total nursing costs. Where suitable patientspecific workload measurement systems are in place, clinical resources’ functional centre costs are to be distributed to patients based on workload.

There are several functional centres for Nursing Administration (see also section 3.2.1.1). These provide general management for both the Department of Nursing and Nursing Clinical Resources. Nursing Administration is included with General Administration and Support Services in the MIS OHRS Chart of Accounts only if the person, in a nonprogram management setting, is responsible for functional centres in addition to Nursing. Only nursing costs in this administration functional centre (71110) are to be allocated as indirect costs. All other Nursing Administration costs are to be distributed as direct costs. These functional centres are then to be cleared to zero by charging the costs to the nursing patient care functional centres. The use of other Nursing Administration functional centres listed below depends on the organizational structure of the facility.

71110 General Administration (if person is responsible for other functional centres as well as Nursing) 7120510 Inpatient Nursing Administration (nonprogram management setting) 7120520 Clinical Resources (centralized)

712052020 IV Therapy 712052040 Enterostomal Therapy 712052092 Transplant Coordination/Organ Procurement 712052094 Palliative Care Team

71206 Program Management Administration (program management setting) 71305 Ambulatory Care Administration 71306 Program Management Administration

If a manager is responsible for both inpatient nursing functional centres and ambulatory care functional centres, then compensation for this individual should be split appropriately between 71205 and 71305.

Patient Transport How patient transport services are organized can impact the direct/indirect cost ratio. The labour costs of a porter who works in a specific absorbing cost functional centre are direct costs if that porter’s hours are posted as part of the functional centre’s hours. It is common in many hospitals to have porters assigned to Radiology or the Operating Room, for example. In many other hospitals, portering is provided by a central porter service established as a support functional centre. In this case the porter hours are charged directly to the portering functional centre, and the costs of portering are allocated to user ACC AFCs as indirect costs based on the total costs of the using departments.

Materials Management Typically, materials management is responsible for providing hospital departments with timely supplies at the best possible cost. Because of varying system capabilities, the choices made can move costs between direct and indirect. For example, disposable supplies are most likely charged through the inventory system as direct expenses, whereas reprocessing costs associated with reusable supplies are allocated as indirect costs. Shifting from disposable to reusable (or back) can affect the direct/indirect cost ratio.



Printing Services Internal printing may not be charged directly to a department, but outside printing and forms from stock are generally charged directly to the using departments.

It is accepted that these cost categorization differences will arise and that they cannot be totally eliminated without extensive effort. Be mindful of these issues when conducting any detailed analysis and comparisons of hospitals’ case costs.

3.4 STEP 3: CALCULATING FUNCTIONAL CENTRE UNIT COSTS OR INTERMEDIATE PRODUCT COSTS

The third step of the case costing process can be accomplished using two methods. The first method involves calculating unit costs for services provided by each nursing functional centre (ACC AFC). This approach is referred to as the Functional Centre Unit Cost method. Calculating functional centre unit cost is typically used in nursing functional centres. The other method is the Intermediate Product Costing method, which is typically used in the Diagnostic and Laboratory functional centres. It is very similar to the Workload + (plus) Costing method described in the MIS Standards 2009, Section 6.5. This method involves defining intermediate products (i.e., tests or procedures) in the patient care functional centres and calculating the cost of each intermediate product using financial, workload (and RVU), and utilization information.

The Functional Centre Unit Costs and the Intermediate Product Costing methods both produce acceptable and valid results. In fact, both yield the same results when the same RVUs are used to distribute costs. The main difference between the two methods is that the Functional Centre Unit Cost method tracks patientspecific unit costs whereas the Intermediate Product method tracks patientspecific utilization of products.

Either method can be used at the facility level; however, the level of detail and flexibility desired should be considered when deciding upon a method. The advantage of the Intermediate Product Costing method is that it details the types and quantity of services/products the patient received in the functional centre, rather than merely the costs incurred at the functional centre level. This information can be useful for patient care planning and utilization review. Furthermore, the Intermediate Product Costing method provides details of the costs of the various fixed and variable resource components of the products. This information will assist in cost analysis.

Both methods are described below, followed by a discussion of the distribution bases for the calculations (workload and RVU development). A numerical example is provided in section 3.6 Chapter 7 to further illustrate the calculations used in both approaches.

3.4.1 THE GENERAL LEDGER, ACCOUNTING GUIDELINES, AND VARIABLE AND FIXED COSTS

The financial general ledger (GL) contains the hospital expenses for each functional centre. Remember that all financial GL expenses (and functional centre numbers) must adhere to the account structure presented in the OHRS MIS Standards. If this is not the practice, it is a requirement to map the current account used to the OHRS account codes.



The GL feeds into the cost accounting system where calculations in Step 3 are performed. In some hospitals, the GL feed maps the GL expenses into cost categories. Generally, these costs are mapped into resource types: labour; patientspecific materials; other materials and supplies; referredout contracted out; sundry and other; building, equipment and grounds; and other. The costs may be further categorized as fixed or variable. Variable costs should change with a moderate change in workload. Fixed costs should not be affected by a moderate change in workload.

Placement of costs into categories must also be consistent with the OHRS MIS Standards, Table 3.2 below shows the OHRS MIS Standards categories of costs and the OHRS MIS secondary accounts that correspond to each cost category (Note that all possible secondary accounts are shown, although not all will apply to each functional centre). A description of the specific contents of the secondary accounts can be found in the specific OHRS Chapters and Chart of Accounts.

Labour costs must be placed into the proper cost category. Management and Operational Support (MOS) and UnitProducing (UP) labour costs are considered as fixed and variable costs respectively. When an employee performs functions in both the MOS and UP categories, which is often the case with supervisors in diagnostic and therapeutic departments, the appropriate time spent in each category should be recorded. Note also that medical fees based on feeforservice payments should be considered a variable cost, but where a physician receives a salary, the salary (and benefits) costs are considered fixed costs.

Table 3.2: OHRS MIS Secondary Accounts by Variable and Fixed Cost Category Direct Variable Costs MIS Secondary Accounts Labour Compensation (Including Benefits):

3 50 ** UnitProducing Personnel 3 90 90 Medical FeeforService

Material 4 ** ** Supplies 5 ** ** Service Recipient PatientSpecific Supplies

Other 8 ** ** Referred Out ContractedOut Services Direct Fixed Costs Labour Compensation (Including Benefits):

3 10 ** Management/Operational Support 3 90 10 to 3 90 85 Medical (Salaried Physicians)

Other–Sundry 6 ** ** Sundry Building, Equipment and Grounds 7 ** ** Equipment Expense (Including Amortization)

9 ** ** Undistributed Building and Grounds

3.4.2 FUNCTIONAL CENTRE UNIT COSTS

In the third step of the case costing process, unit costs are developed for services provided by each patient care functional centre (ACC AFC). Functional centre unit costs vary from period to period. For the calculation, functional centre unit costs should be based on annual statistics and expenditures. If periodic calculations are done, ensure that there is no significant, extraordinary cost item included or missing that will distort the unit cost calculation. Annual service expenditures like service contracts or major supplies shipments should be taken into consideration. Preliminary, or budget, unit costs are useful for management reporting and utilization review. Ensure that actual statistics and expenditures are used in the functional centre unit cost calculation.



3.4.2.1 Information Needed to Calculate Functional Centre Unit Costs

Direct Costs and Indirect Costs The key financial information required to calculate functional centre unit costs includes the ACC AFC total direct expenses for the costing period and the indirect costs allocated to each ACC AFC for the same period. This information has already been obtained in Steps 1 and 2 of the case costing process (sections 3.2 and 3.3). Separate totals for direct costs and indirect costs are kept, even though the full costs of the ACC AFCs are distributed to patients. Keeping them separate is useful for internal hospital management reporting and analysis. Direct expenses and indirect costs are also reported separately to the OCCI.

PatientSpecific Supplies and Drugs Patientspecific supplies that are over $250 and individually dispensed drugs are charged to the patient (microcosted) and should not be included in the functional centre total direct expenses when calculating the functional centre unit direct cost. These costs should be assigned directly to the patient and therefore should be subtracted from the functional centre direct expenses. The OHRS Chart of Accounts provides a separate expense account that can be used to accumulate patientspecific and drug charges so that the total patientspecific costs during the period can be easily separated and excluded from the calculation of functional centre unit direct costs.

Other NonWorkload Distributed Costs The costs associated with expense items that are being distributed by nonworkload relative value units should be removed from the direct expenses before completing the functional centre unit cost calculation. This includes feeforservice physician costs, pathologists’ salaries and general supplies when non workload RVUs are used.

Total Workload Units/Total Relative Value Units To complete the calculation, the total workload units or patient hours provided by the functional centre to patients are required for the period. Note that the patientspecific workload units used for distributing costs to patients are slightly different from standard reported departmental units. Departmental workload typically includes units for activities such as quality control that are not patientspecific, yet are valid, reported departmental workload. This will be explained in detail in section 3.2.2.2

If there are any nonunit cost distributed costs in the functional centre, the total RVUs associated with these items are required for the calculation. Total RVUs will be used instead of unit costs to distribute these costs to patients.

3.4.2.2 Functional Centre Unit Cost Calculation The functional centre unit cost calculation is relatively simple. It is necessary to calculate separate unit costs for direct and indirect costs, since these costs are reported separately. There are two methods of calculating functional centre unit costs for nursing:

Method 1: Using Nursing Workload Method 2: Using Patient hours.

Method 1 Using Nursing Workload to Calculate Functional Centre Unit Cost Total “units of patient service” are workload units generated by the workload measurement system used in the functional centre. The terminology, units of patient service, is used to distinguish these units from the traditional workload units reported for Functional Centre Reporting. Traditional workload units as measured by the NWMS and reported for departmental workload include units that can be linked directly to a patient and those that are part of departmental activities but do not involve the care of specific



patients (i.e., service recipient and nonservice recipient workload). Examples of nonservice recipient workload that are measured but cannot be linked to a specific patient include quality control units for standards and controls in the Laboratory, quality control units in Diagnostic Imaging and some Clinical Pharmacy activities.

Workload Categories Service Recipient Assessment

Therapeutic Intervention Consultation/Collaboration

NonService Recipient Functional Centre Activities Organizational/Community/ Professional Activities Teaching/Inservice Research

The general approach for calculating total workload units for case costing is to use service recipient workload units only. These are workload units that can be linked directly to a patient. For example, a typical Clinical Chemistry workload distribution might include the categories of units shown below:

Service Recipient Workload Units Inpatients 300,000 Outpatients 250,000 Referredin 20,000

Total Service Recipient Workload Units 570,000 Use this value to calculate functional centre unit costs

NonService Recipient Workload Units Quality Control 60,000 Calibration Standards 20,000 Others 5,000 Total NonService Recipient Workload Units 85,000

TOTAL DEPARTMENTAL UNITS 655,000

It must be noted that for facilities opting to use workload, there are no changes in the way workload is reported. For OHRS Trial Balance Submission, both service recipient and nonservice recipient workload are reported. As seen in this example, the Clinical Laboratory Chemistry functional centre would still report 655,000 units of workload for the period. In case costing, only the service recipient workload is used for calculating functional centre unit cost. In the example noted above, the unit costs of Clinical Chemistry will be calculated using the 570,000 total service recipient workload units recorded in the period. The following equations are used for the calculation:




Functional Centre Direct Cost (Less PatientSpecific Supplies, Drugs and Other Non Workload Distributed Costs)

÷ Total Service Recipient Workload Units of the Functional Centre

Functional Centre Unit Indirect Cost = Functional Centre Indirect

Cost ÷ Total Service Recipient Workload Units of Functional Centre

Example: There is a total of 8,000,000 Service Recipient Workload Units Inpatient Actual YearToDate on the General Medicine Nursing Unit. Nonservice recipient workload units are not used when doing cost calculations for services provided. At the end of the reporting period, the total direct costs of the functional centre are determined. The total actual direct costs for the General Medicine Nursing Unit for the fiscal year are $4,500,000.

To determine the direct cost per workload unit, the total direct costs are divided by the total service recipient activity workload units.

Direct Cost per Workload Unit = $4,500,000 ÷ 8,000,000 = $0.56 (rounded)

To determine the indirect cost per workload unit, the indirect costs allocated to this functional centre (step 2 of the Case Costing) are divided by the total service recipient activity workload units.

Indirect Cost per Workload Unit = $2,145,165 ÷ 8,000,000 = $0.27 (rounded)

Method 2 Using Patient Hours to Calculate Functional Centre Unit Cost For acute inpatient functional centres, a patient's hospital stay is measured in hours and is used to calculate unit costs. The patient hours are captured in the ADT system (Admission, Discharge, Transfer). Patient hours are based on the length of time a patient receives care in each functional centre.

In order to produce unit costs comparable to when nursing workload is used in the calculation of functional centre unit cost, patient hours are adjusted in the following areas:

• Operating Room • Obstetrics • Emergency Room • Rehabilitation • Complex Continuing Care • Mental Health

Section 3.4.3, Using Patient Hours Methodology, describes the unit cost adjustments required for these areas. When using patient hours to calculate Functional Centre Unit Cost, the unit cost is per patient hour.




Functional Centre Direct Cost (Less PatientSpecific Supplies, Drugs and Other NonWorkload Distributed Costs)

÷ Total Patient Hours of the Functional Centre

Functional Centre Unit Indirect Cost = Functional Centre Indirect Cost ÷

Total Patient Hours of Functional Centre

An example of the Patient Hours unit cost calculation:

There are a total of 133,400 Patient Hours Inpatient Actual YearToDate on the General Medicine Nursing Unit. At the end of the reporting period, the total direct costs of the functional centre are determined. The total actual direct costs for the General Medicine Nursing Unit for the fiscal year are $4,500,000. The total indirect costs are $2,145,165. The total direct costs are divided by the total patient hours to determine the direct cost per patient hour.

Direct Cost per Patient Hour = $4,500,000 ÷ 133,350 = $33.75

To determine the indirect cost per patient hours, the indirect costs allocated to this functional centre (determined in step 2 of the Case Costing process, section 3.3) are divided by the total patient hours in this functional centre.

Indirect Cost per Patient Hour = $2,145,165 ÷ 133,350 = $16.09

Note that nonworkloaddistributed costs, such as physician feeforservice, are also removed from functional centre direct costs before the calculation of functional centre unit direct costs. A separate unit direct cost is calculated for nonworkloaddistributed costs by dividing these costs by the total functional centre RVUs that are used to distribute these costs. The functional centre unit costs are then applied to each patient as described in Chapter 6 section 3.5 Distributing Costs to Patients.

Calculating Intermediate Product Costs Costs are calculated for all intermediate products in the functional centre. Like functional centre unit costs, intermediate product costs will vary every period. The intermediate product calculation should also be based on a full year of actual statistics and expenditures.

Information required to calculate intermediate product costs includes the following: • Direct costs (by cost category) and indirect costs • Total relative value units (by cost Category) • Other nonworkload distributed costs • Patientspecific supplies and drugs

Direct Costs (by Cost Category) and Indirect Costs Total direct expenses for the ACC AFCs for the period have been gathered earlier in Step 1 of the case costing process (section 3.2). However, hospitals using this method of costing generally further assign the direct GL cost data to fixed and variable cost categories. This is achieved by mapping secondary GL (expense) accounts to the appropriate cost categories, as shown in Table 5.1 3.2. Direct costs are broken



down into fixed and variable detail so that the cost of each resource component can be distributed using the most appropriate RVU.

Total indirect costs for each ACC for the period are taken from the cost allocation calculation in Step 2 of the case costing process.

Total Relative Value Units (by Cost Category) RVUs are assigned to each resource component of each intermediate product in the functional centre and serve as the basis for cost distribution. In most cases, the RVUs are based on workload units. If workload is used to distribute costs to patients, use only patient specific workload (service recipient workload). For some intermediate products, use nonworkload RVUs as the standard for cost distribution because they are more appropriate distribution bases.

For the Intermediate Product Costing approach, the products/services received by each patient must be tracked. Both utilization and relative value unit information are needed to calculate total RVUs.

Other NonWorkload Distributed Costs These expenses, such as physician feeforservice, should be mapped to a distinct cost category to separate them from workload distributed costs. This separation is necessary so that costs can be associated with more suitable RVUs that serve as the basis for distributing these costs to patients.

PatientSpecific Supplies and Drugs The costs of patientspecific supplies over $250, drugs and other microcosted items must be assigned directly to the patient. In practice, hospitals may accomplish this by creating intermediate products and assigning a variable supply RVU to the product that is equivalent to the cost of the item. All other cost categories are associated with RVUs equal to zero. When the cost calculations are completed, the cost of the microcosted item is assigned to the patient.

Intermediate Product Cost Calculation The intermediate product cost calculation is more complex than the functional centre unit cost calculation, and has therefore been broken down into four steps.

1. Calculate Total Relative Value Units The first step is to calculate total RVUs for each cost category across all intermediate products in the functional centre. Use utilization and RVU information to determine total RVUs. First multiply intermediate product utilization for the period by the corresponding RVU for each product in the cost category. These RVUs are then totaled across all intermediate products in the cost category to produce the total RVUs by cost category.

2. For Each Cost Category, Calculate the Average Cost per Relative Value Unit Next calculate an average cost per RVU for each cost category. This calculation involves dividing the total costs in each cost category by the total RVUs in the same cost category.

Average Cost per RVU = Cost Category Total

Costs ÷ Cost Category Total Relative Value Units

3. For each Intermediate Product, Calculate the Cost for each Cost Category The average cost per RVU calculated in the previous step is then multiplied by the intermediate product’s RVU. This calculation is performed for all cost categories.



Cost Category Product Cost = Average Cost per

RVU × Product RVU

The result of the calculation is the cost for each resource component of the intermediate product.

4. Calculate the Total Direct and Total Indirect Cost for Each Product The direct fixed and variable costs of the intermediate product are summed to produce the total direct cost of the product. In contrast, the indirect cost of the intermediate product is calculated using only the workload units, or labour RVUs, associated with the product. Note that direct and indirect costs are reported separately for OCCI purposes.

3.4.3 NEW TESTS/INTERMEDIATE PRODUCTS

A functional centre may perform new procedures or use patientspecific supplies that are not on the list of intermediate products that the functional centre produces. The challenge is first to assign an appropriate relative value unit to the product. Then the product and its corresponding RVU may need to be added to the current list of products both in the departmental system and in the case costing system. The hospital must also determine if the product will be on the list permanently. It may not be worthwhile to add a new unique product if it will not continue to be used. This list of products needs to be reviewed periodically to determine if products should be added or dropped from the costing system.

One approach to consider for costing new patientspecific supplies is to create a group of products with variable supply RVUs that reflect ranges of supply costs. When a new patientspecific supply is used, the RVU that most closely represents the cost of the supply should be used to distribute the product cost.

3.4.4 RELATIVE VALUE UNITS

Relative value units, in the context of case costing, reflect the relative time required to perform a specific service (workload) or the relative cost of products. RVUs are used in case costing as a means to distribute costs to patients. Workload units are the RVUs usually used to distribute most costs to patients, whereas RVUs other than workload are used to distribute the remaining costs to patients. It was already stated that medical feeforservice costs are distributed using RVUs that are based on the professional component of the OHIP fee schedule. In addition, hospitals have the option of distributing pathologists’ salaries based on patient specific workload units or the OMA fee schedule. Some hospitals have also developed a relative value scale, for general supplies, that is specific to the use and cost of supplies associated with each procedure. They have found that using RVUs to distribute supply costs is more valid than workload for distribution of these costs. As part of the evolution of case costing, the OCCI has mandated the following:

For diagnostic functional centres with general supply costs greater than 10% of the functional centre budget, hospitals are to investigate those functional centres for RVU development, to determine how well workload is correlated with the utilization for those supplies. Hospitals are to establish RVUs or microcost supply items until the residual (supply costs not distributed through RVUs or microcosted) is less than 10% of the functional centre budget.

Hospitals may also use a relative value scale as the basis for distributing expenses in other direct cost categories. The following (simplified) Radiology example shows the application of different unit values to the various resource components of the functional centre’s intermediate products:



Table 3.3: Radiology Example for Relative Value Units Intermediate Product

Labour RVUs

Material RVUs

Other Direct RVUs

Indirect RVUs

Upper Body 15 1 2 15 Extremity 10 2 2 10 Head and Neck 20 2 3 20 GI 30 3 1 30 GU 25 4 2 25

Note that indirect costs should be distributed using workload units (the labour RVUs) and not other hospitalspecific RVUs. If the hospital has developed RVUs to distribute any of the direct costs, submit a written description of the methodology to the OCCI for review. The description should include a pointform review and description of:

Rationale Why was this approach chosen? What other approaches were considered and rejected?

Comparison Data How do the RVUs differ on a procedure by procedure basis from the NWMS? Provide a list of groups, procedures within groups and relative unit values.

RVU Development Describe a onetime analysis or study that was completed to establish relative values or other factors. If grouped, describe how procedures were assigned to their respective groups.

State of Implementation Has this methodology been implemented? If implemented, how long has it been in use? What followup study has been done to validate the approach?

3.5 STEP 4: DISTRIBUTING COSTS TO PATIENTS

The last step in the case costing process involves the distribution of costs to patients. The approach to assigning costs to patients will vary depending on whether the functional centre unit cost is calculated using service recipient workload, patient hours, or the costs of intermediate products in section 3.4 Step 3. In this chapter section, the methods for distributing costs to patients will be described as well as different patient cost distribution bases.

3.5.1 DISTRIBUTING FUNCTIONAL CENTRE UNIT COST TO PATIENTS BASED ON WORKLOAD

Functional centre costs are distributed to patients based primarily on the proportion of service recipient workload received from the functional centre. The calculation of the functional centre costs for a case requires the following information:



• Service recipient workload units received by the patient from the functional centre during the period.

• Functional centre unit direct cost and unit indirect cost for the period. • Total cost of patientspecific supplies, including drugs and other microcosted items, provided to


To determine the direct and indirect patient cost for each functional centre providing patient care services (ACC AFC), the service cost must be calculated. The service cost is obtained by multiplying the workload units received by the patient by the cost per workload unit. To calculate the direct patient cost per functional centre, accumulate the costs for any high cost supplies, drugs and nonworkload distributed products that are received by the patient and add these costs to the service cost. The calculations are presented below:


=

Service Recipient Units of Service

× Functional Centre Unit Direct Cost

+

Functional Centre Patient Specific Supplies, Drugs and Nonworkload Distributed Costs

Patient Indirect Cost by Functional Centre = Service recipient Units of

Service × Functional Centre Unit Indirect Cost

The example given below is an extension of the example noted in Step 3 of Case Costing, section 3.4.

Example: For the General Medicine Nursing Unit, the following information is given about Patient A: Dressing Change = 20 workload units (minutes)

The direct cost of this service for Patient A can be calculated as follows: 20 (workload units) X $0.56 (direct cost per workload unit calculated in step 3) = $11.20

The indirect cost of this service can be calculated as: 20 (workload units) X $0.27 (indirect cost per workload unit calculated in step 3) = $5.40

These steps are then repeated to determine the full (direct and indirect) cost for each patient seen and cared for by the functional centre.

As noted in the MIS Standards 2006 2009, the level at which services are costed within a health service organization depend on the detail available from the workload measurement system, coupled with the desire of the user to know the costs by particular service or group of services for management purposes. For example, if care plans are in place, it can prove valuable to know the cost of the exact services that each service recipient received when conducting utilization analysis. On the other hand, some of the nursing workload measurement systems, aggregate workload units related to all of the services provided to a service recipient during one inpatient day (e.g. change dressing, administer medication, take vital signs, ambulate with assistance, etc.).



Note that the patient’s portion of nonworkload distributed direct costs is obtained by multiplying the service recipient RVUs by the cost per RVU.

3.5.2 DISTRIBUTING FUNCTIONAL CENTRE UNIT COST TO PATIENTS BASED ON PATIENT HOURS

This process is similar to the workload costing method and requires the following information: • Patient hours received by the patient from the functional centre during the period. • Functional centre unit direct cost and unit indirect cost for the period. • Total cost of patientspecific supplies, including drugs and other microcosted items, provided to


To determine the direct and indirect patient cost for each functional centre providing patient care services (ACC AFC), the service cost must be calculated. The service cost is obtained by multiplying the patient hours received by the patient by the cost per hour. To calculate the direct patient cost per functional centre, the costs for any high cost supplies, drugs and nonworkload distributed products received by the patient must be added to the service cost. The calculations are presented below:


= Patient Hours ×

Functional Centre Unit Direct Cost

+ Functional Centre Patient Specific Supplies, Drugs and Nonworkload Distributed Costs

Patient Indirect Cost by Functional Centre = Patient Hours × Functional Centre Unit Indirect

Cost

Example: For the General Medicine Nursing Unit, the following information is given about Patient A:

Patient Hours in General Medicine Nursing Unit = 2 Hours

The direct cost of this service for Patient A can be calculated as follows: 2 (Patient Hours) X $ 50 (direct cost per workload unit calculated in step 3) = $ 100

The indirect cost of this service can be calculated as 2 (Patient Hours) X $ 20 (indirect cost per patient hour calculated in step 3) = $40

Total Cost = Direct Cost + Indirect Cost Patient A Total Cost = $ 100 + 40

These steps are then repeated to determine the full (direct and indirect) cost for each patient provided by the functional centre.



3.5.3 INTERMEDIATE PRODUCT COSTING

Intermediate product costs are also distributed to patients primarily through RVUs. The assignment of costs to patients is accomplished by tracking the type and number of different products received by the patient. The costs of these products (calculated in Step 3 and described in section 3.4) are then attached to the patient.

3.5.4 PATIENT COST DISTRIBUTION BASES

The suggested bases for distribution of direct expenses (Labour, Material, Other and Building and Equipment) to patients have been developed based on the OHRS Standards, with minor refinements as noted below. The distribution bases are as shown in Table 3.4. In particular, note the following:

Direct Labour: • Medical feeforservice costs (MIS OHRS Secondary Account 3 90 90) must be distributed to

patients based on the units of service received. Units of service are computed using the professional component of the OHIP Fee Schedule as an RVU for services received.

• Pathologist salary costs can be distributed to patients based on either patientspecific workload units or the OMA Professional Fee Schedule.

• Other physician salaries (if applicable) can be distributed via patient care workload associated with the functional centres they provide service to.

Note that the patientspecific workload units used to distribute physician salary costs are those workload units associated with unitproducing functional centre staff (i.e., nurses, technicians, etc.). Remember that physicians are not required to collect workload.

Direct Material (Supplies): • Patientspecific supplies (including drugs) are “charged” directly to the patient and accumulated

based on actual costs incurred. • General supplies in the diagnostic functional centres which are greater than 10% of the functional

centre budget should be distributed to patients based on RVUs or microcosted until the residual (supply costs not distributed through RVUs or microcosted) is less than 10% of the functional centre budget.

• Ward stock drugs are distributed to patients based either on workload or the average ward stock cost per patient day.

Direct Other/Building and Equipment: • The standard for distributing all remaining functional centre direct expenses to patients is

workload units of service received by the patient. However, hospitals may distribute these costs using hospitalspecific RVUs that are approved by the OCCI.



Table 3.4: Patient Cost Distribution Bases

Category MIS OHRS Secondary Accounts Functional Centre Distribution Base

Labour 3 10 ** – 3 50 ** Compensation (MOS, UP) 3 90 10 – 3 90 85 Medical Salaries

o Pathologists o Other Physicians

3 90 90 Medical Fee for Service

Workload Units / Patient Hours

OMA Fee Schedule or Workload Units/Patient Hours Workload Units / Patient Hours Prof. Component OHIP Fee Schedule

Material 4 ** ** Supplies • NonDiagnostic Functional Centres • Diagnostic Functional Centres

5 ** ** PatientSpecific Supplies Workload Units / Patient Hours Workload Units/Dollar Cost/Hospital Specific RVUs

Dollar Cost Other 6 ** ** Sundry

8 ** ** Referred Out Workload Units / Patient Hours Workload Units / Patient Hours

Building & Equipment

7 ** ** Equipment Expense (Including Amortization) 9 ** ** Undistributed Buildings & Grounds



Indirect: All functional centre indirect expenses are to be distributed to patients based on the functional centre workload units, patient hours, and labour RVUs received by the patient.

3.6 STEP 5: BRINGING IT ALL TOGETHER

In sections 3.2 to 3.5 the four steps of the case costing reporting process have been explained in detail. At this point, the cost data should be available for each patient from each functional centre that provided intermediate products to the patient during the hospital visit. The patient descriptive clinical data associated with each patient’s visit is also available from the Health Records abstracting system. The main objective of case costing is to combine these two types of data to calculate the costs of the patient specific mix of products and services received by each patient.

This section explains how to bring all of the statistical, financial and clinical data together and discusses the final output. It describes the format of the departmental feeds that input data into the case costing system as well as the format of the final case cost data. It is important to remember the definition of the encounter, since the costs are assigned to each patient based on the services/intermediate products received during the encounter. The definition of the encounter depends on the type of case (e.g., acute inpatient, day surgery, ambulatory care or chronic complex continuing care).

3.6.1 INTERFACING DEPARTMENTAL DATA WITH THE CASE COSTING SYSTEM

To understand how the data will come together, it is important to visualize where the data comes from. Each clinical functional centre has collected workload or patient hour units and statistical data on a



patientspecific basis. The financial data has been recorded in the financial systems (e.g., payroll, general ledger, capital assets module, etc.). All of this data must be linked together and transferred to the case costing system to calculate the costs for each patient encounter.

Most hospitals have an ADT (admission, discharge and transfer) system that collects each patient’s encounter data, which includes admission date, chart number and health insurance number. The ADT system assigns a registration number to each visit. The data from the ADT system uniquely identifies each patient encounter. In addition, the system usually tracks the patient through the hospital, recording the Nursing unit to which the patient is admitted.

It is recommended that hospitals have mechanisms in place that interface the ADT information with each departmental information system, so that these data elements do not need to be reentered at the department level. An interface to the ADT system also enables validation that all patients who are registered in a particular nursing unit, for example, receive workload or patient hour units for each day of their stay.

During the costing process, the financial and workload/statistical data from the departmental systems is fed into the case costing system. Depending on the costing system, either patientspecific workload or utilization is compiled into the costing system. Unit costs are calculated and then distributed to patients. Patient descriptive data is pulled in from the Health Records abstracting system to provide additional information, such as procedure and diagnosis detail and the case mix group (CMG) assignment, to the data. Figure 3.1 illustrates the information system flow for the case costing system.

Figure 3.1: Case Costing Information Flow Diagram

Using the OCCI methodology, the case costing process results in a cost record for each patient care functional centre from which the patient received services/intermediate products during the encounter. Each cost record will have a total direct cost and a total indirect cost.

3.6.2 OPTIONS FOR REPORTING CASE COSTS

Several options are available for reporting the patientspecific case cost data, each presenting a different level of detail. The basic format provides the total direct and indirect costs for each patient care functional centre (ACC AFC) that provided services/intermediate products to the patient during the encounter. The following options describe extended formats with a greater level of detail that can be used for a variety of



purposes. Appendix L The OCCI Submission Technical Specifications document provides the basic and extended case cost data record format specifications.

The first extended data option separates costs by day of stay. The second extended data option separates variable costs (those that should change with a moderate change in workload or patient hours) from fixed costs (those that should not change with a moderate change in workload or patient hours).

For Ontario case cost development, the defined cost data record format includes additional data elements to accommodate these optional levels of cost data.

3.6.2.1 Costs by Day of Stay The extended data standards for cost data by day of stay provide a cost data record for each patient for each functional centre from which the patient received service, for each day of stay. For consistency, costs are assigned to the service date—the date the patient received the service—rather than the date ordered or the date reported.

Collection of patient cost data by day of stay has significant implications for data collection, storage, and computation as intermediate product data is required not only for the patient for a functional centre, but also for each day that a patient receives service from that functional centre. For each patient and for each functional centre providing care, one cost record for each day during the stay is required. The only difference in terms of the data provided is the addition of the service date on which the costs were incurred for that patient and that functional centre.

3.6.2.2 Variable/Fixed Detail The fixed or variable categorization of MIS OHRS Secondary Accounts is shown in the table 3.5 for reference. The account definitions are described in detail in the MIS Standards OHRS documentation. Section 3.4.1 explains the MIS OHRS account definitions and their application to case costing.

Table 3.5: MIS OHRS Secondary Accounts by Variable/Fixed Detail Direct Variable Costs MIS OHRS Secondary Accounts Labour Compensation (Including Benefits):

3 50 ** Unit Producing 3 90 90 Medical FeeforService

Material 4 ** ** Supplies 5 ** ** PatientSpecific Supplies

Other 8 ** ** Referred Contracted Out Direct Fixed Costs Labour Compensation (Including Benefits):

3 10 ** Management & Operational Support 3 90 10 to 3 90 85 Medical (Salaried Physicians)

Other—Sundry 6 ** ** Sundry Equipment, Building, and Grounds

7 ** ** Equipment Expense (Inc. Amortization) 9 ** ** Undistributed Building and Grounds



These cost records provide a more detailed breakdown of the direct and indirect costs as follows: Direct Costs

• Variable Labour • Variable PatientSpecific Material • Variable Material Supplies • Variable Other Referred out • Fixed Labour • Fixed Other Sundry • Fixed Equipment, Building and Grounds

Indirect Costs • Variable • Fixed

3.6.2.3 ServiceSpecific Data Elements In the case cost data record, there are two fields submitted only for chronic complex continuing care cases: the MDS reference date and the MDS sequence number. The MDS reference date must match the date submitted to CIHI on the Chronic Care MDS for each patient. The MDS sequence number identifies the specific MDS assessment for each patient. For example, a patient’s first MDS assessment may get the MDS sequence number “1,” the second assessment would get the sequence number “2,” and so on.

For acute inpatient cases, hospitals have the option of reporting the CMG PLUS from the hospital’s inpatient abstracting system and grouper, if available.

3.6.2.4 Procedure Detail It is an option to keep the intermediate products (procedure detail) available in a format that facilitates further analysis, if required. Much of this information is needed to calculate and distribute costs to patients. For example, workload units in different categories would be accumulated and used to calculate pharmacy labour cost for reporting.

There is no one standard coding system readily available to cover the wide range of possible procedures. Hospitals would use its own coding scheme for procedure detail, and any comparative analysis among hospitals would require reconciliation of the different hospitals' coding systems. It is recommended that hospitals that do not have established internal codes use NWMS or provincial fee schedule codes.

OCCI hospitals do not submit procedure cost data routinely, but may keep it available at the hospital along with a list of procedures and relative value units associated with each procedure number used by the hospital. If there is a decision to keep procedure data, it should be organized into records with the following information in each:

• Patient Encounter Identifier: Register or Account Number • Functional Centre Code (to MIS OHRS Level 5) • Service Date • Code of Procedure Incurred (per hospital format) • Number of times procedure done on this date • Name of Procedure (optional) • Relative value/workload units of procedure (optional)



3.6.3 A FRAMEWORK FOR “CASE” COSTING

The care provided for a given health condition can involve a variety of different interactions between the patient and the hospital. It would be of great value to be able to measure the cost of treating a patient over the entire episode of illness, to get the true “case” cost.

For example, many patients have a surgical procedure done on an inpatient basis and are subsequently seen in the outpatient clinics for followup. Both the inpatient and outpatient costs are related to the same health condition. Linking the costs of the related visits together would provide a better estimate of treating that patient.

The process of developing true “case” costs by linking related patient encounters is now more feasible The OCCI has developed a basic conceptual framework to link related encounters and shown in Figure 3.2.

Figure 3.2: Clinical Case Costing Framework

The framework is composed of six levels: 1. Product – the single intermediate product (or service) a patient/client receives; 2. Encounter – the unique presentation to the facility, usually recorded at the point of entry. For CCAC approved referral



3. Episode – a rollup of related encounters (e.g., acute inpatient, ambulatory, chronic complex continuing care, rehabilitation and mental health); (CCAC would be the combination of services of all referrals)

4. Reporting entity – Master number/facility where patient/client received care; 5. Case – the given health condition or service received; and 6. Patient/Client – the individual patient/client.

The framework starts at the bottom at Level 1. This is the level at which detailed information on intermediate product utilization is captured. These products are associated with a specific encounter (e.g., an acute inpatient admission, an outpatient visit, or a chronic care stay). Each encounter can be grouped into an episode. Each episode occurs at the reporting entity or the facility in which the patient is being treated. A case is the underlying health condition that requires the use of health services at various reporting entities. Lastly, level 6 is the individual patient.

Currently, level 2 of the framework is achieved. The OCCI collects costs at the encounter level. The critical piece of the framework is level 5, the case level. A standardized case typing methodology that would allow related encounters of a given health condition to be linked is not yet available. This methodology has been referred to as an “Episode Grouper” or a “Super Grouper”. Some examples of a Case Type are Oncology, Dialysis, Pregnancy and Diabetes. These Case Types are intuitively appealing, as they are consistent with many hospitals’ programs.

OCCI hospitals have agreed that an informal Case Typing system can be developed and implemented on a pilot basis. The OCCI has developed a set of standards to guide the implementation of the framework, such that infrastructure can be built to accommodate future additions to the framework. For instance, the Case Typing system will likely be associated with a numerical system. Hospitals can then develop their information systems to eventually accommodate a number field for the Case Type.

The framework also facilitates the addition of other health care providers, such as doctor’s offices, community clinics and home care organizations, which can be added at Level 4 as other reporting entities. Although this is not likely to be implemented at the provincial level, local communities would be able to utilize this framework to better coordinate services (and information collection) to create a seamless health care delivery system.

3.7 COSTING IN A PROGRAM MANAGEMENT HOSPITAL

Under the program management model, traditional hospital functional centres are amalgamated to form a program. Each program produces a variety of traditional functional centre intermediate products such as nursing services, allied health services, simple laboratory tests, diagnostic imaging exams, and dispensed drug orders. The services delivered to patients (i.e., intermediate products) are essentially the same; however, production of these services has been shifted from the traditional functional centres to programs.

The activities and organization of personnel working in a program management environment are typically different from those in the traditional hospital setting. Many program management hospitals employ multiskilled workers. Multiskilled workers are patient care workers who are crosstrained to provide a variety of services for the patient (e.g., lab tests, nursing services, etc.). Support staff may also be involved in providing patient care services. In addition to using multiskilled workers, many traditional department staff are also ‘deployed’ to the individual programs or functional centres. An example is a social worker stationed and working within a chronic complex continuing care program when no social work department exists in the hospital.



The OCCI case costing methodology is derived from the MIS Standards, which are based on the assumption that hospitals are organized and managed using a traditional departmental approach. This approach presents challenges for case costing implementation in a program management hospital since it involves calculating case costs using the current OHRS functional centre perspective. In this section, the steps are discussed on how costs of products produced in programs are calculated by applying the current case cost methodology. An alternative costing methodology is also presented that is superior to the current methodology, but which is not practical to implement at the present time.

3.7.1 GATHERING DATA Like departmentally based hospitals, program management hospitals require patient descriptive, financial and workload data for case costing. The collection and reporting of financial and workload data are the areas that need special attention.

The collection and organization of financial data is complicated by the fact that all program expenses must be mapped and charged to an OHRS functional centre. The difficulty occurs in separating program expenses, such as supplies, which may be used by all disciplines. This often results in the majority of the costs being assigned to the nursing functional centre, although they are shared by all disciplines.

Program labour costs are distributed back to the functional centres associated with the discipline of the program’s employees. For example, the salary and benefits of a social worker working in the chronic complex continuing care program are recorded in the Social Work functional centre. Program support and administration costs should be assigned as a direct cost to the functional centres they support, based on an estimate of the amount of time support and administrative staff spend managing the activities of each discipline. If there are many disciplines working in the program, it may be difficult to establish an estimate and immaterial to distribute these costs to each functional centre. As a result, some hospitals distribute all of the program support and administration costs to the nursing functional centre.

Some larger hospitals may have created a Program Management Administration (7120600) functional centre for recording the costs of administrative personnel responsible for inpatient programs. The costs in this functional centre should be assigned as a direct cost to the patient care functional centres it supports based on the proportion of functional centre workload, functional centre direct costs, or time that staff spends providing services to patient care functional centres.

Workload data is collected in the same manner as in traditionally organized hospitals. That is, workload is collected by each discipline on a patientspecific basis using workload measurement systems that are MIS OHRS compliant. Because there are a variety of health disciplines working in a program, there may be more than one workload measurement tool being used. The workload collected must be assigned to the functional centre to which the discipline relates. If the hospital has multiskilled workers, ensure that their workload and salaries are assigned to the same functional centre(s). Note that if any new products are created in the functional centres, the RVUs must be calibrated against the other products in the functional centre.

3.7.2 ALLOCATING INDIRECT COSTS The allocation of indirect costs is performed at the functional centre level using the methodology described in Chapter 4 section 3.3. Hospitals are required to use SEAM and the standard allocation bases to allocate the costs of TCC TFCs to patient care functional centres.



Cost allocation requires the collection of allocation statistics for each functional centre. Programs must map their allocation statistics back to the corresponding functional centres. Hospitals already gather some of these statistics on a functional centre basis since it is required for OHRS reporting. For instance, departmental total costs and worked hours are already tracked to functional centres.

Other statistics are either not available or are not practical to estimate. For instance, department net square metres used to allocate Plant Operation costs are difficult to estimate for the functional centres that comprise the program. The approach hospitals have taken is to map these statistics to the nursing functional centres which correspond to the program. The effect of this practice is that the nursing functional centres will have a greater portion of the overhead and relatively high indirect costs. The other functional centres that provide services to the program will have understated indirect costs if all staff members are deployed to the program. If a separate department also exists for each discipline working within the program, then indirect costs for these functional centres will be similar to those in a departmentally organized hospital.

3.7.3 CALCULATING AND DISTRIBUTING PRODUCT COSTS At this point, all program costs are assigned to the OHRS functional centres. Intermediate products and workload produced within the program have also been assigned back to functional centres. In addition, indirect costs have been allocated to functional centres based on the allocation statistics collected for each of the functional centres.

The calculation and distribution of case costs are made simple now that all expenses and statistics are assigned back to departments. The same case costing methodology described in Chapters 5 and 6 sections 3.4 and 3.5 to calculate and distribute costs to patients is followed.

3.7.4 PRODUCT LINE COSTING The difficulties of implementing a departmentally based case costing methodology in a program environment have underscored the need for a costing methodology applicable to a variety of organizational and management approaches. The product line costing methodology provides an alternative to the departmentally focused case costing methodology by approaching case costing from the program perspective.

Product line costing differs from the current methodology in that workload and expense data are collected at the program level. One of the biggest challenges is in reorganizing the way the workload is collected. Capturing workload by program requires the identification of all products within a program, regardless of discipline, and development of a new RVU system that calibrates all products against each other. Workload collection would be simplified with the use of a new multidisciplinary workload measurement tool.

Indirect cost allocation is less complicated and more precise in product line costing. Allocation statistics are collected for programs rather than functional centres and indirect costs are allocated to programs using the standard allocation bases.

The last step is to calculate product costs. The calculations are performed on a program basis using total program costs and total program RVUs. This approach results in products that reflect a blended cost. For example, physiotherapist salaries along with all other expenses related to the program would be used to calculate the cost of a physiotherapy product within a given program. In contrast, the current functional centre approach results in a product cost that more specifically reflects the resources used to produce a



given set of products. Following the same example, the cost of a physiotherapist product is calculated using only physiotherapy salaries and physiotherapy workload.

Hospitals employing product line costing must still report costs to the OCCI by functional centre so that patient costs from different facilities can be compared to each other. Therefore, a hospital choosing to cost intermediate products of a program using a multidisciplinary workload measurement tool is required to identify which products relate to each discipline (or traditional functional centre). These product costs are mapped to functional centres to permit comparison with the costs of similar products produced in traditionally organized hospitals. Note that products may be grouped by program for internal reporting.

It is not currently feasible to implement product line costing because hospitals are still required to report financial and statistical information on a departmental basis to meet OHRS reporting requirements. For product line costing to be a viable option, a standardized financial reporting system that accommodates both the traditional departmental and program management activities is required. The reporting system needs to provide the necessary structure of accounts and guidelines to ensure all expenses are accounted for in a comparable manner for all hospitals. A set of secondary accounts for labour expenses for each discipline working in the program would also be required.

The product line costing approach would also make it difficult for hospitals to report departmental workload statistics to the Ministry of Health and LongTerm Care via OHRS reporting. Hospitals using a multidisciplinary workload measurement tool would still need to report workload activity on a discipline specific basis to conform to OHRS requirements.

3.8 EXAMPLE OF CASE COSTING METHODOLOGY IN ACTION

Sections 3.2 to 3.6 describe how to generate case costs by following the OCCI fourstep case costing approach. This example reinforces the OCCI case costing methodology and concepts through a numerical example. The simplified example presented below follows the four steps of case costing.

3.8.1 EXAMPLE: STEP 1 GATHER THE DATA The data gathered for case costing includes:

• Financial data • Departmental workload and patientspecific workload or utilization statistics • Indirect cost allocation statistics • Patient descriptive data

Financial and statistical data are reported for each functional centre. The hospital in our example has the following TCC TFCs and ACC AFCs:

COST FUNCTIONAL CENTRES Transient Absorbing General Administration Nursing (OR) Housekeeping Laboratory Finance Diagnostic Imaging



The hospital’s financial data is found in the General Ledger (GL) and expenses are tracked to each TCC TFC and ACC AFC as shown in Table 3.6. The GL shows the total costs for each TCC TFC and ACC AFC, as well as a further breakdown of total costs for the three ACC AFCs.

Table 3.6: General Ledger Costs Functional Centre General Ledger Costs General Administration $2,250,000 Housekeeping $1,000,000 Finance $750,000 Nursing (OR)

Labour $6,000,000 PatientSpecific Supplies $500,000

Laboratory Labour $2,000,000 General Supplies $750,000 Depreciation $250,000

Diagnostic Imaging UnitProducing Labour $2,000,000 Management & Support Labour $50,000 General Supplies (GS) $100,000 PatientSpecific Supplies (PSS) $150,000 Depreciation $100,000 Medical FeeForService $100,000

In the statistical GL, workload information is available and summarized in Table 3.7. This hospital only provides services for acute inpatients and outpatients. Complex continuing care and rehabilitation workload would have been included in the total workload if these services were provided.

Table 3.7: Departmental Workload Profiles

Workload Functional Centre Acute Inpatient Outpatient ReferredIn Total

Nursing (OR) 2,700,000 300,000 0 3,000,000 Laboratory 1,500,000 1,000,000 500,000 3,000,000 Diagnostic Imaging 1,500,000 600,000 150,000 2,250,000

Remember that doortodoor time is captured in the OR on a patientspecific basis. Also, note that only patientspecific workload is used in the case costing calculations.

3.8.2 EXAMPLE: STEP 2 ALLOCATE INDIRECT COSTS The allocation of the total costs of TCC TFCs to ACC AFCs is achieved using the Simultaneous Equation Allocation Method (SEAM). SEAM uses allocation bases as a means of estimating the proportion of TCC



TFC costs that each ACC AFC receives. These allocation bases are based on the MIS Standards as given in Table 3.8.

Table 3.8: Standard Allocation Bases

Functional Centre Allocation Numerator Allocation Denominator

General Administration Total Department Cost Total Hospital Cost

Housekeeping Department Weighted Net Square Metres (Total Department Cost is acceptable if Metres not available)

Hospital Weighted Net Square Metres (Total Hospital Cost is acceptable if Metres not available)

Finance Total Department Cost Total Hospital Cost

SEAM allocates the costs of TCC TFCs by solving a system of linear equations. Each equation determines the total allocation of TCC TFC costs to a functional centre using a set of allocation statistics as shown in Table 3.9. The statistics are calculated for each functional centre using the Allocation Numerator and Denominator. These statistics act as approximations of TCC TFC utilization by each functional centre.

Table 3.9: Allocation Statistics

General Administration Housekeeping Finance

General Administration .1500 .1000 .0500 Housekeeping .0500 .0500 .0700 Finance .0250 .0250 .0300 Nursing (OR) .4250 .4750 .5000 Laboratory .2000 .2000 .1500 Diagnostic Imaging .1500 .1500 .2000 Total 1.0000 1.0000 1.0000

The results of SEAM allocation are TCC TFCs with no costs and ACC AFCs with direct costs and indirect costs appear in Table 3.10. The indirect costs are the allocated costs from the TCC TFCs.

Table 3.10: Results after SEAM Allocation

Functional Centre After Allocation

Starting Balance Add Subtract Ending Balance General Administration

$2,250,000 $2,250,000 $0

Housekeeping $1,000,000 $1,000,000 $0 Finance $750,000 $750,000 $0 Nursing (OR) $6,500,000 $2,500,000 $9,000,000 Laboratory $3,000,000 $800,000 $3,800,000 Diagnostic Imaging $2,500,000 $700,000 $3,200,000

Total $16,000,000 $4,000,000 $4,000,000 $16,000,000



3.8.3 EXAMPLE: STEP 3 CALCULATE FUNCTIONAL CENTRE UNIT/ INTERMEDIATE PRODUCT COSTS

As outlined in section 3.4 there are two methods to calculating patient costs.

3.8.3.1 Example: Method 1 Calculate Functional Centre Unit Costs (MIS OHRS Workload Costing) The basis of this approach is to calculate a direct and an indirect cost per unit based on the patientspecific workload units produced by each functional centre. Note that the total direct costs for distribution contain only those expenses to be distributed through workload. Patientspecific supplies and medical feefor service are distributed using other RVUs. The direct cost per unit is obtained by dividing the direct costs, less the costs of microcosted items and nonworkload distributed items, by total functional centre workload as given in the Table 3.11.

Table 3.11: Functional Centre Cost per Unit Calculations

Functional Centre

Total Direct Cost (Exc. PatientSpecific Supplies

And Other Non Workload Distributed

Items)

Total Indirect Cost

Total (Patient Specific) Departmental Workload

Direct Cost per Unit

Indirect Cost per Unit

Nursing (OR) $6,000,000 $2,500,000 3,000,000 $2.00 $0.83 Laboratory $3,000,000 $800,000 3,000,000 $1.00 $0.27

Diagnostic Imaging $2,250,000 $700,000 2,250,000 $1.00 $0.31

The unit cost for medical feeforservice in the Diagnostic Imaging functional centre is also calculated as in Table 3.12:

Table 3.12: Medical FeeforService Costs Per Unit Calculation Total Cost Total RVUs Cost per Unit

Medical FeeForService $100,000 110,000 $0.91

3.8.3.2 Example: Method 2 Calculate Intermediate Product Costs (Intermediate Product Costing) The basis of this approach is to capture patientspecific utilization of intermediate products for each functional centre. A cost for each product is calculated using financial, RVU, and utilization data. In our example, the Diagnostic Imaging functional centre is used to demonstrate this approach. Products produced by each functional centre are identified and assigned RVUs to each cost category as shown in Table 3.13:



Table3.13: Assignment of RVUs to Diagnostic Imaging Functional Centre Intermediate Products Cost Categories

Direct Indirect

Intermediate Products

Variable Labour

Variable Supplies

Variable Other

Fixed Labour

Fixed Equip– ment

Overhead

P1 10 5 7 10 10 10 P2 5 6 11 5 5 5 P3 0 300 0 0 0 0 : : : : : : : Pn 2 5 10 2 2 2

The case costing system also maps the secondary GL accounts to fixed and variable cost categories as in Table 3.14:

Table 3.14: Mapping of General Ledger Costs to Cost Categories Cost Categories

Direct Indirect

Variable Labour

Variable Supplies

Variable Other

Fixed Labour

Fixed Equipment Overhead

Nursing (OR) $6,000,000 $500,000 $0 $0 $0 $2,500,000

Laboratory $2,000,000 $750,000 $0 $0 $250,000 $800,000 Diagnostic Imaging $2,000,000 $250,000 $100,000 $50,000 $100,000 $700,000

The Radiologist expense for the Diagnostic Imaging functional centre is distributed using the professional component of the OHIP fee schedule. Therefore, this expense is mapped to a separate cost category, Direct Variable Other.

Departmental systems feed patientspecific utilization data into the cost accounting system. At the end of the costing period, the GL feeds into the cost accounting system to perform calculations to cost intermediate products.

Functional centre intermediate product quantities are summed by type and multiplied by the corresponding RVU to obtain the total number of RVUs by product type. Total RVUs by product type are then totaled to produce the total RVUs for the cost category: Refer to Table 3.15.



Table 3.15: Total RVU Calculation for Diagnostic Imaging Functional Centre Total RVUs

Intermediate Products Cost Categories

Direct Indirect

Quantity Variable Labour

Variable Supplies

Variable Other

Fixed Labour


P1 10 10 5 7 10 10 10 P2 20 5 6 11 5 5 5 P3 4 0 300 0 0 0 0 : : : : : : : : Pn 1 2 5 10 2 2 2

Total 2,250,000 150,000 PSS 245,000 GS 110,000 2,250,000 2,250,000 2,250,000

Note that PSS=patientspecific supplies and GS=general supplies

To meet the minimum requirement of microcosting supplies greater than $250, RVUs based on actual supply costs are assigned to products in the Direct Variable Supplies cost category. P3 is an example of a patientspecific supply product. Note that all other cost categories for this product have RVUs equal to 0. Separate workload totals are calculated for general supplies and patientspecific supplies. Radiologist expenses are distributed to patients using RVUs based on the professional component of the OHIP fee schedule. These RVUs are found in the Direct Variable Other cost category. An average cost per RVU is calculated for each cost category within each patient care functional centre as shown in Table 3.16:

Table 3.16: Average Cost per Diagnostic Imaging RVU by Cost Category Cost Categories Direct Indirect

Variable Labour

Variable Supplies (General)

Variable Supplies (Patient Specific)

Variable Other (Medical feefor service)

Fixed Labour


Total G/L Costs $2,000,000 $100,000 $150,000 $100,000 $50,000 $100,000 $700,000

Total RVUs 2,250,000 245,000 150,000 110,000 2,250,000 2,250,000 2,250,000

Average Cost/RVU $0.89 $0.41 $1.00 $0.91 $0.02 $0.04 $0.31

The cost of each product is determined by multiplying the RVU of the product by the average cost per RVU for each cost category. The average cost per RVU for general supplies is shown in the Variable Supplies cost category. For patientspecific supplies, the average cost per RVU is $1.00 since total RVUs are equal to the total costs of patientspecific supplies.



Table 3.17: Intermediate Product Costs for Diagnostic Imaging Functional Centre P1 P2 P3

Average Cost Per RVU

RVU Profile

Total Cost

RVU Profile

Total Cost

RVU Profile Total Cost

Direct Variable Labour $0.89 10 $8.90 5 $4.45 0 $0

Direct Variable Supplies – General Supplies

$0.41 5 $2.05 6 $2.46 0 $0

Direct Variable Supplies – Patient Specific Supplies

$1.00 0 $0 0 $0 300 $300.00

Direct Variable Other (Med. fee forservice)

$0.91 7 $6.37 11 $10.01 0 $0

Direct Fixed Labour $0.02 10 $0.20 5 $0.10 0 $0

Direct Fixed Equipment $0.04 10 $0.40 5 $0.20 0 $0

Total Direct Product Cost $17.92 $17.22 $300.00

Overhead (Indirect Product Cost)

$0.31 10 $3.10 5 $1.55 0 $0

Total Cost of Product $21.02 $18.77 $300.00

3.8.4 EXAMPLE: STEP 4 DISTRIBUTE COSTS TO PATIENTS

Method 1: Distribute Costs to Patients Based on the Total Number of Units Received

For each functional centre from which the patient has received services, calculate the patient’s direct and indirect cost. The patient’s direct cost is obtained by multiplying the unit direct cost by workload units received by the patient, then adding the costs of all microcosted items (e.g., patientspecific supplies greater than $250, drugs) and other nonworkload distributed costs (e.g., medical feeforservice). A patient receiving 25 workload units, 15 medical feeforservice RVUs, and $900 of patientspecific supplies in Diagnostic Imaging, has the following patient costs as summarized in Table 3.18:



Table 3.18: Patient Costs Patient Specific RVUs

Cost Per Unit

Patient Cost

Direct Costs (excluding costs of microcosted and nonworkload distributed items) 25 $1.00 $25.00

FeeForService Cost 15 $0.91 $13.65 PatientSpecific Supplies $900.00

Total Patient Direct Cost $938.65

Total Patient Indirect Cost 25 $0.31 $7.75

Total (Full) Patient Cost $946.40

Method 2: Assign Costs to Patients Based on Utilization of Intermediate Products Costs are assigned to patients by tracking the type and number of intermediate products received by the patient. Patientspecific utilization is multiplied by the cost of the intermediate product to generate the patient’s costs. A patient receiving four intermediate products from Diagnostic Imaging, two P1s, one P2 and one P3, has the following costs as in Table 3.19:

Table 3.19: Patient Costs

Intermed iate Product

Patient Specific Utilizatio n

Intermedi ate Product Direct Cost

Intermediate Product Indirect Cost

Total Intermediate Product Cost

Patient Direct Cost

Patient Indirect Cost

Patient Total Cost

P1 2 $17.92 $3.10 $21.02 $35.84 $6.20 $42.04 P2 1 $17.22 $1.55 $18.77 $17.22 $1.55 $18.77 P3 1 $300.00 $0 $300.00 $300.00 $0 $300.00

$353.06 $7.75 $360.81

Now that costs have been calculated for the products/services received by patients, patient descriptive data from the Health Records system should be fed into the case costing system.

MINISTRY OF HEALTH AND LONGTERM CARE OCCI Appendix A Listing of Functional Centres Health System Information Management and Investment Division Health Data Branch


ONTARIO CASE COSTING GUIDE APPENDIX A – LISTING OF FUNCTIONAL CENTRES

TABLE OF CONTENTS

APPENDIX A1: VALID ABSORBING COST FUNCTIONAL CENTRES BY PATIENT TYPE........... 2 Acute Inpatient Valid Absorbing Cost Functional Centres ................................................................... 2 Ambulatory Valid Absorbing Cost Functional Centres....................................................................... 12 Mental Health Valid Absorbing Cost Functional Centres ................................................................... 25 Rehabilitation Valid Absorbing Cost Functional Centres ................................................................... 32 Complex Continuing Care Valid Absorbing Cost Functional Centres................................................. 39 CCAC Absorbing Cost Functional Centres ........................................................................................ 46

APPENDIX A2: VALID ABSORBING FUNCTIONAL CENTRES..................................................... 48 APPENDIX A3: TRANSIENT FUNCTIONAL CENTRES................................................................... 63 APPENDIX A4: CCAC TRANSIENT FUNCTIONAL CENTRES ....................................................... 67



APPENDIX A1: VALID ABSORBING COST FUNCTIONAL CENTRES BY PATIENT TYPE

ACUTE INPATIENT VALID ABSORBING COST FUNCTIONAL CENTRES

ACCOUNT DESCRIPTION COMMENTS

7* 1 95 AS Food Services

7* 1 95 05 AS Food Services Admin.

7* 1 95 20 AS Food Services Production

7* 1 95 30 AS Food Services Tray Assembly & Distrib

7* 1 95 40 AS Food Services Warewashing

7*2 NURSING INPATIENT SERVICES (IP)

7* 2 05 IP Nursing Administration

7* 2 05 10 IP Nursing Administration All staff are reported as MOS

7* 2 05 20 IP Clinical Resources (centralized) Both UPP and MOS staff Workload required for UPP 7* 2 05 20 20 IP Clinical Res. IV Therapy

7* 2 05 20 40 IP Clinical Res. Enterostomy Therapy

7* 2 05 20 92 IP Clinical Res. Transplant Coord./Organ Procurement

Mandatory if funded transplant activity or if expenses

7* 2 05 20 94 IP Clinical Res. Palliative Care Team

7* 2 06 IP Program Management Administration All staff are reported as MOS

7* 2 07 IP Medical Resources Assign medical expenses to IP Functional Centres when possible

7* 2 07 10 IP Medical Resources Psychiatrists

7* 2 07 20 IP Medical Resources All other Medical Staff

7* 2 07 30 IP Medical Resources Hospitalists

7* 2 10 IP Medical Inpatient Services

7* 2 10 10 IP Medical – General

7* 2 10 20 IP Medical – Endocrinology

7* 2 10 25 IP Medical Clinical Investigation

7* 2 10 30 IP Medical –Communicable Diseases

7* 2 10 35 IP Medical –Dermatology

7* 2 10 44 IP Medical –Cardiology

7* 2 10 45 IP Medical Family Practice

7* 2 10 50 IP Medical –Gastroenterology

7* 2 10 55 IP Medical –Metabolic

7* 2 10 61 IP Medical –Neurology

7* 2 10 66 IP Medical –Oncology

7* 2 10 75 IP Medical –Rheumatology

7* 2 10 80 IP Medical –Respirology




7* 2 10 85 IP Medical –Assessment Unit

7* 2 10 86 IP Medical –Nephrology

7* 2 10 90 IP Medical –Hematology

7* 2 10 94 IP Medical –Palliative Care Prev. 7* 2 94

7* 2 20 IP Surgical Inpatient Services

7* 2 20 10 IP Surgical – Surgical

7* 2 20 25 IP Surgical Dental

7* 2 20 28 IP Surgical – Trauma (Post Surgery)

7* 2 20 30 IP Surgical Ear, Nose and Throat

7* 2 20 35 IP Surgical – Gynecology

7* 2 20 42 IP Surgical – Cardiac

7* 2 20 45 IP Surgical Plastic

7* 2 20 55 IP Surgical Oral/Facial

7* 2 20 61 IP Surgical – Neurosurgery

7* 2 20 62 IP Surgical – Ophthalmology

7* 2 20 66 IP Surgical – Oncology

7* 2 20 70 IP Surgical – Thoracic

7* 2 20 72 IP Surgical – Orthopedic

7* 2 20 75 IP Surgical – Urology

7* 2 20 80 IP Surgical – Vascular

7* 2 20 92 IP Surgical – Transplant

7* 2 30 IP Combined Medical/Surgical Not to be used for greater than 60 beds unless multiple small sites Report sites S 8 99 00 in 8* 9 90

7* 2 40 IP Intensive Care Unit (ICU) Use only use if advanced technology

7* 2 40 10 IP ICU – Medical

7* 2 40 20 IP ICU – Surgical

7* 2 40 28 IP ICU Trauma

7* 2 40 30 IP ICU Combined Med/Surg Used by hospitals with single ICU.

7* 2 40 35 IP ICU – Burn

7* 2 40 42 IP ICU Cardiac (Surgical)

7* 2 40 44 IP ICU Coronary Care (Med)

7* 2 40 50 IP ICU – Neonatal Level III Nursery Must be reported if have Level III funding

7* 2 40 61 IP ICU – Neurosurgery

7* 2 40 70 IP ICU – Pediatric

7* 2 40 80 IP ICU – Respirology

7* 2 40 92 IP ICU Transplant

7* 2 42 IP Cardiac Monitored Care Mandatory in small hosp ICU or stepdown unit

7* 2 42 10 IP Cardiac Monitored Care Medical

7* 2 42 20 IP Cardiac Monitored Care Surgical




7* 2 42 30 IP Cardiac Monitored Care Combined

7* 2 42 42 IP Cardiac Monitored Care Cardiac

7* 2 42 44 IP Cardiac Monitored Care Coronary

7* 2 50 IP Obstetrics For comparative purposes detailed functional centres will be rolled to 7* 2 50 90 excl. Level II Nursery

7* 2 50 20 IP Obstetrics Suite (L & D)

7* 2 50 20 20 IP Obstetrics Labour and Delivery Rooms

7* 2 50 20 40 IP Obstetrics Recovery Room

7* 2 50 20 60 IP Obstetrics Caesarean Section Room

7* 2 50 30 IP Obstetrics Birthing Centre Includes pre/post. Hospitalization care

7* 2 50 40 IP Obstetrics Ante/Postpartum

7* 2 50 40 20 IP Obstetrics General Ante/Postpartum

7* 2 50 40 40 IP Obstetrics High Risk Antepartum

7* 2 50 60 IP Obstetrics Combined Care

7* 2 50 60 10 IP Obstetrics General Combined Care

7* 2 50 60 20 IP Obstetrics High Risk Combined Care

7* 2 50 80 IP Obstetrics Nursery

7* 2 50 80 20 IP Obstetrics General Nursery

7* 2 50 80 40 IP Obstetrics Intermediate Nursery (Level 2) Mandatory if approved Level II funding

7* 2 50 90 IP Obstetrics Lab, Delivery, Rec, Postpartum (LDRP)

7* 2 60 IP Operating Room (OR)

7* 2 60 20 OR General Surgical

7* 2 60 25 OR Dental

7* 2 60 28 OR Trauma

7* 2 60 30 OR Cystology

7* 2 60 42 OR Cardiac

7* 2 60 45 OR Plastic Surgery

7* 2 60 61 OR Neurosurgery

7* 2 60 62 OR Ophthalmology

7* 2 60 72 OR Orthopedic

7* 2 60 92 OR Transplant

7* 2 62 IP OR/PARR Combined Small hospitals may combine OR and PARR

7* 2 65 IP PostAnesthetic Recovery Rooms (PARR)

7* 2 65 20 PARR General

7* 2 65 42 PARR Cardiac

7* 2 65 61 PARR Neurosurgery

7* 2 70 IP Pediatric

7* 2 70 10 IP Pediatric – Medical Use 7* 2 76 50 for Mental Health

7* 2 70 20 IP Pediatric – Surgical




7*3 AMBULATORY CARE SERVICES (AC)

7* 3 05 AC Ambulatory Care Administration All staff are reported as MOS

7* 3 05 10 AC Ambulatory Care General

7* 3 05 20 AC Ambulatory Care – Ontario Telemedicine Network (OTN)

NAME CHANGE 2008/09 Q1 Do not use for Service Recipient Activities

7* 3 06 AC Program Management Administration All staff are reported as MOS

7* 3 07 AC Medical Resources Assign expenses to Ambulatory Care functional centres if possible

7* 3 07 10 AC Medical Resources Psychiatrists

7* 3 07 20 AC Medical Resources Other Medical staff

7* 3 07 30 AC Medical Resources Hospital OnCall Coverage

7* 3 07 35 AC Medical Resources UAP – Visiting Specialist Clinics

7* 3 10 AC Emergency (ER) NACRS mandatory FC

7* 3 10 20 AC Emergency – General

7* 3 10 22 AC Emergency – Alternate Funding

7* 3 10 25 AC Emergency – Hospital Urgent Care Centre

7* 3 10 28 AC Emergency – Trauma Must report if Trauma funded

7* 3 10 40 AC Emergency – Interim Assessment Observation unit

7* 3 10 76 AC Emergency – Psychiatric Services/Crisis Intervention

Must report if MH funded

7* 3 20 AC Poison Information Centre

7* 3 30 AC Telehealth Not to be used for videoconferencing services.

7* 3 30 10 AC Telehealth – Network Health Canada (CHIPP) Previously 7* 3 30 Do not use for Telemedicine OTN

7* 3 30 20 AC Telehealth – Provincial Telephone advice Prev. 7* 3 32

7* 3 30 30 AC Telehealth – Hospital Emergency Advice Centre

Prev. 7* 3 10 80

7* 3 40 AC Specialty Day/Night Care

7* 3 40 05 AC Day/Night Care General DO NOT USE FOR L&D Patients

7* 3 40 10 AC Day/Night Care Medical DO NOT USE FOR L&D Patients

7* 3 40 10 10 AC Day/Night Care Medical General

7* 3 40 10 20 AC Day/Night Care Medical AIDS

7* 3 40 15 AC Day/Night Care – Diabetes

7*3 40 20 AC day/Night Care Pre & Post Operative Care (OR/PARR Excl.)

7* 3 40 25 AC Day/Night Care – Surgical/Proc. (OR/PARR Incl.)

NACRS mandatory functional centre Use if surgery physically occurs within this Day/Night Functional Centre

7* 3 40 25 20 AC Day/Night Care Surgical Operating Rooms

7* 3 40 25 40 AC Day/Night Care Surgical Recovery Room

7* 3 40 25 60 AC Day/Night Care Surgical Pre and PostOp. Care

7* 3 40 42 AC Day/Night Care – Cardiac Must report if priority program funding




7* 3 40 42 10 AC Day/Night Care – Cardiac General

7* 3 40 42 20 AC Day/Night Care – Cardiac Hemodynamic

7* 3 40 55 AC Day/Night Care – Endoscopy NACRS mandatory Functional Centre

7* 3 40 65 AC Day/Night Care –Metabolic

7* 3 40 66 AC Day/Night Care – Oncology NACRS mandatory Functional Centre

7* 3 40 66 10 AC Day/Night Care Oncology – Chemotherapy

7* 3 40 66 20 AC Day/Night Care Oncology – Other Supportive Therapy

Only required if unique Functional Centre

7* 3 40 76 AC Day/Night Care –Mental Health/Addictions Must report if Mental Health funded

7* 3 40 76 25 AC Day/Night Care MH Acute

7* 3 40 76 45 AC Day/Night Care Addiction

7* 3 40 76 50 AC Day/Night Care MH Child /Adolescent

7* 3 40 76 55 AC Day/Night Care MH Forensic Psychiatric

7* 3 40 76 95 AC Day/Night Care MH Longer Term Care

7* 3 40 86 AC Renal Dialysis NACRS mandatory Functional Centre

7* 3 40 86 10 AC Day/Night Care Hemodialysis

7* 3 40 86 20 AC Day/Night Care Home Dialysis (Teaching) Comb.

7* 3 40 86 30 AC Day/Night Care Home Hemodialysis (Teaching)

7* 3 40 86 40 AC Day/Night Care Home Peritoneal Dial. (Teaching)

7* 3 40 86 50 AC Day/Night Care Peritoneal Dialysis

7* 3 40 86 60 AC Day/Night Care SelfCare Hemodialysis

7* 3 40 94 AC Day/Night Care – Palliative

7* 3 40 96 AC Day/Night Care – Geriatric

7* 3 40 96 20 AC Day/Night Care Geriatric General

7* 3 40 96 40 AC Day/Night Care Geriatric Assessment and Evaluation

7* 3 40 96 80 AC Day/Night Care Geriatric Social Support

7* 3 40 96 81 AC Day/Night Care Geriatric Rehabilitation /Activation

7* 3 60 Day Surgery Operating Room NEW APRIL 2009 (2009/10)

7* 3 62 Day Surgery Combined OR & PARR NEW APRIL 2009 (2009/10)

7* 3 65 Day Surgery PostAnesthetic Recovery Room NEW APRIL 2009 (2009/10)

7* 3 67 Day Surgery Pre and Post Operative Care NEW APRIL 2009 (2009/10)

7* 3 69 Day Surgery Combined OR, PARR & Pre and Post Care

NEW APRIL 2009 (2009/10)

7*4 DIAGNOSTIC AND THERAPEUTIC SERVICES

7* 4 06 D&T Program Management Administration All staff are reported as MOS

7* 4 10 LAB Clinical Laboratory Small hospitals can use 7* 4 10 99 for all activity

7* 4 10 10 LAB Administration All staff are reported as MOS

7* 4 10 15 LAB Centralized Support Services DO NOT USE AFTER MARCH 31 2009




7* 4 10 15 10 LAB Centralized Laboratory Glassware DO NOT USE AFTER MARCH 31 2009

7* 4 10 15 20 LAB Centralized Media Preparation DO NOT USE AFTER MARCH 31 2009

7* 4 10 15 30 LAB Centralized Reagent Manufacturing DO NOT USE AFTER MARCH 31 2009

7* 4 10 20 LAB Specimen Procurement, Dispatch,Receipt DO NOT USE AFTER MARCH 31 2009

7* 4 10 20 10 LAB Specimen Procurement and Dispatch DO NOT USE AFTER MARCH 31 2009

7* 4 10 20 20 LAB Central Receiving and Accessioning DO NOT USE AFTER MARCH 31 2009

7* 4 10 21 LAB Pre/Post Analysis NEW APRIL 2009 (2009/10)

7* 4 10 21 10 LAB Specimen Procurement NEW APRIL 2009 (2009/10)

7* 4 10 21 20 LAB Specimen Receipt & Dispatch NEW APRIL 2009 (2009/10)

7* 4 10 25 LAB Clinical Chemistry

7* 4 10 25 10 LAB Routine Chemistry

7* 4 10 25 20 LAB Urinalysis

7* 4 10 25 30 LAB Therapeutic Drug Monitoring/Toxicology

7* 4 10 25 40 LAB Radio Immunoassay/Enzyme Immunoassay

7* 4 10 25 50 LAB Specialty Chemistry

7* 4 10 25 60 LAB Prenatal Genetics Screening Mandatory if services provided

7* 4 10 25 70 LAB Biochemical Genetics Mandatory if services provided

7* 4 10 25 80 LAB Blood Gas NEW APRIL 2009 (2009/10)

7* 4 10 25 90 LAB Point of Care Testing NEW APRIL 2009 (2009/10)

7* 4 10 30 LAB Hematology

7* 4 10 30 20 LAB Routine Hematology

7* 4 10 30 40 LAB Coagulation

7* 4 10 30 60 LAB Special Hematology

7* 4 10 35 LAB Transfusion Services

7* 4 10 35 10 LAB Routine Transfusion Services

7* 4 10 35 20 LAB Special Transfusion Services

7* 4 10 35 30 LAB Cryopreservation

7* 4 10 40 LAB Anatomical Pathology DO NOT USE AFTER MARCH 31 2009

7* 4 10 40 20 LAB Surgical Pathology DO NOT USE AFTER MARCH 31 2009

7* 4 10 40 40 LAB Autopsy Pathology DO NOT USE AFTER MARCH 31 2009

7* 4 10 40 60 LAB Cytopathology DO NOT USE AFTER MARCH 31 2009

7* 4 10 40 80 LAB Electron Microscopy DO NOT USE AFTER MARCH 31 2009

7* 4 10 41 LAB Anatomical Pathology NEW APRIL 2009 (2009/10)

7* 4 10 41 20 LAB Surgical Pathology NEW APRIL 2009 (2009/10)

7* 4 10 41 40 LAB Autopsy Pathology NEW APRIL 2009 (2009/10)

7* 4 10 42 LAB Cytopathology NEW APRIL 2009 (2009/10)

7* 4 10 43 LAB Electron Microscopy NEW APRIL 2009 (2009/10)




7* 4 10 45 LAB Microbiology

7* 4 10 45 10 LAB Bacteriology

7* 4 10 45 20 LAB Serology

7* 4 10 45 30 LAB Mycology

7* 4 10 45 40 LAB Parasitology

7* 4 10 45 50 LAB Virology

7* 4 10 45 55 LAB Environmental Testing

7* 4 10 50 LAB Immunology DO NOT USE AFTER MARCH 31 2009

7* 4 10 55 LAB Cytogenetics DO NOT USE AFTER MARCH 31 2009

7* 4 10 60 LAB Tissue Typing Histocompatibility & Immunogenetics

NAME CHANGE APRIL 2009 (2009/10)

7* 4 10 65 LAB Stat Laboratory DO NOT USE AFTER MARCH 31 2009

7* 4 10 75 LAB Molecular Diagnostics DO NOT USE AFTER MARCH 31 2009

7* 4 10 85 LAB Diagnostic Genetics NEW APRIL 2009 (2009/10)

7* 4 10 85 10 LAB Cytogenetics NEW APRIL 2009 (2009/10)

7* 4 10 85 20 LAB Molecular Genetics NEW APRIL 2009 (2009/10)

7* 4 10 99 LAB Combined Functions Small hospitals may use to report all activity

7* 4 15 DI Diagnostic Imaging Small hospitals can use 71 4 15 99

7* 4 15 10 DI Administration All staff are reported as MOS

7* 4 15 12 DI AdministrationPACS PACS Picture Archiving and Communication System. All staff are reported as MOS.

7* 4 15 18 DI Radiography Prev 7* 4 15 15 10

7* 4 15 20 DI Mammography

7* 4 15 20 10 DI Screening Mammography See rules for OBSP (Ontario Breast Screening Program)

7* 4 15 20 20 DI Diagnostic Mammography Prev. 7* 4 15 20

7* 4 15 23 DI Interventional/Angiography

7* 4 15 23 10 DI Interventional Studies

7* 4 15 23 20 DI Angiography Studies

7* 4 15 25 DI Computed Tomography Mandatory if service provided

7* 4 15 30 DI Diagnostic Ultrasound

7* 4 15 30 20 DI Abdominal Ultrasound

7* 4 15 30 30 DI Echocardiography Ultrasound

7* 4 15 30 40 DI Pelvic Ultrasound

7* 4 15 30 60 DI Ophthalmological Ultrasound

7* 4 15 30 80 DI Neurological Ultrasound

7* 4 15 30 90 DI Vascular Ultrasound

7* 4 15 30 99 DI Combined Ultrasound Functions

7* 4 15 35 DI Nuclear Medicine Gamma Cameras NEW APRIL 2009 (2009/10)

7* 4 15 40 DI Nuclear Medicine DO NOT USE AFTER MARCH 31 2009




7* 4 15 44 DI Cardiac Catheterization Lab Mandatory if service is provided. NACRS mandatory Functional Centre.

7* 4 15 44 10 DI Cardiac Catheterization Interventional

7* 4 15 44 20 DI Cardiac Catheterization Diagnostic Services

7* 4 15 60 DI Positron Emission Tomography (PET) NEW APRIL 2009 (2009/10)

7* 4 15 70 DI Magnetic Resonance Imaging Mandatory if service is provided.

7* 4 15 99 DI Combined Functions Small hospitals may use to report all activity

7* 4 25 ED Electrodiagnostic Laboratories

7* 4 25 10 ED EEG

7* 4 25 20 ED EMG

7* 4 25 30 ED Evoked Potentials

7* 4 25 40 ED Polysomnography (formerly Sleep Studies)

7* 4 25 50 ED Intensive Monitoring

7* 4 25 60 ED ENG/EOG

7* 4 25 99 ED Electrodiagnosis – Combined Functions Small hospitals may use to report all activity

Hospitals without dedicated staff may report in the 7* 4 ** functional centre providing the service

7* 4 30 NV NonInvasive Cardiology and Vascular Laboratories

Formerly Other Diagnostics

7* 4 30 20 NV NonInvasive Cardiology Laboratories

7* 4 30 20 20 NV Echocardiography

7* 4 30 20 40 NV Ambulatory Monitoring (formerly Holter)

7* 4 30 20 60 NV Exercise Stress Test

7* 4 30 20 80 NV Electrophysiology

7* 4 30 20 90 NV ECG

7* 4 30 20 99 NV Non Invasive Cardiology – Combined

7* 4 30 40 NV Vascular Laboratories

7* 4 35 RS Respiratory Services Mandatory to report at lower level if Hyperbaric Chamber

7* 4 35 10 RS Respiratory Services Administration

7* 4 35 25 RS Routine/Critical Care

7* 4 35 25 10 RS Routine

7* 4 35 25 20 RS Critical Care

7* 4 35 30 RS Hyperbaric Chamber Must report if service provided

7* 4 35 42 RS Pulmonary Function Laboratory

7* 4 35 45 RS Blood Gas Laboratory Where Clinical Lab staff provide limited blood gas analysis, report in (7* 4 10 **)

7* 4 35 50 RS Anesthesia

7* 4 35 60 RS Perfusion DO NOT USE AFTER MARCH 31 2009

7* 4 36 Cardiovascular (CV) Perfusion NEW APRIL 2009 (2009/10)




7* 4 40 PH Pharmacy

7* 4 40 05 PH General Pharmacy All hospitals workload measurement accounts required

7* 4 40 10 PH Pharmacy Administration Mandatory reporting level changed

7* 4 40 60 PH Clinical Pharmacy

7* 4 40 60 10 PH Clinical Pharmacy Drug Information

7* 4 40 60 20 PH Clinical Pharmacy Other

7* 4 40 70 PH Drug Procurement and Distribution

7* 4 44 TH Combined Therapeutics Less than 5 Therapy FTEs per facility

7* 4 45 TH Clinical Nutrition

7* 4 49 TH Rehabilitation Services Clinical Management All staff are reported as MOS

7* 4 50 TH Physiotherapy

7* 4 55 TH Occupational Therapy

7* 4 55 20 TH Occupational Therapy – General

7* 4 55 76 TH Occupational Therapy Mental Health

7* 4 55 76 10 TH Occupational Therapy MH General

7* 4 55 76 20 TH Occupational Therapy MH Vocational Workshop

7* 4 60 TH Audiology & Speech/Language Pathology

7* 4 60 20 TH Speech/Language Pathology

7* 4 60 40 TH Audiology

7* 4 65 TH Rehabilitation Engineering

7* 4 65 20 TH Rehabilitation Engineering – Prosthetics

7* 4 65 40 TH Rehabilitation Engineering – Orthotics

7* 4 65 60 TH Rehabilitation Engineering – Seating Systems

7* 4 66 RAD Radiation Oncology Previously 7* 4 20 (part of DI framework)

7* 4 66 10 RAD Treatment Planning

7* 4 66 20 RAD Mould Room

7* 4 66 30 RAD Treatment

7* 4 70 TH Social Work

7* 4 70 10 TH Social Work – General

7* 4 70 20 TH Social Work Family Therapy

7* 4 70 30 TH Social Work Community Integration

7* 4 72 TH Addiction Counselors

7* 4 74 TH Genetics Counselling Previously 7*3 50 48, 7*3 50 50 40, 7*3 50 70 45

7* 4 75 TH Psychology and Psychometry

7* 4 75 20 TH Psychology and Psychometry Clinical Psychology

7* 4 75 40 TH Psychology and Psychometry Neuro psychology

7* 4 80 TH Pastoral Care




7* 4 85 TH Therapeutic Recreation

7* 4 85 10 TH Recreation Therapy Goal Oriented

7* 4 85 20 TH Recreation Therapy – Participation

7* 4 90 TH Child Life Report MH Youth Workers in IP Nursing



AMBULATORY VALID ABSORBING COST FUNCTIONAL CENTRES


7*1 ADMINISTRATIVE SERVICES









7* 2 05 20 IP Clinical Resources (centralized) Both UPP and MOS staff Workload required for UPP

7* 2 05 20 20 IP Clinical Res. IV Therapy

7* 2 05 20 40 IP Clinical Res. Enterostomy Therapy

7* 2 05 20 92 IP Clinical Res. Transplant Coord./Organ Procurement

Mandatory if funded transplant activity or if expenses








7* 2 10 10 IP Medical – General

7* 2 10 20 IP Medical – Endocrinology

7* 2 10 25 IP Medical Clinical Investigation

7* 2 10 30 IP Medical –Communicable Diseases

7* 2 10 35 IP Medical –Dermatology

7* 2 10 44 IP Medical –Cardiology

7* 2 10 45 IP Medical Family Practice

7* 2 10 50 IP Medical –Gastroenterology

7* 2 10 55 IP Medical –Metabolic

7* 2 10 61 IP Medical –Neurology

7* 2 10 66 IP Medical –Oncology

7* 2 10 75 IP Medical –Rheumatology

7* 2 10 80 IP Medical –Respirology

7* 2 10 85 IP Medical –Assessment Unit

7* 2 10 86 IP Medical –Nephrology




7* 2 10 90 IP Medical –Hematology

7* 2 10 94 IP Medical –Palliative Care Prev. 7* 2 94

7* 2 20 IP Surgical Inpatient Services

7* 2 20 10 IP Surgical – Surgical

7* 2 20 25 IP Surgical Dental

7* 2 20 28 IP Surgical – Trauma (Post Surgery)

7* 2 20 30 IP Surgical Ear, Nose and Throat

7* 2 20 35 IP Surgical – Gynecology

7* 2 20 42 IP Surgical – Cardiac

7* 2 20 45 IP Surgical Plastic

7* 2 20 55 IP Surgical Oral/Facial

7* 2 20 61 IP Surgical – Neurosurgery

7* 2 20 62 IP Surgical – Ophthalmology

7* 2 20 66 IP Surgical – Oncology

7* 2 20 70 IP Surgical – Thoracic

7* 2 20 72 IP Surgical – Orthopedic

7* 2 20 75 IP Surgical – Urology

7* 2 20 80 IP Surgical – Vascular

7* 2 20 92 IP Surgical – Transplant

7* 2 30 IP Combined Medical/Surgical Not to be used for greater than 60 beds unless multiple small sites Report sites S 8 99 00 in 8* 9 90

7* 2 40 IP Intensive Care Unit (ICU) Use only use if advanced technology

7* 2 40 10 IP ICU – Medical

7* 2 40 20 IP ICU – Surgical

7* 2 40 28 IP ICU Trauma

7* 2 40 30 IP ICU Combined Med/Surg Used by hospitals with single ICU.

7* 2 40 35 IP ICU – Burn

7* 2 40 42 IP ICU Cardiac (Surgical)

7* 2 40 44 IP ICU Coronary Care (Med)

7* 2 40 50 IP ICU – Neonatal Level III Nursery Must be reported if have Level III funding

7* 2 40 61 IP ICU – Neurosurgery

7* 2 40 70 IP ICU – Pediatric

7* 2 40 80 IP ICU – Respirology

7* 2 40 92 IP ICU Transplant

7* 2 42 IP Cardiac Monitored Care Mandatory in small hosp ICU or stepdown unit

7* 2 42 10 IP Cardiac Monitored Care Medical

7* 2 42 20 IP Cardiac Monitored Care Surgical

7* 2 42 30 IP Cardiac Monitored Care Combined

7* 2 42 42 IP Cardiac Monitored Care Cardiac




7* 2 42 44 IP Cardiac Monitored Care Coronary

7* 2 50 IP Obstetrics For comparative purposes detailed functional centres will be rolled to 7* 2 50 90 excl. Level II Nursery

7* 2 50 20 IP Obstetrics Suite (L & D)

7* 2 50 20 20 IP Obstetrics Labour and Delivery Rooms

7* 2 50 20 40 IP Obstetrics Recovery Room

7* 2 50 20 60 IP Obstetrics Caesarean Section Room

7* 2 50 30 IP Obstetrics Birthing Centre Includes pre/post. Hospitalization care

7* 2 50 40 IP Obstetrics Ante/Postpartum

7* 2 50 40 20 IP Obstetrics General Ante/Postpartum

7* 2 50 40 40 IP Obstetrics High Risk Antepartum

7* 2 50 60 IP Obstetrics Combined Care

7* 2 50 60 10 IP Obstetrics General Combined Care

7* 2 50 60 20 IP Obstetrics High Risk Combined Care

7* 2 50 80 IP Obstetrics Nursery

7* 2 50 80 20 IP Obstetrics General Nursery

7* 2 50 80 40 IP Obstetrics Intermediate Nursery (Level 2) Mandatory if approved Level II funding

7* 2 50 90 IP Obstetrics Lab, Delivery, Rec, Postpartum (LDRP)

7* 2 60 IP Operating Room (OR) NACRS mandatory FC

7* 2 60 20 OR General Surgical

7* 2 60 25 OR Dental

7* 2 60 28 OR Trauma

7* 2 60 30 OR Cystology

7* 2 60 42 OR Cardiac

7* 2 60 45 OR Plastic Surgery

7* 2 60 61 OR Neurosurgery

7* 2 60 62 OR Ophthalmology

7* 2 60 72 OR Orthopedic

7* 2 60 92 OR Transplant

7* 2 62 IP OR/PARR Combined NACRS mandatory FC. Small hospitals may combine OR and PARR

7* 2 65 IP PostAnesthetic Recovery Rooms (PARR) NACRS mandatory FC


7* 2 65 42 PARR Cardiac

7* 2 65 61 PARR Neurosurgery

7* 2 70 IP Pediatric

7* 2 70 10 IP Pediatric – Medical Use 7* 2 76 50 for Mental Health

7* 2 70 20 IP Pediatric – Surgical





The following functional centres marked as mandatory for NACRS should be submitted to OCCI. All else are valid AFCs but should not be included to OCCI Annual Submission. 7* 3 05 AC Ambulatory Care Administration All staff are reported as MOS


7* 3 05 20 AC Ambulatory Care – Ontario Telemedicine Network

NAME CHANGE 2008/09 Q1 Do not use for Service Recipient Activities


7* 3 07 AC Medical Resources Assign expenses to ambulatory care Functional Centres if possible





7* 3 10 AC Emergency (ER) NACRS mandatory FC 7*3107*31076





7* 3 10 40 AC Emergency – Interim Assessment /CDU Observation unit





7* 3 30 10 AC Telehealth – Network Health Canada (CHIPP) Prev. 7* 3 30 Do not use for Telemedicine OTN



Prev. 7* 3 10 80


7* 3 40 05 AC Day/Night Care General DO NOT USE FOR L&D Patients

7* 3 40 10 AC Day/Night Care Medical DO NOT USE FOR L&D Patients

7* 3 40 10 10 AC Day/Night Care Medical General

7* 3 40 10 20 AC Day/Night Care Medical AIDS

7* 3 40 15 AC Day/Night Care – Diabetes

7* 3 40 20 AC Day/Night Care Pre & Post Operative Care (OR/PARR Excl.)

DO NOT USE AFTER MARCH 31 2009

7* 3 40 25 AC Day/Night Care – Surgical/Proc. (OR/PARR Incl.)

DO NOT USE AFTER MARCH 31 2009

7* 3 40 25 20 AC Day/Night Care Surgical Operating Rooms DO NOT USE AFTER MARCH 31 2009

7* 3 40 25 40 AC Day/Night Care Surgical Recovery Room DO NOT USE AFTER MARCH 31 2009

7* 3 40 25 60 AC Day/Night Care Surgical Pre and PostOp. Care DO NOT USE AFTER MARCH 31 2009

7* 3 40 42 AC Day/Night Care – Cardiac Must report if priority program funding

7* 3 40 42 10 AC Day/Night Care – Cardiac General




7* 3 40 42 20 AC Day/Night Care – Cardiac Hemodynamic

7* 3 40 55 AC Day/Night Care – Endoscopy NACRS mandatory Functional Center

7* 3 40 65 AC Day/Night Care – Metabolic

7* 3 40 66 AC Day/Night Care – Oncology

7* 3 40 66 10 AC Day/Night Care Oncology – Chemotherapy

7* 3 40 66 20 AC Day/Night Care Oncology – Other Supportive Therapy

NACRS mandatory Functional Center 7* 3 40 667* 3 40 66 20

7* 3 40 76 AC Day/Night Care – Mental Health/Addictions Must report if Mental Health funded






7* 3 40 86 AC Renal Dialysis NACRS mandatory Functional Center 7*34086 7*3408660

7* 3 40 86 10 AC Day/Night Care Hemodialysis

7* 3 40 86 20 AC Day/Night Care Home Dialysis (Teaching) Comb.

7* 3 40 86 30 AC Day/Night Care Home Hemodialysis (Teaching)

7* 3 40 86 40 AC Day/Night Care Home Peritoneal Dial.(Teaching)

7* 3 40 86 50 AC Day/Night Care Peritoneal Dialysis

7* 3 40 86 60 AC Day/Night Care SelfCare Hemodialysis







7* 3 50 AC Ambulatory Care Clinics For services with mandatory reporting: If small volumes report in a Combined FC all staff are reported as MOS

7* 3 50 05 AC Clinic Administration

7* 3 50 10 AC Clinic Medical

7* 3 50 10 10 AC Clinic Medical – General

7* 3 50 10 15 AC Clinic Medical – Sexually Transmitted Diseases

7* 3 50 10 18 AC Clinic Medical – Autologous Blood

7* 3 50 10 19 AC Clinic Medical – Aids

7* 3 50 10 20 AC Clinic Medical – Allergy

7* 3 50 10 25 AC Clinic Medical – Anticoagulant




7* 3 50 10 30 AC Clinic Medical – Chiropody Mandatory if service provided

7* 3 50 10 35 AC Clinic Medical – Communicable Diseases

7* 3 50 10 40 AC Clinic Medical – Dermatology Clinic Medical

7* 3 50 10 45 AC Clinic Medical – Enterostomal Therapy

7* 3 50 10 50 AC Clinic Medical – Gastroenterology

7* 3 50 10 55 AC Clinic Medical – Hematology

7* 3 50 10 56 AC Clinic Medical – Hemophiliac Required if funded

7* 3 50 10 60 AC Clinic Medical – Hypertension

7* 3 50 10 65 AC Clinic Medical – Immunology

7* 3 50 10 70 AC Clinic Medical – PreAdmission

7* 3 50 10 75 AC Clinic Medical – Pain Management

7* 3 50 10 80 AC Clinic Medical – Podiatry Mandatory if service provided

7* 3 50 10 85 AC Clinic Medical – Respirology Includes Asthma Clinics

7* 3 50 10 86 AC Clinic Medical – Nephrology Mandatory if service provided

7* 3 50 10 87 AC Clinic Medical – Cystic Fibrosis

7* 3 50 10 88 AC Clinic Medical – Sexual Assault and Domestic Violence

Mandatory if service provided

7* 3 50 10 90 AC Clinic Medical – Travel and Inoculation

7* 3 50 15 AC Clinic Surgical

7* 3 50 15 10 AC Clinic Surgical General

7* 3 50 15 20 AC Clinic Surgical Dental Mandatory if service is provided

7* 3 50 15 25 AC Clinic Surgical – Ear, Nose and Throat

7* 3 50 15 30 AC Clinic Surgical Minor

7* 3 50 15 35 AC Clinic Surgical Oral/Facial

7* 3 50 15 40 AC Clinic Surgical Orthodontic Mandatory if service is provided

7* 3 50 15 45 AC Clinic Surgical PreAdmission

7* 3 50 15 50 AC Clinic Surgical – Thoracic

7* 3 50 15 60 AC Clinic Surgical Urology

7* 3 50 15 87 AC Clinic Surgical – Bone Marrow

7* 3 50 15 92 AC Clinic Surgical Transplant Mandatory if service provided

7* 3 50 17 AC Clinic Combined Specific clinic profile activity accounts 5 ** ** is required

7* 3 50 17 10 AC Clinic Combined – General Med/Surg.

7* 3 50 17 20 AC Clinic Combined Obs./Gynecological

7* 3 50 17 30 AC Clinic Combined Maternal Child Health Report a visit for both mother and baby

7* 3 50 25 AC Clinic Family Practice

7* 3 50 35 AC Clinic – Gynecology

7* 3 50 35 10 AC Clinic Gynecology General Gynecology

7* 3 50 35 30 AC Clinic Gynecology Colposcopy

7* 3 50 35 40 AC Clinic Gynecology Family Planning




7* 3 50 35 50 AC Clinic Gynecology Infertility

7* 3 50 35 60 AC Clinic Gynecology Therapeutic Abortion

7* 3 50 35 70 AC Clinic Gynecology Well Women

7* 3 50 40 AC Clinic Metabolic

7* 3 50 40 10 AC Clinic Metabolic General

7* 3 50 40 20 AC Clinic Metabolic Diabetes – Combined

7* 3 50 40 22 AC Clinic Metabolic Diabetes – Pediatric

7* 3 50 40 24 AC Clinic Metabolic Diabetes – Adult

7* 3 50 42 AC Clinic Cardiac

7* 3 50 42 10 AC Clinic Cardiac – General Cardiology

7* 3 50 42 20 AC Clinic Cardiac – Cardiovascular Surgery

7* 3 50 42 30 AC Clinic Cardiac – Congenital

7* 3 50 42 40 AC Clinic Cardiac – Pacemaker

7* 3 50 42 60 AC Clinic Cardiac – Rehabilitation

7* 3 50 42 70 AC Clinic Cardiac – Valve

7* 3 50 43 AC Clinic Endocrinology

7* 3 50 50 AC Clinic Obstetrics DO NOT USE FOR L&D Clients

7* 3 50 50 20 AC Clinic Obstetrics General Antepartum

7* 3 50 50 60 AC Clinic Obstetrics High Risk Ante/Postpartum

7* 3 50 50 80 AC Clinic Obstetrics Postpartum

7* 3 50 61 AC Clinic Neurology

7* 3 50 61 10 AC Clinic Neurology General Neurology

7* 3 50 61 20 AC Clinic Neurology General Neurosurgery

7* 3 50 61 30 AC Clinic Neurology Convulsive Disorders

7* 3 50 61 40 AC Clinic Neurology Migraine

7* 3 50 61 50 AC Clinic Neurology Neuromuscular Disorders

7* 3 50 61 60 AC Clinic Neurology Vertigo

7* 3 50 61 80 AC Clinic Neurology Multiple Sclerosis

7* 3 50 62 AC Clinic Ophthalmology Ophthalmology

7* 3 50 62 10 AC Clinic Ophthalmology General Ophthalmology

7* 3 50 62 20 AC Clinic Ophthalmology Contact Lens

7* 3 50 62 30 AC Clinic Ophthalmology Cryosurgery

7* 3 50 62 35 AC Clinic Ophthalmology Visudyne Required if funded

7* 3 50 62 40 AC Clinic Ophthalmology Flouroscein

7* 3 50 62 50 AC Clinic Ophthalmology Glaucoma

7* 3 50 62 60 AC Clinic Ophthalmology Laser

7* 3 50 62 70 AC Clinic Ophthalmology Orthoptic

7* 3 50 62 80 AC Clinic Ophthalmology Tonography




7* 3 50 62 90 AC Clinic Ophthalmology Ultrasound

7* 3 50 66 AC Clinic Oncology

7* 3 50 66 05 AC Clinic Onc. – Systemic Pre and Post Treatment Report Treatment in 7* 3 40 66

7* 3 50 66 15 AC Clinic Onc. – Radiation Pre and Post Treatment Report Treatment in 7* 4 66

7* 3 50 66 20 AC Clinic Oncology Surgical Pre and Post

7* 3 50 66 30 AC Clinic Oncology – Combined

7* 3 50 70 AC Clinic Pediatric

7* 3 50 70 10 AC Clinic Pediatric General

7* 3 50 70 20 AC Clinic Pediatric Well Baby

7* 3 50 70 30 AC Clinic Pediatric Child Protection

7* 3 50 70 35 AC Clinic Pediatric Spina Bifida

7* 3 50 70 50 AC Clinic Pediatric Growth and Development

7* 3 50 70 55 AC Clinic Pediatric Scoliosis

7* 3 50 70 65 AC Clinic Pediatric Neonatology

7* 3 50 70 75 AC Clinic Pediatric Pediatric Connective Tissues

7* 3 50 70 85 AC Clinic Pediatric Juvenile Convulsive Disorders

7* 3 50 72 AC Clinic Orthopedic

7* 3 50 72 10 AC Clinic Orthopedic General

7* 3 50 72 20 AC Clinic Orthopedic Fracture Mandatory if service is provided

7* 3 50 72 30 AC Clinic Orthopedic Orthotics Mandatory if service is provided

7* 3 50 72 40 AC Clinic Orthopedic Plaster Room

7* 3 50 72 50 AC Clinic Orthopedic Sports Medicine

7* 3 50 75 AC Clinic Plastic

7* 3 50 75 10 AC Clinic Plastic General

7* 3 50 75 20 AC Clinic Plastic Burn Mandatory if service provided

7* 3 50 75 30 AC Clinic Plastic Cosmetic

7* 3 50 75 40 AC Clinic Plastic Hand

7* 3 50 75 50 AC Clinic Plastic – Reconstructive

7* 3 50 76 AC Clinic Mental Health Mental Health/Addictions

7* 3 50 76 10 AC Clinic Mental Health – Assessment Psychiatry

7* 3 50 76 25 AC Clinic Mental Health Acute Psychiatry

7* 3 50 76 45 AC Clinic Mental Health – Addiction

7* 3 50 76 50 AC Clinic Mental Health Child Adolescent

7* 3 50 76 55 AC Clinic Mental Health – Forensic

7* 3 50 76 60 AC Clinic Mental Health – Spousal Battering Do not use MH service recipient

7* 3 50 76 65 AC Clinic Mental Health Stress Management Do not use MH service recipient

7* 3 50 76 70 AC Clinic Mental Health Eating Disorders

7* 3 50 76 90 AC Clinic Mental Health – Psychiatric Crisis Spec.




7* 3 50 76 95 AC Clinic Mental Health Longer Term Psychiatric

7* 3 50 81 AC Clinic Rehabilitation Report treatment in 7* 4 50, 7* 4 55 or 7* 5 20 81*

7* 3 50 81 10 AC Clinic Rehabilitation Medical Use only for Physician visits

7* 3 50 81 28 AC Clinic Rehabilitation – Trauma

7* 3 50 81 30 AC Clinic Rehabilitation – Combined

7* 3 50 81 35 AC Clinic Rehabilitation Burn

7* 3 50 81 42 AC Clinic Rehabilitation – Cardiac

7* 3 50 81 61 AC Clinic Rehabilitation Head Injury / ABI

7* 3 50 81 63 AC Clinic Rehabilitation Spinal Cord

7* 3 50 81 66 AC Clinic Rehabilitation – Oncology

7* 3 50 81 72 AC Clinic Rehabilitation – Orthopedic (Including Hips and Knees)

7* 3 50 81 73 AC Clinic Rehabilitation – Amputee

7* 3 50 81 75 AC Clinic Rehabilitation – Urodynamic

7* 3 50 95 AC Clinic Rheumatology

7* 3 50 95 20 AC Clinic Rheumatology – General

7* 3 50 95 40 AC Clinic Rheumatology Gold Treatment

7* 3 50 95 60 AC Clinic Rheumatology Lupus

7* 3 50 95 80 AC Clinic Rheumatology – Scleroderma

7* 3 50 96 AC Clinic Geriatric

7* 3 50 96 10 AC Clinic Geriatric General

7* 3 50 96 20 AC Clinic Geriatric Assessment

7* 3 60 Day Surgery Operating Room NEW APRIL 2009 (2009/10)

7* 3 62 Day Surgery Combined OR & PARR NEW APRIL 2009 (2009/10)

7* 3 65 Day Surgery PostAnesthetic Recovery Room NEW APRIL 2009 (2009/10)

7* 3 67 Day Surgery Pre and Post Operative Care NEW APRIL 2009 (2009/10)

7* 3 69 Day Surgery Combined OR, PARR & Pre and Post Care

NEW APRIL 2009 (2009/10)




























7* 4 10 30 LAB Clinical Hematology NAME CHANGE APRIL 2009 (2009/10)




7* 4 10 35 LAB Transfusion Services Medicine NAME CHANGE APRIL 2009 (2009/10)









7* 4 10 41 LAB Anatomical Pathology NEW APRIL 2009 (2009/10

7* 4 10 41 20 LAB Surgical Pathology NEW APRIL 2009 (2009/10

7* 4 10 41 40 LAB Autopsy Pathology NEW APRIL 2009 (2009/10

7* 4 10 42 LAB Cytopathology NEW APRIL 2009 (2009/10

7* 4 10 43 LAB Electron Microscopy NEW APRIL 2009 (2009/10

7* 4 10 45 LAB clinical Microbiology NAME CHANGE APRIL 2009 (2009/10)
















7* 4 10 85 LAB Diagnostic Genetics NEW APRIL 2009 (2009/10) 7* 4 10 85 10 LAB Cytogenetics NEW APRIL 2009 (2009/10) 7* 4 10 85 20 LAB Molecular Genetics NEW APRIL 2009 (2009/10)

7* 4 10 99 LAB Combined Functions Small hospitals may use to report all activity











7* 4 15 25 DI Computed Tomography Mandatory if service is provided











Mandatory if service is provided 7* 4 15 44 DI Cardiac Catheterization Lab

NACRS mandatory FC from 7*41544 7*4154420 7* 4 15 44 10 DI Cardiac Catheterization Interventional



7* 4 15 70 DI Magnetic Resonance Imaging Mandatory if service is provided






7* 4 25 10 ED EEG

7* 4 25 20 ED EMG




7* 4 25 60 ED ENG/EOG










7* 4 30 20 90 NV ECG






7* 4 35 25 10 RS Routine


7* 4 35 30 RS Hyperbaric Chamber Must report if service is provided






7* 4 40 PH Pharmacy






































7* 4 75 40 TH Psychology and Psychometry Neuro psychology








MENTAL HEALTH VALID ABSORBING COST FUNCTIONAL CENTRES

















7* 2 65 IP PostAnesthetic Recovery Rooms (PARR)


7* 2 76 IP Mental Health/Addictions

7* 2 76 25 IP Mental Health – Acute

7* 2 76 45 IP Addiction Use ONLY if abstracted in the DAD

7* 2 76 45 15 IP Short Term Residential If Not Abstracted report In 7* 5 40 76

7* 2 76 45 25 IP Detoxification

7* 2 76 45 30 IP Combined

7* 2 76 45 99 IP Other Addictions

7* 2 76 50 IP Mental Health – Child/Adolescent

7* 2 76 55 IP Mental Health – Forensic

7* 2 76 55 20 IP Mental Health – Forensic Provincial

7* 2 76 55 40 IP Mental Health – Forensic Regional Secure

7* 2 76 55 60 IP Mental Health – Forensic General Protected

7* 2 76 90 IP Mental Health – Psychiatric Crisis Unit

7* 2 76 95 IP Mental Health – Longer Term

7* 2 76 95 20 IP Mental Health – LT Dual Diagnosis

7* 2 76 95 30 IP Mental Health – LT Combined

7* 2 76 95 81 IP Mental Health – LT Rehabilitation




7* 2 76 95 96 IP Mental Health – LT Geriatrics

7* 2 76 95 99 IP Mental Health – LT Other Longer Term





NAME CHAGNE 2008/09 Q1. Do not use for Service Recipient Activities.


7* 3 07 AC Medical Resources Assign expenses to ambulatory care functional centres if possible.

7* 3 07 10 AC Medical Resources – Psychiatrists

7* 3 07 20 AC Medical Resources – Other Medical staff

7* 3 07 30 AC Medical Resources – Hospital OnCall Coverage


7* 3 10 AC Emergency (ER) NACRS mandatory FC





7* 3 30 10 AC Telehealth – Network – Health Canada (CHIPP) Prev. 7* 3 30 Do not use for Telemedicine OTN.



Prev. 7* 3 10 80


7* 3 40 76 AC Day/Night Care – Mental Health/Addictions Must report if Mental Health funded






7* 3 50 AC Ambulatory Care Clinics For services with mandatory reporting: All staff are reported as MOS. If small volumes repot in a Combined FC

7* 3 50 05 AC Clinic Administration


7* 3 50 76 AC Clinic Mental Health Mental Health/Addictions

7* 3 50 76 10 AC Clinic Mental Health – Assessment Psychiatry

7* 3 50 76 25 AC Clinic Mental Health Acute Psychiatry

7* 3 50 76 45 AC Clinic Mental Health – Addiction

7* 3 50 76 50 AC Clinic Mental Health Child Adolescent

7* 3 50 76 55 AC Clinic Mental Health – Forensic




7* 3 50 76 60 AC Clinic Mental Health – Spousal Battering Do not use MH service recipient

7* 3 50 76 65 AC Clinic Mental Health Stress Management Do not use MH service recipient

7* 3 50 76 70 AC Clinic Mental Health Eating Disorders

7* 3 50 76 90 AC Clinic Mental Health – Psychiatric Crisis Spec.

7* 3 50 76 95 AC Clinic Mental Health Longer Term Psychiatric























7* 4 10 25 80 LAB Blood Gas NEW APRIL 2009 (2009/10) 7* 4 10 25 90 LAB Point of Care Testing NEW APRIL 2009 (2009/10) 7* 4 10 30 LAB Hematology
















7* 4 10 41 LAB Anatomical Pathology NEW APRIL 2009 (2009/10) 7* 4 10 41 20 LAB Surgical Pathology NEW APRIL 2009 (2009/10) 7* 4 10 41 40 LAB Autopsy Pathology NEW APRIL 2009 (2009/10) 7* 4 10 42 LAB Cytopathology NEW APRIL 2009 (2009/10) 7* 4 10 43 LAB Electron Microscopy NEW APRIL 2009 (2009/10) 7* 4 10 45 LAB Microbiology













7* 4 10 85 LAB Diagnostic Genetics NEW APRIL 2009 (2009/10) 7* 4 10 85 10 LAB Cytogenetics NEW APRIL 2009 (2009/10) 7* 4 10 85 20 LAB Molecular Genetics NEW APRIL 2009 (2009/10) 7* 4 10 99 LAB Combined Functions Small hospitals may use to report all activity











7* 4 15 25 DI Computed Tomography Mandatory if service provided















NACRS mandatory FC 7* 4 15 44 10 DI Cardiac Catheterization Interventional






7* 4 25 10 ED EEG

7* 4 25 20 ED EMG




7* 4 25 60 ED ENG/EOG










7* 4 30 20 90 NV ECG






7* 4 35 25 10 RS Routine





7* 4 35 30 RS Hyperbaric Chamber Mandatory to report if service is provided






7* 4 40 PH Pharmacy

7* 4 40 05 PH General Pharmacy All hospitals Workload measurement accounts required





































7* 4 75 40 TH Psychology and Psychometry Neuropsychology








REHABILITATION VALID ABSORBING COST FUNCTIONAL CENTRES ACCOUNT DESCRIPTION COMMENTS
















7* 2 81 IP Rehabilitation

7* 2 81 10 IP Medical Rehabilitation

7* 2 81 10 11 IP Rehabilitation – Respiratory

7* 2 81 10 12 IP Rehabilitation – Rheumatology

7* 2 81 10 13 IP Rehabilitation – Back Pain

7* 2 81 10 14 IP Rehabilitation – Stroke

7* 2 81 10 61 IP Rehabilitation – Neurology

7* 2 81 10 72 IP Rehabilitation – Musculoskeletal

7* 2 81 10 95 IP Rehabilitation – Chronic Pain

7* 2 81 10 96 IP Rehabilitation – Geriatric

7* 2 81 20 IP Surgical Rehabilitation

7* 2 81 20 28 IP Rehabilitation – Trauma

7* 2 81 20 35 IP Rehabilitation – Burns

7* 2 81 20 42 IP Rehabilitation – Cardiac

7* 2 81 20 61 IP Rehabilitation – Head Injury/Acquired Brain Injury (ABI)

7* 2 81 20 63 IP Rehabilitation – Spinal Cord

7* 2 81 20 72 IP Rehabilitation – Orthopedic (including Hips/ Knees)

7* 2 81 20 73 IP Rehabilitation – Amputee

7* 2 81 30 IP Rehabilitation – Combined




7* 2 81 66 IP Rehabilitation – Oncology





NAME CHANGE 2008/09 Q1. Do not use for Service Recipient Activities.


7* 3 07 AC Medical Resources Assign expenses to Ambulatory Care Functional Centres if possible.





7* 3 10 AC Emergency (ER) NACRS mandatory Functional Centre.










7* 3 30 10 AC Telehealth – Network Health Canada (CHIPP) Previously 7* 3 30 Do not use for Telemedicine OTN.



Prev. 7* 3 10 80







7* 3 50 AC Ambulatory Care Clinics For services with mandatory reporting:

7* 3 50 05 AC Clinic Administration All staff are reported as MOS. If small volumes repot in a Combined FC


7* 3 50 81 AC Clinic Rehabilitation Report treatment in 7* 4 50, 7* 4 55 or 7* 5 20 81*

7* 3 50 81 10 AC Clinic Rehabilitation Medical Use only for Physician visits

7* 3 50 81 28 AC Clinic Rehabilitation – Trauma




7* 3 50 81 30 AC Clinic Rehabilitation – Combined

7* 3 50 81 35 AC Clinic Rehabilitation Burn

7* 3 50 81 42 AC Clinic Rehabilitation – Cardiac

7* 3 50 81 61 AC Clinic Rehabilitation Head Injury / ABI

7* 3 50 81 63 AC Clinic Rehabilitation Spinal Cord

7* 3 50 81 66 AC Clinic Rehabilitation – Oncology

7* 3 50 81 72 AC Clinic Rehabilitation – Orthopedic (Including Hips and Knees)

7* 3 50 81 73 AC Clinic Rehabilitation – Amputee

7* 3 50 81 75 AC Clinic Rehabilitation – Urodynamic




































7* 4 10 30 LAB Hematology

































7* 4 15 18 DI Radiography Previously 7* 4 15 15 10



7* 4 15 20 20 DI Diagnostic Mammography Previously 7* 4 15 20
















NACRS mandatory Functional Centre 7* 4 15 44 10 DI Cardiac Catheterization Interventional






7* 4 25 10 ED EEG

7* 4 25 20 ED EMG




7* 4 25 60 ED ENG/EOG

7* 4 25 99 ED Electrodiagnosis – Combined Functions Small hospitals may use to report all activity. Hospitals without dedicated staff may report in the 7* 4 ** functional centre providing the service











7* 4 30 20 90 NV ECG






7* 4 35 25 10 RS Routine


7* 4 35 30 RS Hyperbaric Chamber Mandatory if service is provided





7* 4 36 Cardiovascular (CV) Perfusion NEW APRIL 2009 (2009/10) 7* 4 40 PH Pharmacy



















COMPLEX CONTINUING CARE VALID ABSORBING COST FUNCTIONAL CENTRES ACCOUNT DESCRIPTION COMMENTS

















7* 2 10 94 IP Medical –Palliative Care Previously 7* 2 94

7* 2 95 IP Long Term Care

7* 2 95 20 IP LTC Complex Continuing Care Complex Continuing Care facilities are encouraged to report lower level

7* 2 95 20 05 IP LTC Complex Continuing CareShortterm Assessment

7* 2 95 20 10 IP LTC Complex Continuing CareComplex Care Adults

7* 2 95 20 20 IP LTC Complex Continuing CareTransitional Care

7* 2 95 20 30 IP LTC Complex Continuing CareCombined Care

7* 2 95 20 35 IP LTC Complex Continuing CareVentilator Dependent

7* 2 95 20 76 IP LTC Complex Continuing CareBehavioral Health

7* 2 95 20 81 IP LTC Complex Continuing Care Reactivation/Restorative

7* 2 95 20 94 IP LTC Complex Continuing Care Palliative/Hospice

7* 2 95 20 96 IP LTC Complex Continuing CareComplex Care Geriatric

7* 2 95 40 IP LTC Respite Care

7* 2 95 60 IP LTC – Intermediate Care (ELDCAP) and Interim LTC

ILTC is reported as Fund Type 2

7* 2 95 80 IP LTC – Supervisory/Limited Personal Care Legal corporation may report here as fund type 3




7* 2 97 IP LTC All Inclusive Complex Continuing Care (CCC)

Contracted out by third party provider




7* 3 05 20 AC Ambulatory Care Telemedicine Must report if MOHLTC funded


7* 3 07 AC Medical Resources Assign expenses to Ambulatory Care functional centres if possible





7* 3 10 AC Emergency (ER) NACRS mandatory Functional Centre










7* 3 30 10 AC Telehealth – Network Health Canada (CHIPP) Previously 7* 3 30

7* 3 30 20 AC Telehealth – Provincial Telephone advice Previously 7* 3 32


Previously 7* 3 10 80







7* 3 50 AC Ambulatory Care Clinics For services with mandatory reporting:

7* 3 50 05 AC Clinic Administration For services with mandatory reporting: If small volumes report in a Combined FC All staff are reported as MOS

7* 3 50 10 AC Clinic


































7* 4 10 25 80 LAB Blood Gas NEW APRIL 2009 (2009/10) 7* 4 10 25 90 LAB Point of Care Testing NEW APRIL 2009 (2009/10) 7* 4 10 30 LAB Hematology

































7* 4 15 18 DI Radiography Previously 7* 4 15 15 10



7* 4 15 20 20 DI Diagnostic Mammography Previously 7* 4 15 20
















7* 4 15 35 DI Nuclear Medicine Gamma Cameras NEW APRIL 2009 (2009/10) 7* 4 15 40 DI Nuclear Medicine DO NOT USE AFTER MARCH 31 2009

7* 4 15 44 DI Cardiac Catheterization Lab Mandatory if service is provided NACRS mandatory FC

7* 4 15 44 10 DI Cardiac Catheterization Interventional


7* 4 15 60 DI Positron Emission Tomography (PET) NEW APRIL 2009 (2009/10) 7* 4 15 70 DI Magnetic Resonance Imaging Mandatory if service is provided



7* 4 25 10 ED EEG

7* 4 25 20 ED EMG




7* 4 25 60 ED ENG/EOG

7* 4 25 99 ED Electrodiagnosis – Combined Functions Small hospitals may use to report all activity. Hospitals without dedicated staff may report in the 7* 4 ** functional centre providing the service








7* 4 30 20 90 NV ECG









7* 4 35 25 10 RS Routine


7* 4 35 30 RS Hyperbaric Chamber Mandatory if service is provided





7* 4 36 Cardiovascular (CV) Perfusion NEW APRIL 2009 (2009/10) 7* 4 40 PH Pharmacy

7* 4 40 05 PH General Pharmacy All hospitals WLM accts. required































CCAC ABSORBING COST FUNCTIONAL CENTRES Comments: Use only if responsible for more than one level three functional centre

Includes all activity as previously reported in FC 7*5 09 10, 7*5 09 20 and 7*5 09 25

MoH ACCOUNT DESCRIPTION MoH 72505 COM Clinical Management MoH 7250720 COM Medical Resources Other Medical Staff MoH 7250930 COM Case Management

MoH 7251005 COM Primary Care Practice MoH 7251015 COM Primary Care Nursing Clinic MoH 7251020 COM Primary Care General Clinic MoH 7251030 COM Primary Care Combined Clinic

MoH 7251040 COM Primary Care Therapy Clinic

MoH 725304011 COM InHome Health Care Nursing Visiting MoH 725304012 COM InHome Health Care Nursing Shift MoH 725304035 COM InHome Health Care Respiratory Services MoH 725304045 COM InHome Health Care Nutrition/Dietetic MoH 725304050 COM InHome Health Care Physiotherapy MoH 725304055 COM InHome Health Care Occupational Therapy MoH 725304062 COM InHome Health Care Speech Lang. Path. MoH 725304070 COM InHome Health Care Social Work MoH 725304075 COM InHome Health Care Psychology

MoH 725304211 COM Private/Home Schools Nursing Visiting MoH 725304212 COM Private/Home Schools Nursing Shift MoH 725304245 COM Private/Home Schools Nutrition/Dietetic MoH 725304250 COM Private/Home Schools Physiotherapy MoH 725304255 COM Private/Home Schools Occupational Therapy MoH 725304262 COM Private/Home Schools Speech Lang. Path.

MoH 725304411 COM Publicly Funded Schools Nursing Visiting MoH 725304412 COM Publicly Funded Schools Nursing Shift MoH 725304445 COM Publicly Funded Schools Nutrition/Dietetic MoH 725304450 COM Publicly Funded Schools Physiotherapy MoH 725304455 COM Publicly Funded Schools Occ. Therapy MoH 725304462 COM Publicly Funded Schools Speech Lang. Path.

MoH 725354010 COM InHome Support Personal Support MoH 725354020 COM InHome Support Homemaking Services MoH 725354030 COM InHome Support Comb. PS and HM Services

MoH 725354210 COM Private/Home School Support Personal Services



MoH ACCOUNT DESCRIPTION

MoH 7253545 COM Respite Service MoH 725409511 Residential Hospice End of Life (EOL) Nursing Visiting MoH 725409512 Residential Hospice End of Life (EOL) Nursing Shift MoH 725409530 Residential Hospice End of Life (EOL) Combined PS and HM Services MoH 725409545 Residential Hospice End of Life (EOL) Nutrition/Dietetic MoH 725409550 Residential Hospice End of Life (EOL) Physiotherapy MoH 725409555 Residential Hospice End of Life (EOL) Occupational Therapy MoH 725409562 Residential Hospice End of Life (EOL) Speech Lang. Path. MoH 725409570 Residential Hospice End of Life (EOL) Social Work

MoH 7255010 COM Health Prom/Educ General MoH 725509410 COM Health Promotion/Education Palliative Care Interdisciplinary MoH 725509491 COM Health Prom. /Educ Palliative Care Pain and Symptom Management MoH 725509610 COM Health Promotion Education General Geriatric MoH 725509676 COM Health Promotion Education PsychoGeriatric MoH 7257010 COM Information and Referral Service General



APPENDIX A2: VALIDABSORBING FUNCTIONAL CENTRES

Patient Types Acute Inpatient – AIP Complex Continuing Care CCC Comm. Care Access Centre CCAC

Ambulatory – AMB Mental Health – MH Rehabilitation – REHAB

Functional Centre AIP AMB CCC AMH REHAB CCAC 7* 1 95 AS Food Services AIP AMB CCC AMH REHAB 7* 1 95 05 AS Food Services Admin. AIP AMB CCC AMH REHAB 7* 1 95 20 AS Food Services Production AIP AMB CCC AMH REHAB 7* 1 95 30 AS Food Services Tray Assembly &

Distrib AIP AMB CCC AMH REHAB 7* 1 95 40 AS Food Services Warewashing AIP AMB CCC AMH REHAB 7* 2 05 IP Nursing Administration AIP AMB CCC AMH REHAB 7* 2 05 10 IP Nursing Administration AIP AMB CCC AMH REHAB 7* 2 05 20 IP Clinical Resources (centralized) AIP AMB CCC AMH REHAB 7* 2 05 20 20 IP Clinical Res. IV Therapy AIP AMB 7* 2 05 20 40 IP Clinical Res. Enterostomy Therapy AIP AMB 7* 2 05 20 92 IP Clinical Res. Transplant

Coord./Organ Procurement AIP AMB 7* 2 05 20 94 IP Clinical Res. Palliative Care Team AIP AMB CCC 7* 2 06 IP Program Management Administration AIP AMB CCC AMH REHAB 7* 2 07 IP Medical Resources AIP AMB CCC AMH REHAB 7* 2 07 10 IP Medical Resources Psychiatrists AIP AMB CCC AMH REHAB 7* 2 07 20 IP Medical Resources All other Medical

Staff AIP AMB CCC AMH REHAB 7* 2 07 30 IP Medical Resources Hospitalists AIP AMB CCC AMH REHAB 7* 2 10 IP Medical Inpatient Services AIP AMB CCC 7* 2 10 10 IP Medical – General AIP AMB 7* 2 10 20 IP Medical – Endocrinology AIP AMB 7* 2 10 25 IP Medical Clinical Investigation AIP AMB 7* 2 10 30 IP Medical –Communicable Diseases AIP AMB 7* 2 10 35 IP Medical –Dermatology AIP AMB 7* 2 10 44 IP Medical –Cardiology AIP AMB 7* 2 10 45 IP Medical Family Practice AIP AMB 7* 2 10 50 IP Medical –Gastroenterology AIP AMB 7* 2 10 55 IP Medical –Metabolic AIP AMB 7* 2 10 61 IP Medical –Neurology AIP AMB 7* 2 10 66 IP Medical –Oncology AIP AMB 7* 2 10 75 IP Medical –Rheumatology AIP AMB 7* 2 10 80 IP Medical –Respirology AIP AMB 7* 2 10 85 IP Medical –Assessment Unit AIP AMB 7* 2 10 86 IP Medical –Nephrology AIP AMB 7* 2 10 90 IP Medical –Hematology AIP AMB 7* 2 10 94 IP Medical –Palliative Care AIP AMB CCC 7* 2 20 IP Surgical Inpatient Services AIP AMB 7* 2 20 10 IP Surgical – Surgical AIP AMB 7* 2 20 25 IP Surgical Dental AIP AMB





Functional Centre AIP AMB CCC AMH REHAB CCAC 7* 2 20 28 IP Surgical – Trauma (Post Surgery) AIP AMB 7* 2 20 30 IP Surgical Ear, Nose and Throat AIP AMB 7* 2 20 35 IP Surgical – Gynecology AIP AMB 7* 2 20 42 IP Surgical – Cardiac AIP AMB 7* 2 20 45 IP Surgical Plastic AIP AMB 7* 2 20 55 IP Surgical Oral/Facial AIP AMB 7* 2 20 61 IP Surgical – Neurosurgery AIP AMB 7* 2 20 62 IP Surgical – Ophthalmology AIP AMB 7* 2 20 66 IP Surgical – Oncology AIP AMB 7* 2 20 70 IP Surgical – Thoracic AIP AMB 7* 2 20 72 IP Surgical – Orthopedic AIP AMB 7* 2 20 75 IP Surgical – Urology AIP AMB 7* 2 20 80 IP Surgical – Vascular AIP AMB 7* 2 20 92 IP Surgical – Transplant AIP AMB 7* 2 30 IP Combined Medical/Surgical AIP AMB 7* 2 40 IP Intensive Care Unit (ICU) AIP AMB 7* 2 40 10 IP ICU – Medical AIP AMB 7* 2 40 20 IP ICU – Surgical AIP AMB 7* 2 40 28 IP ICU Trauma AIP AMB 7* 2 40 30 IP ICU Combined Med/Surg AIP AMB 7* 2 40 35 IP ICU – Burn AIP AMB 7* 2 40 42 IP ICU Cardiac (Surgical) AIP AMB 7* 2 40 44 IP ICU Coronary Care (Med) AIP AMB 7* 2 40 50 IP ICU – Neonatal Level III Nursery AIP AMB 7* 2 40 61 IP ICU – Neurosurgery AIP AMB 7* 2 40 70 IP ICU – Pediatric AIP AMB 7* 2 40 80 IP ICU – Respirology AIP AMB 7* 2 40 92 IP ICU Transplant AIP AMB 7* 2 42 IP Cardiac Monitored Care AIP AMB 7* 2 42 10 IP Cardiac Monitored Care Medical AIP AMB 7* 2 42 20 IP Cardiac Monitored Care Surgical AIP AMB 7* 2 42 30 IP Cardiac Monitored Care Combined AIP AMB 7* 2 42 42 IP Cardiac Monitored Care Cardiac AIP AMB 7* 2 42 44 IP Cardiac Monitored Care Coronary AIP AMB 7* 2 50 IP Obstetrics AIP AMB 7* 2 50 20 IP Obstetrics Suite (L & D) AIP AMB 7* 2 50 20 20 IP Obstetrics Labour and Delivery

Rooms AIP AMB 7* 2 50 20 40 IP Obstetrics Recovery Room AIP AMB 7* 2 50 20 60 IP Obstetrics Caesarean Section Room AIP AMB 7* 2 50 30 IP Obstetrics Birthing Centre AIP AMB 7* 2 50 40 IP Obstetrics Ante/Postpartum AIP AMB 7* 2 50 40 20 IP Obstetrics General Ante/Postpartum AIP AMB





Functional Centre AIP AMB CCC AMH REHAB CCAC 7* 2 50 40 40 IP Obstetrics High Risk Antepartum AIP AMB 7* 2 50 60 IP Obstetrics Combined Care AIP AMB 7* 2 50 60 10 IP Obstetrics General Combined Care AIP AMB 7* 2 50 60 20 IP Obstetrics High Risk Combined Care AIP AMB 7* 2 50 80 IP Obstetrics Nursery AIP AMB 7* 2 50 80 20 IP Obstetrics General Nursery AIP AMB 7* 2 50 80 40 IP Obstetrics Intermediate Nursery

(Level 2) AIP AMB 7* 2 50 90 IP Obstetrics Lab, Delivery, Rec,

Postpartum (LDRP) AIP AMB 7* 2 60 IP Operating Room (OR) AIP AMB 7* 2 60 20 OR General Surgical AIP AMB 7* 2 60 25 OR Dental AIP AMB 7* 2 60 28 OR Trauma AIP AMB 7* 2 60 30 OR Cystology AIP AMB 7* 2 60 42 OR Cardiac AIP AMB 7* 2 60 45 OR Plastic Surgery AIP AMB 7* 2 60 61 OR Neurosurgery AIP AMB 7* 2 60 62 OR Ophthalmology AIP AMB 7* 2 60 72 OR Orthopedic AIP AMB 7* 2 60 92 OR Transplant AIP AMB 7* 2 62 IP OR/PARR Combined AIP AMB 7* 2 65 IP PostAnesthetic Recovery Rooms (PARR) AIP AMB AMH

7* 2 65 20 PARR General AIP AMB AMH

7* 2 65 42 PARR Cardiac AIP AMB 7* 2 65 61 PARR Neurosurgery AIP AMB 7* 2 70 IP Pediatric AIP AMB 7* 2 70 10 IP Pediatric – Medical AIP AMB 7* 2 70 20 IP Pediatric – Surgical AIP AMB 7* 2 76 IP AMH/Addictions AMH 7* 2 76 25 IP AMH – Acute AMH 7* 2 76 45 IP Addiction AMH 7* 2 76 45 15 IP Short Term Residential AMH 7* 2 76 45 25 IP Detoxification AMH 7* 2 76 45 30 IP Combined AMH 7* 2 76 45 99 IP Other Addictions AMH 7* 2 76 50 IP AMH – Child/Adolescent AMH 7* 2 76 55 IP AMH – Forensic AMH 7* 2 76 55 20 IP AMH – Forensic Provincial AMH 7* 2 76 55 40 IP AMH – Forensic Regional Secure AMH 7* 2 76 55 60 IP AMH – Forensic General Protected AMH 7* 2 76 90 IP AMH – Psychiatric Crisis Unit AMH 7* 2 76 95 IP AMH – Longer Term AMH





Functional Centre AIP AMB CCC AMH REHAB CCAC 7* 2 76 95 20 IP AMH – LT Dual Diagnosis AMH 7* 2 76 95 30 IP AMH – LT Combined AMH 7* 2 76 95 81 IP AMH – LT Rehabilitation AMH 7* 2 76 95 96 IP AMH – LT Geriatrics AMH 7* 2 76 95 99 IP AMH – LT Other Longer Term AMH 7* 2 81 IP Rehabilitation REHAB 7* 2 81 10 IP Medical Rehabilitation REHAB 7* 2 81 10 11 IP Rehabilitation – Respiratory REHAB 7* 2 81 10 12 IP Rehabilitation – Rheumatology REHAB 7* 2 81 10 13 IP Rehabilitation – Back Pain REHAB 7* 2 81 10 14 IP Rehabilitation – Stroke REHAB 7* 2 81 10 61 IP Rehabilitation – Neurology REHAB 7* 2 81 10 72 IP Rehabilitation – Musculoskeletal REHAB 7* 2 81 10 95 IP Rehabilitation – Chronic Pain REHAB 7* 2 81 10 96 IP Rehabilitation – Geriatric REHAB 7* 2 81 20 IP Surgical Rehabilitation REHAB 7* 2 81 20 28 IP Rehabilitation – Trauma REHAB 7* 2 81 20 35 IP Rehabilitation – Burns REHAB 7* 2 81 20 42 IP Rehabilitation – Cardiac REHAB 7* 2 81 20 61 IP Rehabilitation – Head

Injury/Acquired Brain Injury (ABI) REHAB 7* 2 81 20 63 IP Rehabilitation – Spinal Cord REHAB 7* 2 81 20 72 IP Rehabilitation – Orthopedic

(including Hips/ Knees) REHAB 7* 2 81 20 73 IP Rehabilitation – Amputee REHAB 7* 2 81 30 IP Rehabilitation – Combined REHAB 7* 2 81 66 IP Rehabilitation – Oncology REHAB 7* 2 95 IP Long Term Care CCC 7* 2 95 20 IP LTC Complex Continuing Care CCC 7* 2 95 20 05 IP LTC Complex Continuing CareShort

term Assessment CCC 7* 2 95 20 10 IP LTC Complex Continuing Care

Complex CareAdults CCC 7* 2 95 20 20 IP LTC Complex Continuing Care

Transitional Care CCC 7* 2 95 20 30 IP LTC Complex Continuing Care

Combined Care CCC 7* 2 95 20 35 IP LTC Complex Continuing Care

Ventilator Dependent CCC 7* 2 95 20 76 IP LTC Complex Continuing Care

Behavioral Health CCC 7* 2 95 20 81 IP LTC Complex Continuing Care

Reactivation/Restorative CCC 7* 2 95 20 94 IP LTC Complex Continuing Care

Palliative/Hospice CCC 7* 2 95 20 96 IP LTC Complex Continuing Care

Complex CareGeriatric CCC





Functional Centre AIP AMB CCC AMH REHAB CCAC 7* 2 95 40 IP LTC Respite Care CCC 7* 2 95 60 IP LTC – Intermediate Care (ELDCAP)

and Interim LTC CCC 7* 2 95 80 IP LTC – Supervisory/Limited Personal

Care CCC 7* 2 97 IP LTC All Inclusive Complex Continuing

Care (CCC) CCC 7* 3 05 AC Ambulatory Care Administration AIP AMB CCC AMH REHAB 7* 3 05 10 AC Ambulatory Care General AIP AMB CCC AMH REHAB 7* 3 05 20 AC Ambulatory Care – Ontario

Telemedicine Network (OTN) AIP AMB CCC AMH REHAB 7* 3 06 AC Program Management Administration AIP AMB CCC AMH REHAB 7* 3 07 AC Medical Resources AIP AMB CCC AMH REHAB 7* 3 07 10 AC Medical Resources Psychiatrists AIP AMB CCC AMH REHAB 7* 3 07 20 AC Medical Resources Other Medical

staff AIP AMB CCC AMH REHAB 7* 3 07 30 AC Medical Resources Hospital On

Call Coverage AIP AMB CCC AMH REHAB 7* 3 07 35 AC Medical Resources UAP – Visiting

Specialist Clinics AIP AMB CCC AMH REHAB 7* 3 10 AC Emergency (ER) AIP AMB CCC AMH REHAB 7* 3 10 20 AC Emergency – General AIP AMB CCC REHAB 7* 3 10 22 AC Emergency – Alternate Funding AIP AMB CCC REHAB 7* 3 10 25 AC Emergency – Hospital Urgent Care

Centre AIP AMB CCC REHAB 7* 3 10 28 AC Emergency – Trauma AIP AMB CCC REHAB 7* 3 10 40 AC Emergency – Interim Assessment AIP AMB CCC REHAB 7* 3 10 76 AC Emergency – Psychiatric

Services/Crisis Intervention AIP AMB CCC AMH REHAB 7* 3 20 AC Poison Information Centre AIP AMB CCC AMH REHAB 7* 3 30 AC Telehealth AIP AMB CCC AMH REHAB 7* 3 30 10 AC Telehealth – Network Health

Canada (CHIPP) AIP AMB CCC AMH REHAB 7* 3 30 20 AC Telehealth – Provincial Telephone

advice AIP AMB CCC AMH REHAB 7* 3 30 30 AC Telehealth – Hospital Emergency

Advice Centre AIP AMB CCC AMH REHAB 7* 3 40 AC Specialty Day/Night Care AIP AMB AMH REHAB 7* 3 40 05 AC Day/Night Care General AIP AMB 7* 3 40 10 AC Day/Night Care Medical AIP AMB 7* 3 40 10 10 AC Day/Night Care Medical General AIP AMB 7* 3 40 10 20 AC Day/Night Care Medical AIDS AIP AMB 7* 3 40 15 AC Day/Night Care – Diabetes AIP AMB 7* 3 40 42 AC Day/Night Care – Cardiac AIP AMB 7* 3 40 42 10 AC Day/Night Care – Cardiac General AIP AMB 7* 3 40 42 20 AC Day/Night Care – Cardiac

Hemodynamic AIP AMB 7* 3 40 55 AC Day/Night Care – Endoscopy AIP AMB





Functional Centre AIP AMB CCC AMH REHAB CCAC 7* 3 40 65 AC Day/Night Care – Metabolic AIP AMB 7* 3 40 66 AC Day/Night Care – Oncology AIP AMB 7* 3 40 66 10 AC Day/Night Care Oncology –

Chemotherapy AIP AMB 7* 3 40 66 20 AC Day/Night Care Oncology – Other

Supportive Therapy AIP AMB 7* 3 40 76 AC Day/Night Care – AMH/Addictions AIP AMB AMH 7* 3 40 76 25 AC Day/Night Care MH Acute AIP AMB AMH 7* 3 40 76 45 AC Day/Night Care Addiction AIP AMB AMH 7* 3 40 76 50 AC Day/Night Care MH Child

/Adolescent AIP AMB AMH 7* 3 40 76 55 AC Day/Night Care MH Forensic

Psychiatric AIP AMB AMH 7* 3 40 76 95 AC Day/Night Care MH Longer Term

Care AIP AMB AMH 7* 3 40 86 AC Renal Dialysis AIP AMB 7* 3 40 86 10 AC Day/Night Care Hemodialysis AIP AMB 7* 3 40 86 20 AC Day/Night Care Home Dialysis

(Teaching) Comb. AIP AMB 7* 3 40 86 30 AC Day/Night Care Home

Hemodialysis (Teaching) AIP AMB 7* 3 40 86 40 AC Day/Night Care Home Peritoneal

Dial.(Teaching) AIP AMB 7* 3 40 86 50 AC Day/Night Care Peritoneal

Dialysis AIP AMB 7* 3 40 86 60 AC Day/Night Care SelfCare

Hemodialysis AIP AMB 7* 3 40 94 AC Day/Night Care – Palliative AIP AMB CCC 7* 3 40 96 AC Day/Night Care – Geriatric AIP AMB CCC REHAB 7* 3 40 96 20 AC Day/Night Care Geriatric General AIP AMB CCC REHAB 7* 3 40 96 40 AC Day/Night Care Geriatric

Assessment and Evaluation AIP AMB CCC REHAB 7* 3 40 96 80 AC Day/Night Care Geriatric Social

Support AIP AMB CCC REHAB 7* 3 40 96 81 AC Day/Night Care Geriatric

Rehabilitation /Activation AIP AMB CCC REHAB 7* 3 50 AC Ambulatory Care Clinics AMB CCC AMH REHAB 7* 3 50 05 AC Clinic Administration AMB CCC AMH REHAB 7* 3 50 10 AC Clinic Medical AMB CCC AMH REHAB 7* 3 50 10 10 AC Clinic Medical – General AMB 7* 3 50 10 15 AC Clinic Medical – Sexually

Transmitted Diseases AMB 7* 3 50 10 18 AC Clinic Medical – Autologous Blood AMB 7* 3 50 10 19 AC Clinic Medical – Aids AMB 7* 3 50 10 20 AC Clinic Medical – Allergy AMB 7* 3 50 10 25 AC Clinic Medical – Anticoagulant AMB 7* 3 50 10 30 AC Clinic Medical – Chiropody AMB





Functional Centre AIP AMB CCC AMH REHAB CCAC 7* 3 50 10 35 AC Clinic Medical – Communicable

Diseases AMB 7* 3 50 10 40 AC Clinic Medical – Dermatology

Clinic Medical AMB 7* 3 50 10 45 AC Clinic Medical – Enterostomal

Therapy AMB 7* 3 50 10 50 AC Clinic Medical – Gastroenterology AMB 7* 3 50 10 55 AC Clinic Medical – Hematology AMB 7* 3 50 10 56 AC Clinic Medical – Hemophiliac AMB 7* 3 50 10 60 AC Clinic Medical – Hypertension AMB 7* 3 50 10 65 AC Clinic Medical – Immunology AMB 7* 3 50 10 70 AC Clinic Medical – PreAdmission AMB 7* 3 50 10 75 AC Clinic Medical – Pain Management AMB 7* 3 50 10 80 AC Clinic Medical – Podiatry AMB 7* 3 50 10 85 AC Clinic Medical – Respirology AMB 7* 3 50 10 86 AC Clinic Medical – Nephrology AMB 7* 3 50 10 87 AC Clinic Medical – Cystic Fibrosis AMB 7* 3 50 10 88 AC Clinic Medical – Sexual Assault

and Domestic Violence AMB 7* 3 50 10 90 AC Clinic Medical – Travel and

Inoculation AMB 7* 3 50 15 AC Clinic Surgical AMB 7* 3 50 15 10 AC Clinic Surgical General AMB 7* 3 50 15 20 AC Clinic Surgical Dental AMB 7* 3 50 15 25 AC Clinic Surgical – Ear, Nose and

Throat AMB 7* 3 50 15 30 AC Clinic Surgical Minor AMB 7* 3 50 15 35 AC Clinic Surgical Oral/Facial AMB 7* 3 50 15 40 AC Clinic Surgical Orthodontic AMB 7* 3 50 15 45 AC Clinic Surgical PreAdmission AMB 7* 3 50 15 50 AC Clinic Surgical – Thoracic AMB 7* 3 50 15 60 AC Clinic Surgical Urology AMB 7* 3 50 15 87 AC Clinic Surgical – Bone Marrow AMB 7* 3 50 15 92 AC Clinic Surgical Transplant AMB 7* 3 50 17 AC Clinic Combined AMB 7* 3 50 17 10 AC Clinic Combined – General

Med/Surg. AMB 7* 3 50 17 20 AC Clinic Combined

Obs./Gynecological AMB 7* 3 50 17 30 AC Clinic Combined Maternal Child

Health AMB 7* 3 50 25 AC Clinic Family Practice AMB 7* 3 50 35 AC Clinic – Gynecology AMB 7* 3 50 35 10 AC Clinic Gynecology General

Gynecology AMB 7* 3 50 35 30 AC Clinic Gynecology Colposcopy AMB





Functional Centre AIP AMB CCC AMH REHAB CCAC 7* 3 50 35 40 AC Clinic Gynecology Family

Planning AMB 7* 3 50 35 50 AC Clinic Gynecology Infertility AMB 7* 3 50 35 60 AC Clinic Gynecology Therapeutic

Abortion AMB 7* 3 50 35 70 AC Clinic Gynecology Well Women AMB 7* 3 50 40 AC Clinic Metabolic AMB 7* 3 50 40 10 AC Clinic Metabolic General AMB 7* 3 50 40 20 AC Clinic Metabolic Diabetes –

Combined AMB 7* 3 50 40 22 AC Clinic Metabolic Diabetes –

Pediatric AMB 7* 3 50 40 24 AC Clinic Metabolic Diabetes – Adult AMB 7* 3 50 42 AC Clinic Cardiac AMB 7* 3 50 42 10 AC Clinic Cardiac – General Cardiology AMB 7* 3 50 42 20 AC Clinic Cardiac – Cardiovascular

Surgery AMB 7* 3 50 42 30 AC Clinic Cardiac – Congenital AMB 7* 3 50 42 40 AC Clinic Cardiac – Pacemaker AMB 7* 3 50 42 60 AC Clinic Cardiac – Rehabilitation AMB 7* 3 50 42 70 AC Clinic Cardiac – Valve AMB 7* 3 50 43 AC Clinic Endocrinology AMB 7* 3 50 50 AC Clinic Obstetrics AMB 7* 3 50 50 20 AC Clinic Obstetrics General

Antepartum AMB 7* 3 50 50 60 AC Clinic Obstetrics High Risk

Ante/Postpartum AMB 7* 3 50 50 80 AC Clinic Obstetrics Postpartum AMB 7* 3 50 61 AC Clinic Neurology AMB 7* 3 50 61 10 AC Clinic Neurology General

Neurology AMB 7* 3 50 61 20 AC Clinic Neurology General

Neurosurgery AMB 7* 3 50 61 30 AC Clinic Neurology Convulsive

Disorders AMB 7* 3 50 61 40 AC Clinic Neurology Migraine AMB 7* 3 50 61 50 AC Clinic Neurology Neuromuscular

Disorders AMB 7* 3 50 61 60 AC Clinic Neurology Vertigo AMB 7* 3 50 61 80 AC Clinic Neurology Multiple

Sclerosis AMB 7* 3 50 62 AC Clinic Ophthalmology Ophthalmology AMB 7* 3 50 62 10 AC Clinic Ophthalmology General

Ophthalmology AMB 7* 3 50 62 20 AC Clinic Ophthalmology Contact

Lens AMB 7* 3 50 62 30 AC Clinic Ophthalmology

Cryosurgery AMB 7* 3 50 62 35 AC Clinic Ophthalmology Visudyne AMB





Functional Centre AIP AMB CCC AMH REHAB CCAC 7* 3 50 62 40 AC Clinic Ophthalmology Flouroscein AMB 7* 3 50 62 50 AC Clinic Ophthalmology Glaucoma AMB 7* 3 50 62 60 AC Clinic Ophthalmology Laser AMB 7* 3 50 62 70 AC Clinic Ophthalmology Orthoptic AMB 7* 3 50 62 80 AC Clinic Ophthalmology Tonography AMB 7* 3 50 62 90 AC Clinic Ophthalmology Ultrasound AMB 7* 3 50 66 AC Clinic Oncology AMB 7* 3 50 66 05 AC Clinic Onc. – Systemic Pre and

Post Treatment AMB 7* 3 50 66 15 AC Clinic Onc. – Radiation Pre and

Post Treatment AMB 7* 3 50 66 20 AC Clinic Oncology Surgical Pre

and Post AMB 7* 3 50 66 30 AC Clinic Oncology – Combined AMB 7* 3 50 70 AC Clinic Pediatric AMB 7* 3 50 70 10 AC Clinic Pediatric General AMB 7* 3 50 70 20 AC Clinic Pediatric Well Baby AMB 7* 3 50 70 30 AC Clinic Pediatric Child Protection AMB 7* 3 50 70 35 AC Clinic Pediatric Spina Bifida AMB 7* 3 50 70 50 AC Clinic Pediatric Growth and

Development AMB 7* 3 50 70 55 AC Clinic Pediatric Scoliosis AMB 7* 3 50 70 65 AC Clinic Pediatric Neonatology AMB 7* 3 50 70 75 AC Clinic Pediatric Pediatric

Connective Tissues AMB 7* 3 50 70 85 AC Clinic Pediatric Juvenile

Convulsive Disorders AMB 7* 3 50 72 AC Clinic Orthopedic AMB 7* 3 50 72 10 AC Clinic Orthopedic General AMB 7* 3 50 72 20 AC Clinic Orthopedic Fracture AMB 7* 3 50 72 30 AC Clinic Orthopedic Orthotics AMB 7* 3 50 72 40 AC Clinic Orthopedic Plaster Room AMB 7* 3 50 72 50 AC Clinic Orthopedic Sports Medicine AMB 7* 3 50 75 AC Clinic Plastic AMB 7* 3 50 75 10 AC Clinic Plastic General AMB 7* 3 50 75 20 AC Clinic Plastic Burn AMB 7* 3 50 75 30 AC Clinic Plastic Cosmetic AMB 7* 3 50 75 40 AC Clinic Plastic Hand AMB 7* 3 50 75 50 AC Clinic Plastic – Reconstructive AMB 7* 3 50 76 AC Clinic AMH AMH/Addictions AMB AMH 7* 3 50 76 10 AC Clinic AMH – Assessment

Psychiatry AMB AMH 7* 3 50 76 25 AC Clinic AMH Acute Psychiatry AMB AMH 7* 3 50 76 45 AC Clinic AMH – Addiction AMB AMH 7* 3 50 76 50 AC Clinic AMH Child Adolescent AMB AMH





Functional Centre AIP AMB CCC AMH REHAB CCAC 7* 3 50 76 55 AC Clinic AMH – Forensic AMB AMH 7* 3 50 76 60 AC Clinic AMH – Spousal Battering AMB AMH 7* 3 50 76 65 AC Clinic AMH Stress Management AMB AMH 7* 3 50 76 70 AC Clinic AMH Eating Disorders AMB AMH 7* 3 50 76 90 AC Clinic AMH – Psychiatric Crisis

Spec. AMB AMH 7* 3 50 76 95 AC Clinic AMH Longer Term

Psychiatric AMB AMH 7* 3 50 81 AC Clinic Rehabilitation AMB REHAB 7* 3 50 81 10 AC Clinic Rehabilitation Medical AMB REHAB 7* 3 50 81 28 AC Clinic Rehabilitation – Trauma AMB REHAB 7* 3 50 81 30 AC Clinic Rehabilitation – Combined AMB REHAB 7* 3 50 81 35 AC Clinic Rehabilitation Burn AMB REHAB 7* 3 50 81 42 AC Clinic Rehabilitation – Cardiac AMB REHAB 7* 3 50 81 61 AC Clinic Rehabilitation Head Injury /

ABI AMB REHAB 7* 3 50 81 63 AC Clinic Rehabilitation Spinal Cord AMB REHAB 7* 3 50 81 66 AC Clinic Rehabilitation – Oncology AMB REHAB 7* 3 50 81 72 AC Clinic Rehabilitation – Orthopedic AMB REHAB 7* 3 50 81 73 AC Clinic Rehabilitation – Amputee AMB REHAB 7* 3 50 81 75 AC Clinic Rehabilitation – Urodynamic AMB REHAB 7* 3 50 95 AC Clinic Rheumatology AMB CCC REHAB 7* 3 50 95 20 AC Clinic Rheumatology – General AMB CCC REHAB 7* 3 50 95 40 AC Clinic Rheumatology Gold

Treatment AMB CCC REHAB 7* 3 50 95 60 AC Clinic Rheumatology Lupus AMB CCC REHAB 7* 3 50 95 80 AC Clinic Rheumatology – Scleroderma AMB CCC REHAB 7* 3 50 96 AC Clinic Geriatric AMB CCC REHAB 7* 3 50 96 10 AC Clinic Geriatric General AMB CCC REHAB 7* 3 50 96 20 AC Clinic Geriatric Assessment AMB CCC REHAB 7* 3 60 Day Surgery Operating Room AIP AMB 7* 3 62 Day Surgery Combined OR & PARR AIP AMB 7* 3 65 Day Surgery PostAnesthetic Recovery Room AIP AMB 7* 3 67 Day Surgery Pre and Post Operative Care AIP AMB 7* 3 69 Day Surgery Combined OR, PARR & Pre and

Post Care AIP AMB 7* 4 06 D&T Program Management Administration AIP AMB CCC AMH REHAB 7* 4 10 LAB Clinical Laboratory AIP AMB CCC AMH REHAB 7* 4 10 10 LAB Administration AIP AMB CCC AMH REHAB 7* 4 10 21 LAB Pre/Post Analysis AIP AMB CCC AMH REHAB

7* 4 10 21 10 LAB Specimen Procurement AIP AMB CCC AMH REHAB

7* 4 10 21 20 LAB Specimen Receipt & Dispatch AIP AMB CCC AMH REHAB

7* 4 10 25 LAB Clinical Chemistry AIP AMB CCC AMH REHAB 7* 4 10 25 10 LAB Routine Chemistry AIP AMB CCC AMH REHAB 7* 4 10 25 20 LAB Urinalysis AIP AMB CCC AMH REHAB





Functional Centre AIP AMB CCC AMH REHAB CCAC 7* 4 10 25 30 LAB Therapeutic Drug

Monitoring/Toxicology AIP AMB CCC AMH REHAB 7* 4 10 25 40 LAB Radio Immunoassay/Enzyme

Immunoassay AIP AMB CCC AMH REHAB 7* 4 10 25 50 LAB Specialty Chemistry AIP AMB CCC AMH REHAB 7* 4 10 25 60 LAB Prenatal Genetics Screening AIP AMB CCC AMH REHAB 7* 4 10 25 70 LAB Biochemical Genetics AIP AMB CCC AMH REHAB 7* 4 10 25 80 LAB Blood Gas AIP AMB CCC AMH REHAB 7* 4 10 25 90 LAB Point of Care Testing AIP AMB CCC AMH REHAB 7* 4 10 30 LAB Hematology AIP AMB CCC AMH REHAB 7* 4 10 30 20 LAB Routine Hematology AIP AMB CCC AMH REHAB 7* 4 10 30 40 LAB Coagulation AIP AMB CCC AMH REHAB 7* 4 10 30 60 LAB Special Hematology AIP AMB CCC AMH REHAB 7* 4 10 35 LAB Transfusion Services AIP AMB CCC AMH REHAB 7* 4 10 35 10 LAB Routine Transfusion Services AIP AMB CCC AMH REHAB 7* 4 10 35 20 LAB Special Transfusion Services AIP AMB CCC AMH REHAB 7* 4 10 35 30 LAB Cryopreservation AIP AMB CCC AMH REHAB 7* 4 10 41 LAB Anatomical Pathology AIP AMB CCC AMH REHAB 7* 4 10 41 20 LAB Surgical Pathology AIP AMB CCC AMH REHAB 7* 4 10 41 40 LAB Autopsy Pathology AIP AMB CCC AMH REHAB 7* 4 10 42 LAB Cytopathology AIP AMB CCC AMH REHAB 7* 4 10 43 LAB Electron Microscopy AIP AMB CCC AMH REHAB 7* 4 10 45 LAB Microbiology AIP AMB CCC AMH REHAB 7* 4 10 45 10 LAB Bacteriology AIP AMB CCC AMH REHAB 7* 4 10 45 20 LAB Serology AIP AMB CCC AMH REHAB 7* 4 10 45 30 LAB Mycology AIP AMB CCC AMH REHAB 7* 4 10 45 40 LAB Parasitology AIP AMB CCC AMH REHAB 7* 4 10 45 50 LAB Virology AIP AMB CCC AMH REHAB 7* 4 10 45 55 LAB Environmental Testing AIP AMB CCC AMH REHAB 7* 4 10 60 LAB Histocompatibility &

Immunogenetics AIP AMB CCC AMH REHAB 7* 4 10 85 LAB Diagnostic Genetics AIP AMB CCC AMH REHAB 7* 4 10 85 10 LAB Cytogenetics AIP AMB CCC AMH REHAB 7* 4 10 85 20 LAB Molecular Genetics AIP AMB CCC AMH REHAB 7* 4 10 99 LAB Combined Functions AIP AMB CCC AMH REHAB 7* 4 15 DI Diagnostic Imaging AIP AMB CCC AMH REHAB 7* 4 15 10 DI Administration AIP AMB CCC AMH REHAB 7* 4 15 12 DI AdministrationPACS AIP AMB CCC AMH REHAB 7* 4 15 18 DI Radiography AIP AMB CCC AMH REHAB 7* 4 15 20 DI Mammography AIP AMB CCC AMH REHAB 7* 4 15 20 10 DI Screening Mammography AIP AMB CCC AMH REHAB 7* 4 15 20 20 DI Diagnostic Mammography AIP AMB CCC AMH REHAB 7* 4 15 23 DI Interventional/Angiography AIP AMB CCC AMH REHAB 7* 4 15 23 10 DI Interventional Studies AIP AMB CCC AMH REHAB





Functional Centre AIP AMB CCC AMH REHAB CCAC 7* 4 15 23 20 DI Angiography Studies AIP AMB CCC AMH REHAB 7* 4 15 25 DI Computed Tomography AIP AMB CCC AMH REHAB 7* 4 15 30 DI Diagnostic Ultrasound AIP AMB CCC AMH REHAB 7* 4 15 30 20 DI Abdominal Ultrasound AIP AMB CCC AMH REHAB 7* 4 15 30 30 DI Echocardiography Ultrasound AIP AMB CCC AMH REHAB 7* 4 15 30 40 DI Pelvic Ultrasound AIP AMB CCC AMH REHAB 7* 4 15 30 60 DI Ophthalmological Ultrasound AIP AMB CCC AMH REHAB 7* 4 15 30 80 DI Neurological Ultrasound AIP AMB CCC AMH REHAB 7* 4 15 30 90 DI Vascular Ultrasound AIP AMB CCC AMH REHAB 7* 4 15 30 99 DI Combined Ultrasound Functions AIP AMB CCC AMH REHAB 7* 4 15 35 DI Nuclear Medicine Gamma Cameras AIP AMB CCC AMH REHAB 7* 4 15 44 DI Cardiac Catheterization Lab AIP AMB CCC AMH REHAB 7* 4 15 44 10 DI Cardiac Catheterization

Interventional AIP AMB CCC AMH REHAB 7* 4 15 44 20 DI Cardiac Catheterization Diagnostic

Services AIP AMB CCC AMH REHAB 7* 4 15 60 DI Positron Emission Tomography (PET) AIP AMB CCC AMH REHAB 7* 4 15 70 DI Magnetic Resonance Imaging AIP AMB CCC AMH REHAB 7* 4 15 99 DI Combined Functions AIP AMB CCC AMH REHAB 7* 4 25 ED Electrodiagnostic Laboratories AIP AMB CCC AMH REHAB 7* 4 25 10 ED EEG AIP AMB CCC AMH REHAB 7* 4 25 20 ED EMG AIP AMB CCC AMH REHAB 7* 4 25 30 ED Evoked Potentials AIP AMB CCC AMH REHAB 7* 4 25 40 ED Polysomnography (formerly Sleep

Studies) AIP AMB CCC AMH REHAB 7* 4 25 50 ED Intensive Monitoring AIP AMB CCC AMH REHAB 7* 4 25 60 ED ENG/EOG AIP AMB CCC AMH REHAB 7* 4 25 99 ED Electrodiagnosis – Combined

Functions AIP AMB CCC AMH REHAB 7* 4 30 NV NonInvasive Cardiology and Vascular

Laboratories AIP AMB CCC AMH REHAB 7* 4 30 20 NV NonInvasive Cardiology

Laboratories AIP AMB CCC AMH REHAB 7* 4 30 20 20 NV Echocardiography AIP AMB CCC AMH REHAB 7* 4 30 20 40 NV Ambulatory Monitoring (formerly

Holter) AIP AMB CCC AMH REHAB 7* 4 30 20 60 NV Exercise Stress Test AIP AMB CCC AMH REHAB 7* 4 30 20 80 NV Electrophysiology AIP AMB CCC AMH REHAB 7* 4 30 20 90 NV ECG AIP AMB CCC AMH REHAB 7* 4 30 20 99 NV Non Invasive Cardiology –

Combined AIP AMB CCC AMH REHAB 7* 4 30 40 NV Vascular Laboratories AIP AMB CCC AMH REHAB 7* 4 35 RS Respiratory Services AIP AMB CCC AMH REHAB 7* 4 35 10 RS Respiratory Services Administration AIP AMB CCC AMH REHAB 7* 4 35 25 RS Routine/Critical Care AIP AMB CCC AMH REHAB 7* 4 35 25 10 RS Routine AIP AMB CCC AMH REHAB





Functional Centre AIP AMB CCC AMH REHAB CCAC 7* 4 35 25 20 RS Critical Care AIP AMB CCC AMH REHAB 7* 4 35 30 RS Hyperbaric Chamber AIP AMB CCC AMH REHAB 7* 4 35 42 RS Pulmonary Function Laboratory AIP AMB CCC AMH REHAB 7* 4 35 45 RS Blood Gas Laboratory AIP AMB CCC AMH REHAB 7* 4 35 50 RS Anesthesia AIP AMB CCC AMH REHAB 7* 4 36 Cardiovascular (CV) Perfusion AIP AMB CCC AMH REHAB 7* 4 40 PH Pharmacy AIP AMB CCC AMH REHAB 7* 4 40 05 PH General Pharmacy AIP AMB CCC AMH REHAB 7* 4 40 10 PH Pharmacy Administration AIP AMB CCC AMH REHAB 7* 4 40 60 PH Clinical Pharmacy AIP AMB CCC AMH REHAB 7* 4 40 60 10 PH Clinical Pharmacy Drug Information AIP AMB CCC AMH REHAB 7* 4 40 60 20 PH Clinical Pharmacy Other AIP AMB CCC AMH REHAB 7* 4 40 70 PH Drug Procurement and Distribution AIP AMB CCC AMH REHAB 7* 4 44 TH Combined Therapeutics AIP AMB CCC AMH REHAB 7* 4 45 TH Clinical Nutrition AIP AMB CCC AMH REHAB 7* 4 49 TH Rehabilitation Services Clinical

Management AIP AMB CCC AMH REHAB 7* 4 50 TH Physiotherapy AIP AMB CCC AMH REHAB 7* 4 55 TH Occupational Therapy AIP AMB CCC AMH REHAB 7* 4 55 20 TH Occupational Therapy – General AIP AMB CCC AMH REHAB 7* 4 55 76 TH Occupational Therapy AMH AIP AMB CCC AMH REHAB 7* 4 55 76 10 TH Occupational Therapy MH

General AIP AMB CCC AMH REHAB 7* 4 55 76 20 TH Occupational Therapy MH

Vocational Workshop AIP AMB CCC AMH REHAB 7* 4 60 TH Audiology & Speech/Language

Pathology AIP AMB CCC AMH REHAB 7* 4 60 20 TH Speech/Language Pathology AIP AMB CCC AMH REHAB 7* 4 60 40 TH Audiology AIP AMB CCC AMH REHAB 7* 4 65 TH Rehabilitation Engineering AIP AMB CCC AMH REHAB 7* 4 65 20 TH Rehabilitation Engineering –

Prosthetics AIP AMB CCC AMH REHAB 7* 4 65 40 TH Rehabilitation Engineering –

Orthotics AIP AMB CCC AMH REHAB 7* 4 65 60 TH Rehabilitation Engineering – Seating

Systems AIP AMB CCC AMH REHAB 7* 4 66 RAD Radiation Oncology AIP AMB CCC AMH REHAB 7* 4 66 10 RAD Treatment Planning AIP AMB CCC AMH REHAB 7* 4 66 20 RAD Mould Room AIP AMB CCC AMH REHAB 7* 4 66 30 RAD Treatment AIP AMB CCC AMH REHAB 7* 4 70 TH Social Work AIP AMB CCC AMH REHAB 7* 4 70 10 TH Social Work – General AIP AMB CCC AMH REHAB 7* 4 70 20 TH Social Work Family Therapy AIP AMB CCC AMH REHAB 7* 4 70 30 TH Social Work Community Integration AIP AMB CCC AMH REHAB 7* 4 72 TH Addiction Counselors AIP AMB CCC AMH REHAB





Functional Centre AIP AMB CCC AMH REHAB CCAC 7* 4 74 TH Genetics Counselling AIP AMB CCC AMH REHAB 7* 4 75 TH Psychology and Psychometry AIP AMB CCC AMH REHAB 7* 4 75 20 TH Psychology and Psychometry

Clinical Psychology AIP AMB CCC AMH REHAB 7* 4 75 40 TH Psychology and Psychometry

Neuropsychology AIP AMB CCC AMH REHAB 7* 4 80 TH Pastoral Care AIP AMB CCC AMH REHAB 7* 4 85 TH Therapeutic Recreation AIP AMB CCC AMH REHAB 7* 4 85 10 TH Recreation Therapy Goal Oriented AIP AMB CCC AMH REHAB 7* 4 85 20 TH Recreation Therapy – Participation AIP AMB CCC AMH REHAB 7* 4 90 TH Child Life AIP AMB CCC AMH REHAB 72505 COM Clinical Management CCAC

257250720 COM Medical Resources Other Medical Staff CCAC

7257250930 COM Case Management CCAC 7257251005 COM Primary Care Practice CCAC 7257251015 COM Primary Care Nursing Clinic CCAC 7257251020 COM Primary Care General Clinic CCAC 7257251030 COM Primary Care Combined Clinic CCAC 7257251040 COM Primary Care Therapy Clinic CCAC 725725304011 COM InHome Health Care Nursing

Visiting CCAC 725725304012 COM InHome Health Care Nursing Shift CCAC 725725304035 COM InHome Health Care Respiratory

Services CCAC 725725304045 COM InHome Health Care

Nutrition/Dietetic CCAC 725725304050 COM InHome Health Care Physiotherapy CCAC 725725304055 COM InHome Health Care Occupational

Therapy CCAC 725725304062 COM InHome Health Care Speech Lang.

Path. CCAC 725725304070 COM InHome Health Care Social Work CCAC 725725304075 COM InHome Health Care Psychology CCAC 725725304211 COM Private/Home Schools Nursing

Visiting CCAC 725725304212 COM Private/Home Schools Nursing Shift CCAC 725725304245 COM Private/Home Schools

Nutrition/Dietetic CCAC 725725304250 COM Private/Home Schools Physiotherapy CCAC 725725304255 COM Private/Home Schools Occupational

Therapy CCAC 725725304262 COM Private/Home Schools Speech Lang.

Path. CCAC 725725304411 COM Publicly Funded Schools Nursing

Visiting CCAC 725725304412 COM Publicly Funded Schools Nursing

Shift CCAC





Functional Centre AIP AMB CCC AMH REHAB CCAC 725725304445 COM Publicly Funded Schools

Nutrition/Dietetic CCAC 725725304450 COM Publicly Funded Schools

Physiotherapy CCAC 725725304450 COM Publicly Funded Schools

Physiotherapy CCAC 725725304455 COM Publicly Funded Schools Occ.

Therapy CCAC 725725304462 COM Publicly Funded Schools Speech

Lang. Path. CCAC 725725354010 COM InHome Support Personal Support CCAC 725725354020 COM InHome Support Homemaking

Services CCAC 725725354030 COM InHome Support Comb. PS and HM

Services CCAC 725725354210 COM Private/Home School Support

Personal Services CCAC 7257253545 COM Respite Service CCAC 725725409511 Residential Hospice End of Life (EOL)

Nursing Visiting CCAC 725725409512 Residential Hospice End of Life (EOL)

Nursing Shift CCAC 725725409530 Residential Hospice End of Life (EOL)

Combined PS and HM Services CCAC 725725409544 Residential Hospice End of Life (EOL)

Therapies Combined CCAC 725725409545 Residential Hospice End of Life (EOL)

Nutrition/Dietetic CCAC 725725409550 Residential Hospice End of Life (EOL)

Physiotherapy CCAC 725725409555 Residential Hospice End of Life (EOL)

Occupational Therapy CCAC 725725409562 Residential Hospice End of Life (EOL)

Speech Lang. Path. CCAC 725725409570 Residential Hospice End of Life (EOL)

Social Work CCAC 7257255010 COM Health Prom/Educ General CCAC 725725509410 COM Health Promotion/Education Palliative

Care CCAC 725725509491 COM Health Prom. /Educ Palliative Care

Pain and Symptom Management CCAC 725725509610 COM Health Promotion Education General

Geriatric CCAC 725725509676 COM Health Promotion Education Psycho

Geriatric CCAC 7257257010 COM Information and Referral Service

General CCAC



APPENDIX A3: TRANSIENT FUNCTIONAL CENTRES

Functional Center Number

Transient Functional Centre Name Cost Allocation Numerator Cost Allocation Denominator

7*110 General Administration Department Total Costs Hospital Total Costs 10 Executive Offices Department Total Costs Hospital Total Costs

25 Utilization Management Department Total Costs Hospital Total Costs

30 Board of Trustees Department Total Costs Hospital Total Costs 40 Public Relations Department Total Costs Hospital Total Costs

50 Planning & Development Department Total Costs Hospital Total Costs

53 Privacy Officer Department Total Costs Hospital Total Costs 55 Risk Management Department Total Costs Hospital Total Costs 60 Quality Assurance Department Total Costs Hospital Total Costs 70 Internal Audit Department Total Costs Hospital Total Costs

90 French Language Services Department Total Costs Hospital Total Costs

7*112 Emergency Preparedness Services Department Total Costs Hospital Total Costs

7*115 Finance Department Total Costs Hospital Total Costs 10 General Accounting Department Total Costs Hospital Total Costs 20 Payroll Department Earned Hours Hospital Total Earned Hours 30 Accounts Receivable Department Total Costs Hospital Total Costs 40 Accounts Payable Department Total Costs Hospital Total Costs 50 Budget Control Department Total Costs Hospital Total Costs 60 Case Costing Department Total Costs Hospital Total Costs

7*120 Human Resources Department Earned Hours Hospital Total Earned Hours 20 Personnel Records Department Earned Hours Hospital Total Earned Hours

30 Employee Comp. and Benefits Mgmt Department Earned Hours Hospital Total Earned Hours

40 Labour Relations Department Earned Hours Hospital Total Earned Hours 60 Employee Health Department Earned Hours Hospital Total Earned Hours

80 Employee Assistance programs Department Earned Hours Hospital Total Earned Hours

90 Occupational Health and Safety Department Earned Hours Hospital Total Earned Hours

7*125 Information Systems Support Department Total Costs Hospital Total Costs 20 Data Processing Department Total Costs Hospital Total Costs 40 Systems Engineering Department Total Costs Hospital Total Costs

50 Implementation and Maintenance Department Total Costs Hospital Total Costs

7*130 Communications Department Total Costs Hospital Total Costs 20 Telecommunications Department Total Costs Hospital Total Costs 40 Visitor Information Department Total Costs Hospital Total Costs 60 Mail Service Department Total Costs Hospital Total Costs

7*135 Material Management Dept Supply and PatientSpecific Supply Cost (excluding drugs)

Total Supply and PatientSpecific Supply Cost (excluding drugs)

05 Administration

10 Purchasing Dept Supply and PatientSpecific Supply Cost (excluding drugs)


15 Capital Asset Control Dept Amortization Expense Total Amortization Expense

20 Receiving and Shipping Dept Supply and PatientSpecific Supply Cost (excluding drugs)






30 Stores Dept Supply and PatientSpecific Supply Cost (excluding drugs)


40 Reprocessing Using Dept Total Direct Costs Total Costs for Using Depts

50 Printing W/O Residual By Dept Total Direct Costs Hospital Total Costs

55 Contract Management Using Dept Total Direct Costs Total Costs for Using Depts

60 Distribution: Internal Dept Supply and PatientSpecific Supply Cost (excluding drugs)


70 Distribution: External Dept Supply and PatientSpecific Supply Cost (excluding drugs)


99 Combined Functions Dept Supply and PatientSpecific Supply Cost (excluding drugs)


7*140 Volunteer Services Department Total Costs Hospital Total Costs

7*145 Housekeeping

Dept Weighted Net Square Metres (excluding Common Areas) or Dept Housekeeping Worked Hours

Hospital Weighted Net Square Metres (excluding Common Areas) or Total Housekeeping Worked Hours

7*150 Laundry and Linen

Laundry and Linen is no longer an indirect cost for Ministry of Health reporting. OCCP hospitals must assign these costs to the appropriate AFCs as direct costs.

20 Laundry 40 Linen Note: Total Costs may be used instead of Square Meters.

7*153 Plant Administration Dept. Net Square Meters (excluding

Common Areas) Hospital Net Square Metres (excluding Common Areas)

7*155 Plant Operation Dept. Net Square Meters

(excluding Common Areas) Hospital Net Square Metres (excluding Common Areas)

10 General Dept. Net Square Meters (excluding Common Areas)

Hospital Net Square Metres (excluding Common Areas)

20 Incinerator Dept. Net Square Meters (excluding Common Areas)


7*160 Plant Security Dept. Net Square Meters (excluding Common Areas)


20 Security Dept. Net Square Meters (excluding Common Areas)


40 Fire and Safety Dept. Net Square Meters (excluding Common Areas)


7*165

Plant Maintenance W/O completed; Res by Dept Net Square Metres (excluding Common Areas)

Total Net Square Meters (excluding Common Areas)

20 Grounds Maintenance Dept Net Square Metres (excluding Common Areas)


40 Building Maintenance

W/O completed; Res by Dept Net Square Metres (excluding Common Areas)

Total Net Square Metres (excluding Common Areas)

60 Bldg. Svc. Equipment Maintenance

Dept Net Square Metres (excluding Common Areas)


80 Major Equipment Maintenance

W/O completed; Res by Dept Net Square Metres (excluding Common Areas)

Total Net Square Metres (excluding Common Areas)

7*175 BioMedical Engineering/Med. Physics

W/O Residual by Dept # of work orders completed Total # of work orders completed

20 BioMedical Engineering

W/O Residual by Dept # of work orders completed Total # of work orders completed

40 Medical Physics W/O Residual by Dept # of work orders completed Total # of work orders completed





7*179 Interpretation/Translation Department Total Costs Hospital Total Costs

7*180 Registration (Admitting)

Split costs by IP/Res/Client, then allocate by Dept Hospital Registrations Completed

Total Hospital Registrations Completed

20 Inpatient Registration Dept Inpatient/Resident Registrations Completed

Total Inpatient/Resident Registrations Completed

40 Outpatient Registration Outpatient Dept Registrations Completed

Total Outpatient Registrations Completed

60 Emergency Registration Emergency Registrations Total Emergency Registrations

80 Centralized Booking

Split costs by IP/Resident/OP, then by Dept # of appointments scheduled Total # of Appointments Scheduled

7*182 Case Management Coordination Dept. Service Recipients Seen Total Service Recipients Seen 10 Admission Dept. Service Recipients Seen Total Service Recipients Seen 20 Discharge Dept. Service Recipients Seen Total Service Recipients Seen

7*185 Patient Transport Using Dept Total Costs Total Costs of Using Depts

20 Central Patient Portering Using Dept Total Costs Total Costs of Using Depts

40 External Patient Transport Using Dept Total Costs Total Costs of Using Depts

Non Service Recipient Transport Dept Total Costs Hospital Total Costs

7*186 Note: Patient Hours may be used instead of NWMS (nursing workload) Note: NWMS units may be used instead of # Separations/Visits for Health Records Functional Centres

7*190

Health Records Split costs by IP/Resident/OP, then allocate by Dept Health Records Processed Total Health Records Processed

05 Administration

Split costs by IP/Resident/OP, then allocate by Dept Health Records Processed Total Health Records Processed

20 Transcription

Split costs by IP/Resident/OP, then allocate by Dept Transcription Lines Processed Total Transcription Lines Processed

10 Medical Transcription NWMS Units for Department

Total Functional Centre NWMS Units

20 NonMedical Transcription NWMS Units for Department


40 Record Processing


10 Clerical Record Processing NWMS Units for Department


20 Data Collection NWMS Units for Department Total Functional Centre NWMS Units

30 Release of Patient Information NWMS Units for Department


60 Health Data and information Services


Education

7*810 Hospital Library Using Dept Total Costs Total Costs of Using Depts 7*820 Audiovisual Using Dept Total Costs Total Costs of Using Depts





7*830 Medical Illustration Using Dept Total Costs Total Costs of Using Depts 7*840 InService Education Using Dept Total Costs Total Costs of Using Depts

Selected Undistributed Accounting Centers

8*945 NEER Rebate Department Total Costs Hospital Total Costs

8*955 Interest on Long Term Liabilities Using Dept Total Costs Hospital Total Costs

8*960 Municipal Taxes Using Dept Total Costs Hospital Total Costs 8*965 Employee Future Benefits Departmental Earned Hours Hospital Total Earned Hours

8*990

Other Undistributed Expenses – Operating (Including NEER Penalities) Department Total Costs Hospital Total Costs

8*995 Employee Benefits Debit Clearing Account Departmental Earned Hours Hospital Total Earned Hours

8*996 Employee Benefits Credit Clearing Account Departmental Earned Hours Hospital Total Earned Hours

NOTES

∙ Patient Food Services Costs in FC 71195 are classified as direct costs in OCCI. ∙ Inclusion of the selected accounting centers is a methodological change, effective April 1st, 2004. ∙ W/O Most of the TFC's costs are to be distributed to departments receiving service from this TFC based on a costed

Work Order. Any undistributed costs at period end are allocated using the Cost Allocation Numerator and Denominator.



APPENDIX A4: CCAC TRANSIENT FUNCTIONAL CENTRES Functional Center Code

Transient Functional Centre Name

Cost Allocation Numerator Cost Allocation Denominator

72110 General Administration Department Total Costs CCAC Total Costs

72115 Finance Department Total Costs CCAC Total Costs

72120 Human Resources Department Earned Hours CCAC Total Earned Hours

72125 Information Systems Support Department Total Costs CCAC Total Costs

72130 Communications Department Total Costs CCAC Total Costs

72135 Material Management Dept Supply and ClientSpecific Supply Cost (excluding drugs)

Total Supply and ClientSpecific Supply Cost (excluding drugs)

10 Purchasing Dept Supply and clientSpecific Supply Cost (excluding drugs)

Total Supply and ClientSpecific Supply Cost (excluding drugs)

55 CCAC Contract Management Using Dept Total Direct Costs Total Costs for Using Depts.

72145 Housekeeping Dept Weighted Net Square Metres (excluding Common Areas) or

CCAC Weighted Net Square Metres (excluding Common

Dept Housekeeping Worked Hours Areas) or Total Housekeeping Worked Hours Note: Total Costs may be used instead of Square Meters.

72155 Plant Operation Dept. Net Square Meters (excluding Common Areas)

CCAC Net Square Metres (excluding Common Areas)

10 General Dept. Net Square Meters (excluding Common Areas)

CCAC Net Square Metres (excluding Common Areas)

72190 Health Records Department Total Costs CCAC Total Costs

Education

72840 InService Education Using Dept Total Costs Total Costs of Using Depts.

7284050 InService Community & Social Services Using Dept Total Costs Total Costs of Using Depts.

Selected Undistributed Accounting Centers

82945 NEER Rebate Department Total Costs 82965 Employee Future Benefits Departmental Earned Hours

82990 Other Undistributed Expenses – Operating (Including NEER Penalties)

Department Total Costs

MINISTRY OF HEALTH AND LONG-TERM CARE OCCI Appendix B - Hospital Profiles Health System Information Management and Investment Division Health Data Branch

OCCI Version 7.0 Page 1 of 6 Effective April 2009-March 2010 Updated February 2010

ONTARIO CASE COSTING GUIDE: APPENDIX B: HOSPITAL PROFILES

TABLE OF CONTENTS

OCCP Hospital Profile First Generation, January 1998 ............................................................................... 2 OCCP Hospital Profile Second Generation, January 1998........................................................................... 2 OCCI Hospital Profile Expansion Project 2006 to 2010 .............................................................................. 3 Pre-Existing Case Costing Facilities that have Transitioned to OCCI Project (2010).................................. 5 Type Abbreviations....................................................................................................................................... 6

The tables on the following pages provide a brief profile of all First and Second Generation as well as Expansion hospitals participating in the OCCI.

Case Costing System Vendor indicates the case costing software the hospital is using. Note that the vendor may be providing a single vendor solution (the financial, departmental and case costing systems) or just the case costing application itself.



OCCP Hospital Profile First Generation, January 1998 Original Hospital Name Current Hospital Name City Type Case Costing

System Vendor

Chedoke-McMaster Hospitals Hamilton Health Sciences Corporation Hamilton Teaching In-house

Hawkesbury and District General Hospital Hawkesbury Community Phoenix Solutions

Inc. Hotel Dieu Hospital St. Catharines Community Coopers and LybrandMount Sinai Hospital Toronto Teaching Eclipsys St. Joseph’s Hospital North Bay General Hospital North Bay Community Meditech

Oshawa General Hospital Lakeridge Health Corporation, Oshawa Campus

Oshawa Community Meditech

Ottawa General Hospital Ottawa Hospital, General Campus Ottawa Teaching Eclipsys

Sunnybrook Health Sciences Centre

Sunnybrook and Women’s College Health Sciences Centre

Toronto Teaching Eclipsys

The Credit Valley Hospital Mississauga Community Meditech

The Mississauga Hospital Trillium Health Centre, Mississauga Site Mississauga Community Meditech

The Riverside Hospital of Ottawa

Ottawa Hospital,The Riverside Campus Ottawa Community Meditech

University Hospital Victoria Hospital

London Health Sciences Centre London Teaching Eclipsys

OCCP Hospital Profile Second Generation, January 1998 Original Hospital Name Current Hospital Name City Type Case Costing

System Vendor Arnprior and District Memorial Hospital Arnprior Community Phoenix Solutions

Inc. Grand River Hospital Kitchener Community HBO&Company

Humber Memorial Hospital Humber River Regional Hospital Toronto Community Meditech

Kirkland and District Hospital Kirkland Lake Community Meditech

Laurentian Hospital Sudbury Regional Hosp. Corp. Sudbury Community Eclipsys

Markham-Stouffville Hospital Markham Community Meditech Montfort Hospital Ottawa Community HosCos Pembroke General Hospital Pembroke Community Combeck Providence Continuing Care Center Kingston Specialty HosCos

Renfrew Victoria Hospital Renfrew Community Combeck Riverside Health Care Facilities Fort Frances Community Coopers and Lybrand

Royal Ottawa Health Care Group Ottawa Specialty HBO&Company

St. Joseph's Hospital and Peterborough Community Coopers and Lybrand



Original Hospital Name Current Hospital Name City Type Case Costing System Vendor

Health Center St. Michael's Hospital Toronto Teaching Eclipsys Temiskaming Hospital New Liskeard Community Meditech The Doctor’s Hospital Toronto Specialty Meditech The Princess Margaret Hospital Toronto Specialty Eclipsys

The St. Catharines General Hospital St. Catharines Community Meditech

The Toronto Hospital University Health Network Toronto Teaching Eclipsys Toronto East General Hospital Toronto Teaching Network Inc. Welland County General Hospital Welland Community HealthVISION

West Park Hospital Toronto Specialty HCm OCCI Hospital Profile Expansion Project 2006 to 2010 Facility Name Address City Postal

Code Type

(see abbreviations below)

Campbellford Memorial Hospital

146 Oliver Road Campbellford K0L 1L0 AM, AT, CR

Hamilton Health Sciences 237 Barton Street East, General Site

Hamilton L8L 2X2 AM, AT, CR, SR,GR

Headwaters Health Care Centre

100 Rolling Hills Drive Orangeville L9W 4X9 AM, AT, CR

Humber River Regional Hospital

200 Church Street Toronto M9N 1N8 AM, AT, GR, MH

Northeast Mental Health Centre – North Bay campus

P.O.Box 3010 North Bay P1B 8G4 CM,SF,MH,DT

Peterborough Regional Health Centre

1 Hospital Drive Peterborough K9J 7C6 AM, AT, CR, GR, LT, MH

Queensway Carleton Hospital 3045 Baseline Road Nepean K2H 8P4 AM, AT, GR, MH

Renfrew Victoria Hospital 499 Raglan Street North Renfrew K7V 1P6 AM, AT, CR

Rouge Valley Health System 2867 Ellesmere Road Toronto M1E 4B9 AM, AT, GR, MH, CR

Royal Victoria 201 Georgian Drive Barrie L4M 6M2 AM, AT, CR, GR, MH

Runnymede Healthcare Centre

625 Runnymede Road Toronto M6S 3A3 CR

Salvation Army Grace Hospital

650 Church Street Toronto M4Y 2G5 CR, AT

Scarborough Hospital 2425 Eglinton Avenue East, Suite 301

Toronto M1K 5G8 AM, AT, CR, GR, MH

Southlake Regional Hospital 596 Davis Drive Newmarket L3Y 2P9 AM, AT, CR, GR, MH



Facility Name Address City Postal Code

Type (see abbreviations

below)

St. Francis Memorial Hospital

7 St. Francis Memorial Drive

Barry's Bay K0J 1B0 AM, AT, CR

St. John's Rehabilitation Hospital

285 Cummer Avenue Toronto M2M 2G1 GR, SR

St. Joseph's Healthcare Hamilton

50 Charlton Ave. E. Hamilton L8N 4A6 MH, AM, AT, CR, GR

St. Mary's General Hospital 911 Queen's Blvd Kitchener N2M 1B2 AM, AT, GR

The Ottawa Hospital - Civic Campus

1053 Carling Ave Ottawa K1Y 4E9 AM, AT, MH

Toronto East General Hospital (TEGH)

825 Coxwell Ave Toronto M4C 3E7 DT, AT, AM, GR, CR, MH

Toronto Rehabilitation Institute

550 University Avenue Toronto M5G 2A2 GR, CR, SR

York Central Hospital 10 Trench Street Richmond Hill L4C 4Z3 AT, CR, GR, AM, MH,

Clinton Public 98 Shipley Street Clinton N0M 1L0 AT,AM

Seaforth Community Hospital 24 Centennial Drive Seaforth N0K 1W0 AT, AM, CR

Stratford General Hospital 46 General Hospital Dr. Stratford N5A 2Y6 AM, AT, CR, GR, MH

St. Mary’s Memorial 267 Queen St. W. P.O. Box 940

St. Mary's N4X 1B6 AT, AM, CR

Hospital for Sick Children 555 University Ave. Toronto M5G 1X8 AM, AT

Relig. Hospital of St. Joseph of Hotel Dieu

541 Glenridge Ave., St. Catharines L2T 4C2 CR, GR

Centre for Addiction & Mental Health

1001 Queen Street West Toronto M6J 1H4 DT,AM, MH

St. Joseph’s Health Care London

268 Grosvenor Street London N6A 4V2 DT,AT,DM,GR,CR,,MH

Hopital regional de Sudbury-Laurentian

41 Ramsey Lake Road Sudbury 5J1 P3E AT,CR, SR, AM,TM,MH

St Joseph’s Health Centre - Toronto

30 The Queensway Toronto

M6R 1B5 AT,DT,AM,GR,MH

Bruyere – Sisters of Charity 43 Bruyère St, Suite 152 Ottawa K1N 5C8 CR,GR

Providence Care - Kingston 340 Union Street Kingston K7L 5A2 CR,GR,MH,AM

CE (Central East) CCAC 209 Dundas St. E, 5th Flr. Whitby L1N 7H8 HC

HNHB (Hamilton Niagara Haldimand Brant) CCAC

310 Limeridge Road W Hamilton L9C 2V2 HC

NSM (North Simcoe Muskoka) CCAC

15 Sperling Dr., Suite 100 Barrie L4M 6K9 HC



Pre-Existing Case Costing Facilities that have Transitioned to OCCI Project (2010)

Facility Name Address City Postal Code

Type (see abbreviations

below)

Sunnybrook Health Sciences 2075 Bayview Ave. Toronto M4Y 1H1 AT, CR, GR, MH, AM,

Arnprior and District Memorial Hospital

350 John Street North Arnprior K7S 2P6 AT,CR,AM

West Park Health Centre 82 Buttonwood Avenue Toronto M6M 2J5 CR,SR

University Health Network 190 Elizabeth St Toronto M5G 2C4 DT,AT,AM,MH

St. Michael’s Hospital 30 Bond Street Toronto M5B 1W8 DT,AT,AM,MH

Lakeridge Health Corporation

850 Champlain Avenue, Unit 1

Oshawa L1J 8R2 AT,CR,GR,AM,MH

William Osler Health Centre 2100 Bovaird Dr. E. Brampton L6R 3J7 AT,CR,AM,GR,MH,

Credit Valley Hospital 2200 Eglinton Avenue West

Mississauga L5M 2N1 AT,CR,GR,AM,MH

Trillium Health Centre 100 Queensway West Mississauga L5B 1B8 AT,CR,AM,GR,MH

Mount Sinai Hospital 600 University Avenue Toronto M5G 1X5 AT,AM,MH

Quinte HealthCare Corporation

265 Dundas Street East Belleville K8N 5A9 AT,CR,GR,AM,MH

Ottawa General 501 Smyth Rd Ottawa K1H 8L6 AT,AM,MH, GR

London Health Sciences Centre

800 Commissioners Road East, PO Box 5010

London N6A 5W9

AT,AM,MH



Type Abbreviations

Ministry of Health and Long-Term CareHealth Data BranchData Standards Unit

Ontario Case Costing GuideAppendix C

Appendix C.1

Overview of Data Collection and Reporting Within Functional Centre Framework

Level Functional Framework Patient Identification Workload UnitsCentre Exists Operates Chart

NumberEncounter Number

Service Date

Procedure Total Patient Specific

Total Patient Specific

Unit Producing

Mgmt. & Support

Medical FFS

Medical Salary

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Supply Costs Labour Hours

OCCI Version 7.0Effective April 2009 - March 2010 Appendix C.1-Overview

Page 1 of 5Updated December 2009



Appendix C.2

Patient Identification Data Collection and Reporting Within Functional Centre Framework

Level Functional Centre Patient Identification Accounting Office Reporting Information SystemChart

NumberEncounter Number

Service Date

Procedure Code

Procedures Collected

Manual Process

Automated Process

Combined Process

Automated CPI-A/D/T Interface

CPI-A/D/T Access

1a 1b 1c 1d 2a 2b 2c 2d 3a 3b 4

OCCI Version 7.0Effective: April 2009 - March 2010 Appendix C.2 - Patient Id

Page 2 of 5Updated: December 2009

Ministry of Health and Long-Term CareHealth System Information Management and Investment DivisionHealth Data Branch

OCCI Appendix C

Level Functional Centre Workload System Workload Units Collected Workload Unit Sub-TotalsNational Other Technical Support Other Inpatient Outpatient Referred

OutReferred

InPatient- Specific Workload

1 2 3 4 5 6 7 8 9 10

Appendix C.3

Workload Data Collection and Reporting Within Functional Centre Framework

OCCI Version 7.0Effective: April 2009 - March 2010 Appendix C.3-Workload

Page 3 of 5Updated: February 2010

Ministry of Health and Long-Term CareHealth System Information Management and Investment DivisionHealth Data Branch

OCCI Appendix C

Level Functional Centre Audit

ProcessProd.

TargetsManual Process

Auto-mated

Process

Manual Forms

Dept'l System

Interface

Other Feeder System

11 12 13a 13b 14a 14b 14c

Workload Data Collection and Reporting Within Functional Centre Framework (cont.)

Workload Collection Statistical Ledger ReportingAdditional Comments of Considerations

OCCI Version 7.0Effective: April 2009 - March 2010 Appendix C.3-Workload

Page 4 of 5Updated: February 2010



Appendix C.4

Labour Hour Tracking Within Functional Centre Framework

Level Functional Centre Staff Categories Labour Hour Collection Payroll System ReportingUnit

ProducingMgm't & Support

Medical Staff

Labour Hours Tracked To

Funct. Center

UP & MOS Hours

Tracked

Manual Process

Automated Process

Manual Forms

Dept'l System

Interface

Dept'l Data Entry

GL Input Thru

Payroll

1a 1b 1c 2 3 4a 4b 5a 5b 5c 6

OCCI Version 7.0Effective April 2009 - March 2010 Appendix C.4-Labour Hour

Page 5 of 5Updated December 2009

MINISTRY OF HEALTH AND LONGTERM CARE OCCI Appendix D Health System Information Management and Investment Division Health Data Branch


ONTARIO CASE COSTING GUIDE: APPENDIX D: NURSING PER HOUR WEIGHTS FOR REHABILITATION AND COMPLEX CONTINUING

CARE PATIENT GROUPS Nursing Per Hour Weights for Rehabilitation Patient Groups



Nursing Per Hour Weights for Complex Continuing Care RUGIII Group

Note: Weighting Scales between Rehabilitation Inpatient and Complex

Ministry of Health and Long-Term CareHealth System Information Management and Investment Division Health Data Branch

Appendix E

Instructions for Completing Calculation of Patient Specific Cost Distribution Percentage ReportThe worksheet Appendix E.2 PSCD is used to confirm the percentage of costs to be distributed to patients for each patient population.Note:AIPCCCMHRehabAMB

Acute InpatientComplex Continuing CareMental HealthRehabilitation

The facility may include additional functional centres.

Also, note that Pharmacy’s drug, labour and supply costs are separate items.The following instructions are numbered and correspond to the columns in the worksheet called Appendix E.2 PSCD. Enter the total direct cost for each functional centre.

Ambulatory

(5) To calculate the Percentages to be Distributed, divide the sum of Costs to be Distributed by the sum of Total Costs. (i.e. [4] divided by [3]) for each patient population and enter the resulting values.

PATIENT SPECIFIC COST DISTRIBUTION PERCENTAGE REPORT (PSCD), COST DISTRIBUTION BASES, AND TRANSIENT COST FUNCTIONAL CENTRES (TCC TFC) COST ALLOCATION METHODOLOGY TABLE

Appendix E.2: PATIENT SPECIFIC COST DISTRIBUTION PERCENTAGE REPORT (PSCD)

(1) Based on patient care workload only, calculate and enter the proportion of total workload by patient population as a percentage of total department workload.(2) Multiply total direct cost (1) by the percentages calculated in (2) to arrive at total costs associated with each patient population for each functional centre.(3) Carry over the total costs from (3) that will be distributed to patients through workload. Mandatory functional centre costs that are required to be distributed are represented by the shaded areas for the patient population to be costed. These areas must be carried over. If the hospital will not distribute the costs of a functional centre, enter zero.

(4) Sum the Total Costs columns and Costs to be Distributed columns for each patient population.

The information to complete this report is available from the hospital’s Trial Balance and Ontario Cost Distribution Methodology (OCDM).

OCCI APPENDIX E:

OCCI Version 7.0Effective April 2009 - March 2010 Appendix E.1 README

Page 1 of 6Updated February 2010


Appendix E

Different data types can be used as cost distribution bases. The following are the approved cost distribution bases:NOTE: Additional rows can be added to this table to list all distribution bases.

Number of Exams

Appendix E.3: COST DISTRIBUTION BASES

Each TCC TFC overhead department allocates its costs based on a defined set of statistics. The statistics determine which departments will receive dollars from a particular overhead department. For example, the costs in the Laundry center may be most appropriately allocated to the nursing units based on the total pounds of laundry processed for each unit. Other examples of allocation statistics or cost allocation numerator include square footage occupied, number of employees, total earned hours, etc. Facilities are required to submit the table below with their annual data submission.

Number of Cases Hospitals should select distribution bases that meet their organizational patient care model and cost curve. To maintain transparency with the allocation of resources, hospitals are required to submit the following table with their annual data submission.

The Simultaneous Equation Allocation Method (SEAM) must be used to compute the indirect cost allocation. This algorithm allows us to determine the relative use of administrative and support services by each patient care functional centre. SEAM allocates a portion of the TCC TFC costs as indirect costs to other TCCs TFCs as well as ACCs AFCs (Absorbing Cost Functional Centres or Patient Care Areas), then simultaneously allocates out all the TCC TFC direct and indirect costs to all the ACCs AFCs as indirect costs.

Appendix E.4 TRANSIENT COST FUNCTIONAL CENTRES (TCC TFC) COST ALLOCATION METHODOLOGY TABLE

WorkloadPatient HoursPatient Days

OCCI Version 7.0Effective April 2009 - March 2010 Appendix E.1 README



Appendix E

Patient Specific Cost Distribution Percentage ReportNOTE: The facility may include additional functional centres to accommodate Level 4 reporting.

Functional CentreTotal Direct

Cost (1) AIP CCC OP MH Rehab AIP CCC OP MH Rehab AIP CCC OP MH Rehab71210 Medical71220 Surgical71230 Combined Medical/Surgical71240 Intensive Care71250 Obstetrics71260 Operating Room71265 Post-Anesthetic Recovery Room71270 Pediatric 71276 Mental Health/Addictions71281 Rehabilitation 71294 Palliative 71295 Long-Term Care71310 Emergency71320 Poison Information Centre71340 Day/Night Care71350 Clinics713501070 Pre-Admission – Medical713501545 Pre-Admission – Surgical71355 Private Clinics71360 Day Surgery O/R 71410 Clinical Laboratory71415 Diagnostic Imaging71425 Electrodiagnostic Laboratories71430 Non-Invasive Cardiology and Vascular Laboratories71435 Respiratory Therapy71440 Pharmacy Drugs71440 Pharmacy Labour and Supplies71445 Clinical Nutrition71450 Physiotherapy71455 Occupational Therapy71460 Audiology & Speech/Lang Path71465 Rehabilitation Engineering71466 Radiation Oncology71470 Social Work71475 Psychology71480 Pastoral Care71485 Recreation71490 Child Life715 Community Service

Total (5)

% % % % %% % % % %

Costs to be Distributed (4)

Percentages of Costs Distributed (6) For First and Second Year of OCCI Submission: Minimum Required Percentage to be DistributedFor Third Year and Over of OCCI Submission: Minimum Required Percentage to be Distributed

Percentage (2) Total Costs (3)

OCCI Version 7.0Effective April 2009 - March 2010 Appendix E.2 PSCD



Appendix E

COST DISTRIBUTION BASESNOTE: Additional rows can be added to this table to list all distribution bases.

Variable Direct Labour

Variable Direct Supply -Patient

SpecificVariable Direct

Supply - GeneralVariable Direct

OtherFixed Direct

LabourFixed Direct

OtherFixed Direct Building, Equipment, Grounds

7**** Equipment (incl Depreciation)

9**** Undistributed (Building and Grounds)

Nursing 71210*-7129* exc 71260*Workload or Patient Hours

Workload or Patient Hours


Workload or Patient Hours Day Day Day

DI 71415*Workload or Patient Hours Exam Exam Exam Exam Exam Exam

Lab 71410*Workload or Patient Hours Procedures Exam Exam Exam Exam Exam

OR, PARR 7126*, 7136*Workload or Patient Hours


Patient Specific Cost

Patient Specific Cost Case Case Case

Allied Health 714*Ambulatiory care 713*

Functional Centre

Cost Type

350*, 3909* 5*** PSS Supplies 4**** Supplies 8****

Contracted Out310***, 39010-

39085 6**** Sundry

OCCI Version 7.0Effective April 2009 - March 2010 App E.3 Cost Distribution Bases



Appendix E

Overhead Functional Centre Number Cost Allocation Numerator71110 General Administration71112 Emergency Preparedness Services71115 10 General Accounting71115 20 Payroll71115 30 Accounts Receivable71115 40 Accounts Payable71115 50 Budget Control71115 60 Case Costing71120 Human Resources71125 Information Systems Support71130 Communications71135 10 Purchasing71135 15 Capital Asset Control71135 20 Receiving and Shipping71135 30 Stores71135 40 Reprocessing71135 50 Printing71135 60 Distribution: Internal71135 70 Distribution: External71135 99 Combined Functions71140 Volunteer Services71145 Housekeeping71150 Laundry and Linen71153 Plant Adminstration71155 Plant Operation71160 Plant Security71165 20 Grounds Maintenance71165 40 Building Maintenance71165 60 Building Service Equipment Maintenance71165 80 Major Equipment Maintenance

TCC TFC Cost Allocation Methodology Table

OCCI Version 7.0Effective April 2009 - March 2010 App E.4 TFC Allocation Table



Appendix E

Overhead Functional Centre Number Cost Allocation NumeratorTCC TFC Cost Allocation Methodology Table

71175 20 Bio-Medical Engineering71175 40 Medical Physics71179 Interpretation/Translation71180 20 Inpatient Registration71180 40 Outpatient Registration71180 60 Emergency Registration71180 80 Centralized Booking71182 Admission/Discharge Coordinator71185 Service Recipient Transport71186 Non Service Recipient Transport71190 20 10 Medical Transcription71190 20 20 Non-Medical Transcription71190 40 10 Clerical Record Processing71190 40 20 Data Collection71190 40 30 Release of Patient Information71190 60 Health Data and Information Services71810 Hospital Library71820 Audiovisual71830 Medical Illustration71840 In-Service Education

Undistributed Accounting Centres81945 NEER Rebate81955 Interest on Long Term Liabilities81960 Municipal Taxes81965 Employee Future Benefits81990 Other Undistributed Expenses – Operating (including NEER Penalties81995 Employee Benefits Debit Clearing Account81996 Employee Benefits Credit Clearing Account

OCCI Version 7.0Effective April 2009 - March 2010 App E.4 TFC Allocation Table
