Weighted Inlier Equivalent Separation (WIES)

see also:

• funding of Emergency Departments in Australia
• Australian Refined Diagnosis Related Groups (AR-DRGs)

• Victorian Government uses WIES as their activity based case mix funding policy for public hospitals
• each hospital admission is assigned a WIES value
• each hospital is then paid for their total WIES activity for the fiscal year up to a capped WIES target
• activity beyond the WIES target does not attract further funding but may assist in increasing the cap target for the following year and thus enable increased funding in subsequent years
• from 2013-2014 onwards, the Australian Government will pay the state governments according to a new case mix funding model based around the concept of National Weighted Activity Unit (National Weighted Activity Unit (NWAU)).
• The ‘average’ hospital service is worth one NWAU – the most intensive and expensive activities are worth multiple NWAUs, the simplest and least expensive are worth fractions of an NWAU.
• the Victorian Government will convert WIES in NWAU equivalents.

• each patient admission is assigned on of some 700 DRGs by a DRG Grouper software which assesses patient age, sex, diagnoses and procedures
• the Government publishes a table of WIES values for each of these DRGs depending on whether same day, one day (ie. overnight stay), or multi-day admission, and also factors to account for excessively low or high LOS and whether Hospital in the Home (HITH) was utilised.
• further loadings are applied if the patient is indigenous, or has thalasaemia, had certain procedures performed such as mechanical ventilation hours, AAA stent or ASD repair.

• Vic Govt 2012-13 WIES19 technical guidelines (doc)
• main changes from WIES18 affecting ED are:
  • “• Episodes where the patient’s entire care is provided in the Emergency Department (ED only), and that meet criterion for admission in 2011-12, will no longer be considered admitted care in 2012-13 and will no longer be reported to the VAED. The amount of WIES funding that Health Services would have received for these patients will be funded through the Non Admitted Emergency Services Grant (NAESG) to ensure a neutral financial outcome.”
• Vic Govt 2011-12 WIES18 technical (rtf)
• Vic Health Policy and funding guidelines - links to the hospital fundings, WIES values and calculators