Organisational structure

The Independent Health and Aged Care Pricing Authority (IHACPA) is a Corporate Commonwealth Entity under the Public Governance, Performance and Accountability Act 2013.

IHACPA’s role and functions are set out in the National Health Reform Act 2011, the Aged Care Act 1997 and the Quality and the Safety Commission Act 2018. Under these agreements, IHACPA works in six priority areas:

  • determination of the national efficient price and national efficient cost for public hospital services 
  • development of national classifications for activity based funding
  • resolution of disputes on cost-shifting and cross-border issues
  • provision of advice on healthcare pricing and costing matters
  • provision of advice on aged care pricing and costing matters
  • performance of certain functions conferred by the Aged Care Act.

The Chief Executive Officer (CEO) is responsible for the day‑to‑day management of IHACPA and its staff.

Alongside the Office of the CEO, there are a number of teams that support the core activities of IHACPA as presented in the following IHACPA organisational structure.

Analytics

The Analytics team is responsible for analysing and reporting on IHACPA’s activity data collections and providing insights which will improve data quality, identify variation and inform policy development and implementation. This includes analysing National Hospital Cost Data Collection data, leading analytics for future funding models and developing the National Benchmarking Portal.

Pricing Development

The Pricing Development team provides advice to the Australian Government on aged care matters as well as prosthesis pricing. They also work in collaboration with other teams within IHACPA to develop innovative methods for determining prices for public hospital services, evidence driven national health policies, alternative health care funding models, and classification systems. 

Pricing Implementation

The Pricing Implementation team maintains and builds the pricing models that inform the annual national efficient price and national efficient cost determinations, which in turn inform the funding of Australia’s public hospitals. This work is done in consultation with Australian Government and state and territory governments, as well as clinicians and other stakeholders, and is set out in IHACPA’s pricing framework. The team also develops supporting documentation and tools that explain and help with the application of the price tables and adjustments to health data.

Aged Care Costing

The Aged Care Costing team coordinates the collection, validation and analysis of both financial and service utilisation data for residential and in home aged care services. This data is collected and analysed to create data sets to show the cost that is required to deliver the aged care services at a client level for both residential and in home aged care services. To ensure that the costing data for residential and in home aged care can continue to be a well-informed, evidence-based data collection, the Aged Care Costing team also conduct specific costing studies.

Data Acquisition

The Data Acquisition team works with states and territories to develop appropriate data specifications, and to acquire, validate and maintain data in the IHACPA information technology environment, as well as provide analytical support to various teams.

Hospital Costing

The Hospital Costing team coordinates the collection, validation, analysis and reporting of the National Hospital Cost Data Collection (NHCDC), in conjunction with states and territories and private hospitals. To ensure the NHCDC can continue to be a well-informed, evidence-based data collection, the Hospital Costing team also conduct specific costing studies.

Infrastructure

The Infrastructure team manages IHACPA’s computing resources used to deliver the national efficient price and national efficient cost, and provides support for technology-based projects.

Acute Care Classification

The Acute Care Classification team refines and maintains the clinical classifications and coding standards that are used to classify admitted care activity in public and private hospitals in Australia:

  • International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) – used to classify diseases, injuries and related health problems
  • Australian Classification of Health Interventions (ACHI) – used to classify surgeries, therapies and health interventions
  • Australian Coding Standards (ACS) – guidelines designed for nationally consistent application of ICD-10-AM and ACHI; collectively known as ICD-10-AM/ACHI/ACS
  • Australian Refined Diagnosis Related Groups (AR-DRGs).

The AR-DRG classification groups admitted episodes of care into clinically meaningful and cost coherent groups and is underpinned by ICD-10-AM/ACHI/ACS

The classifications are developed in consultation with clinical, technical and jurisdictional stakeholders to ensure they remain current and fit for purpose. 

The ICD-10-AM/ACHI/ACS and AR-DRG classification system underpins the activity based funding framework for public hospital admitted acute care, but also serves multiple other purposes including research, education, epidemiology, health service planning and research into the quality of health care and patient safety.

Classifications

The Classifications team refines, develops and maintains the clinical classifications, coding rules and business rules that are used to classify emergency care, subacute and non-acute care, mental health care, non-admitted care, and teaching and training activity in Australian public hospitals. Specifically, the five service categories and the corresponding classification systems include:

The AECC, AN-SNAP and AMHCC classifications group episodes emergency, subacute or mental health care activity into clinically meaningful cost coherent groups and are underpinned by the ICD-10-AM. While the Tier 2 classification groups episodes into clinically meaningful cost coherent groups based on the nature of the service provided and the type of clinician, and the ATTC groups episodes based on the profession and training stage. 

The classifications are refined and developed in consultation with clinical, technical and jurisdictional stakeholders to ensure they remain current and fit for purpose. Each classification system underpins the activity based funding framework for public hospitals but also serves multiple other purposes including research, education, epidemiology, health service planning and research into the quality of health care and patient safety.

Hospital Policy Development

The Hospital Policy Development team develops activity based funding policies across the agency, including matters relating to the Pricing Framework for Australian Public Hospital Services, the National Efficient Price Determination and National Efficient Cost Determination.

Aged Care Policy

The Aged Care Policy team develops and reviews the policies, procedures and frameworks that support the agency in undertaking its role in providing annual aged care pricing advice to the Australian Minister for Health and Aged Care. The scope of IHACPA’s annual pricing advice includes residential, respite and in-home aged care services.

IHACPA seeks input from stakeholders on its policy approach, methodology and high-level principles through an annual consultation paper that governs its advice. The resulting Pricing Framework for Australian Aged Care Services is reviewed and updated annually to reflect new costing and pricing priorities and developments.

Through its committee structure IHACPA consults broadly with aged care stakeholders, including aged care providers across the for-profit, not-for-profit and government sectors, providers and aged care recipients in rural and remote locations, as well as peak organisations and industrial bodies, governments, and consumers and their carers. 

Aged Care Policy (Accommodation)

The functions of the Aged Care Policy (Accommodation) team are to review applications for Refundable Accommodation Deposits above the maximum determined by the Minister for Health and Aged Care, as well as the assessment of applications for Extra Service Fees. This team also shares information with the Department of Health and Aged Care and the Aged Care Quality and Safety Commission as permitted within the Aged Care Act 1997 to support their functions.

Communications and Media

The Communications and Media team drives strategic communications, engagement, events and public affairs activities, promoting the role and function of IHACPA and its work plan.

Legal, Corporate Services and Secretariat

The Office of the CEO provides the business infrastructure for the organisation by delivering secretariat services, legal, governance and executive services.

Finance

The Finance team is responsible for ensuring that IHACPA’s financial compliance framework meets the financial related obligations under the Commonwealth’s legislative and policy environment. Their core responsibilities include the management of financial operations including budget submissions and forecasting, preparation of monthly and annual financial statements and the provision of financial and procurement advise including management reporting, and managing audit activity.

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