Cost Per Case-Mix Weighted Activity For Complex Continuing Care In Ontario

Transcription

1 J O I N T P O L I C Y A N D P L A N N I N G C O M M I T T E E Cost Per Case-Mix Weighted Activity For Complex Continuing Care In Ontario (Using 1997/98 Year End MIS Trial Balance & CIHI OCCPS/MDS 2.0 Data) AN INTERIM SUMMARY REPORT FROM THE JPPC COMPLEX CONTINUING CARE FUNDING WORKING GROUP JPPC Reference Document RD #8-11, September 1999 AN ONTARIO MINISTRY OF HEALTH AND ONTARIO HOSPITAL ASSOCIATION PARTNERSHIP

2 All inquiries and questions pertaining to the methodology described in this document should be sent by at or by facsimile to Howard Baker, Technical Planning Consultant, JPPC Secretariat, at (416) Any concerns pertaining to the MIS TRAIL BALANCE DATA used in the calculation should be directed to your Finance and Information Consultant at the Ministry of Health. Any concerns pertaining to the OCCPS/MDS 2.0 DATA used in the calculation should be directed to your Continuing Care Client Support contact at the Canadian Institute for Health Information.

3 September 1999 To: Hospital Chief Executive Officers/Presidents Ministry of Health Ontario Hospital Association The Ontario Joint Policy and Planning Committee (JPPC) Complex Continuing Care Funding Working Group (CCCFWG), a sub-committee of the JPPC Hospital Funding Committee, firmly believes that to more appropriately serve Ontario s residents, we as an industry must strive to accurately measure what it is we do for our patients. For the first time, the JPPC is distributing comparative reports that indicate provincial and facility-specific 1997/98 costs per RUG-IIIweighted patient day to Ontario hospitals with Ministry of Health designated chronic beds. These comparative reports, included with this summary document and its companion technical document (JPPC Reference Document #8-12), enhance our understanding in this regard. The purpose behind releasing this information at this time is two-fold. First, it is hoped that facilities will use this information to identify data quality and reporting issues and to use the insights gained from this information to make any necessary final changes to their data from 1998/99 and beyond, for both cost and patient activity. Second, the CCCFWG would appreciate feedback from the field regarding the work completed thus far. This feedback will be used during Phase Two of its work; to use 1998/99 data to develop a funding model for implementation for April The CCFWG is also planning technical briefing sessions for the fall 1999 to assist facilities in interpreting these comparative reports as well as understanding the methodology used in their construction. It is for these reasons that we strongly urge facilities to use this information for internal purposes only. This data is not meant to indicate relative efficiencies or suggest proposed future funding allocations. The CCCFWG s concerns regarding data quality remain a prominent issue to be addressed through its future work plans. One way to do so is to ensure that the data upon which evidencedbased decisions are made is reliable and accurate. The JPPC anticipates that fiscal year will represent a re-vitalization of the interest in and focus upon data quality and measurement. The JPPC committees are orienting their work plans along this theme and intend to strengthen their role as leaders in this regard. We look forward to the industry s continued support and commitment of our efforts. Sincerely, Greg Fougère Greg Fougère Chair, JPPC Complex Continuing Care Funding Working Group

4 Table of Contents Background...1 The Resident Assessment Instrument Minimum Data Set (MDS 2.0) and Resource Utilization Groups in Ontario...1 Patient-Centred Funding...1 Case-Mix Funding For Complex Continuing Care (Chronic Care)...2 Understanding the Case-Mix Index...2 Phase One of Work Plan Adaptation of RUG-III weights for Ontario Calculation of cost/rug-iii weighted unit...3 Calculation of RUG-III-weighted Patient Days...3 Linkage of RUG-III-weighted Patient Days to Facility Cost Data from the Management Information Systems Data...3 Reference Data and Calculations Used to Check the Validity of the Patient Volumes (Days) Calculated Using the OCCPS/MDS 2.0 Data...4 Next Steps: Phase Two of Work Plan...5 Appendices...6

5 Background In 1994 the JPPC formed the Chronic Care & Rehabilitation Working Group. A significant part of its mandate was to investigate patient classification systems for chronic care hospital patient populations and to recommend one for use in Ontario. The goal was to implement a classification system that would enable chronic care funding based on patient resource needs (that is, case-mix based) rather than the current system based on historical hospital budgets. Upon conclusion of their work, that committee recommended the Resource Utilization Groups, version III (RUG-III) be collected, beginning fiscal 1996, using the Resident Assessment Instrument Minimum Data Set version 2.0 (MDS 2.0). (For further detail, see Moving Toward Classification of Chronic Care Patients in Ontario, JPPC Reference Document #3-9). Thus on July 1, 1996, Ontario hospitals began the collection of MDS 2.0, mandated by the Ontario Ministry of Health (MoH) for all patients in designated chronic beds. Subsequently, on April 8, 1998, the MoH approved the use of RUG-III for chronic care funding. In July 1998, the JPPC established the Complex Continuing Care Funding Working Group (CCCFWG) with a mandate to develop this funding model to be used to allocate funds for patients in MoHdesignated chronic care beds in chronic care facilities and chronic care units in public hospitals. The Resident Assessment Instrument Minimum Data Set (MDS 2.0) and Resource Utilization Groups in Ontario The Ontario Ministry of Health requires all Ontario hospitals to complete MDS 2.0 assessments for all patients by the fourteenth day after admission to designated chronic care beds, and quarterly (approximately every 90 days) thereafter for the duration of their stay. Assessments are not required for patients discharged before the fourteenth day after admission, however admission and discharge tracking forms were to be completed for all patients, regardless of length of stay. While not required, hospitals may chose to do the MDS 2.0 assessment for shortstay (less than 14 days) patients, and several have done so. Data are submitted quarterly, in electronic format, to the Canadian Institute for Health Information, which administrates the provincial MDS 2.0 database, called the Ontario Chronic Care Patient System (OCCPS). Patient-Centred Funding One of the most significant trends in health care funding is the international adoption of the concept of "patient-centred" funding. Associating funding with patient characteristics, rather than the historical cost structures of specific institutions or providers, promotes not only equity of access to resources by individual patients but reduces inappropriate allocation of resources. Patientcentred funding was first introduced ten years ago for acute inpatient care provided by hospitals in Ontario. Based on discharge abstract data (diagnoses, Cost Per Case-Mix Weighted Activity For Complex Continuing Care In Ontario (RD#8-11) page 1

6 surgical procedures, complications, etc.), each inpatient is classified into a single Case Mix Group (CMG). A relative Resource Intensity Weight (RIW) is associated with each CMG so that a total case-weighted activity can be calculated for all inpatients in each hospital. Funding, then, can be related to case-weighted activity. There are three essential elements required for the development of a patientcentred funding system. They are: 1) a patient-specific data collection instrument, 2) a patient grouping system, and 3) a relative resource weighting system. 1) Data Collection Instrument Just as Discharge Abstract Data (DAD) is mandated for all acute inpatients in Ontario, the MDS 2.0 has been mandated since July 1996 for all patients in Ministry-of-Health-designated chronic care beds. MDS 2.0, designed expressly for the types of patients in chronic care beds, captures a broad range of resource-determining patient characteristics including cognitive patterns, mood and behaviour, physical functioning, continence, diagnoses, and special treatments. 2) Patient Grouping System Whereas acute inpatients are grouped into CMGs, patients in chronic beds are classified into RUG-III groups based on the information captured by the MDS 2.0. There are a total of 44 RUG-III groups, including 14 rehabilitation groups. (See Appendix A) 3) Relative Resource Weighting System Analogous to acute inpatient RIWs, relative per diem resource weights for each RUGs group have been developed and adapted using Ontario wage rates for various labour categories including RNs, RNAs, Physiotherapists, and Occupational therapists. Case-Mix Funding For Complex Continuing Care (Chronic Care) In complex continuing care (i.e., chronic care) diagnoses are not as closely linked with resource use as are the functional abilities and the types of services received. Furthermore, episodic payment models are inappropriate for complex continuing care due to the high variability in length of stay, even among patients with the same diagnosis. Lengths of stay in chronic care can range from days to years, and the goals of care are generally to restore, or slow the decline of, patients' daily functional abilities, rather than curing organic disease. In such continuing care settings, a per-diem funding perspective is more appropriate than an episodic model. Understanding the Case-Mix Index Since approximately 75 to 85 % of the cost of continuing care is due to staff costs, the RUG-III system was designed to classify groups of patients with similar staff resource use. The case-mix index (CMI) for a group in the classification Cost Per Case-Mix Weighted Activity For Complex Continuing Care In Ontario (RD#8-11) page 2

7 system is the relative weight of resource use in that group to some base resource use level. The base used in the RUG-III system is generally chosen to be the average resource use in the population. Thus the case-mix index for a group represents the relative cost of caring for the average patient within that group, compared to the average patient in the population. Phase One of Work Plan Phase One of the CCCFWG work plan has recently been completed. The milestones reached during this phase were the following: 1. Adaptation of RUG-III weights for Ontario 2. Calculation of cost/rug-iii weighed unit 1. Adaptation of RUG-III weights for Ontario Ontario wage-weights were calculated as the ratios of licensed nursing, therapy and therapy assistant staff wages to nursing aide wages. The wage figures used for deriving these Ontario wage weights were taken from results of fiscal year 1997/98 Ontario Hospital Association salary surveys. 2. Calculation of cost/rug-iii weighted unit Calculation of RUG-III-weighted Patient Days In the funding system being developed for Complex Continuing Care (CCC) in Ontario, the basic units of patient volume are days of patient care (patient days). The CCFWG assumes that funding equity will be introduced by weighting the days of care for patients by the resource intensity of their care relative to that of the average CCC patient in Ontario. These RUG-III case-mix index weighted patient days have been labelled as RUG-weighted patient days (RWPD). Calculation of RUG-weighted patient days involved the following four distinct steps: 1. RUG-III classification for each MDS assessment associated with an episode of care. 2. Calculation of the patient days associated with the RUG-III classification for each MDS assessment within an episode. 3. Weighting of patient days 4. Calculation of the facility total RWPD and a facility summary score, the Facility Case-Mix Index. Linkage of RUG-III-weighted Patient Days to Facility Cost Data from the Management Information Systems Data Based on financial data supplied by all hospitals to the Ontario Ministry of Health in compliance with Management Information Systems (MIS) requirements, the Ontario Cost Distribution Methodology (OCDM) is used to allocate costs to Direct Care costs and Overhead costs. (For a detailed examination of the OCDM applied to 1997/98 data, see JPPC Reference Document #8-1). Hospitals with Cost Per Case-Mix Weighted Activity For Complex Continuing Care In Ontario (RD#8-11) page 3

8 different levels of care (e.g. chronic care, rehabilitation, acute care) must appropriately allocate costs to the different levels of care when submitting their MIS data to the Ministry of Health. The MIS data submission process is audited annually 1. Direct Care Costs and Total Costs allocated to chronic care were derived for each hospital with chronic care beds. The data were divided by Total RUGWPD to yield facility Total Cost per RUG-weighted day (Appendix B, column F). Reference Data and Calculations Used to Check the Validity of the Patient Volumes (Days) Calculated Using the OCCPS/MDS 2.0 Data Two sources of facility total patient days for FY 97/98, based on data sources external to the MDS, and a further method of calculating patient days using OCCPS data were employed to check the validity of the number of patient days calculated based on the MDS data. The Ministry of Health supplied a report of total chronic care patient days for Ontario hospitals, based on their submissions of midnight census information to the Ministry. The Ministry also provided the total chronic care patient days reported by hospitals in their MIS submissions. Total patient days can also be calculated based solely on admission and discharge information in the OCCPS database. In general, for most facilities there is substantial agreement among the patient day totals calculated as part of the RWPD calculations and the total patient days from the midnight census, MIS data and MDS admission/discharge information only. The reasons for disagreements among these values are discussed elsewhere 2. 1 The JPPC plans data quality tests through what is known as a data blitz. Annually, the JPPC along with the Ministry of Health jointly organize this event, over a short period, to focus and review hospital specific MIS Trial Balances. The purpose of this review is to ensure that all data submitted by hospitals meet audit criteria for inclusion in JPPC funding formulae. 2 For an in-depth examination of the work of the CCCFWG, see companion technical document, Case-Mix Weighted Patient Volumes for Chronic Care: Resource Utilization Groups (RUG-III) weighted Patient Days, JPPC Reference Document #8-12. Additional information, including the CCCFWG Terms of Reference, Implementation Plan, and annotated bibliography can be found at Cost Per Case-Mix Weighted Activity For Complex Continuing Care In Ontario (RD#8-11) page 4

9 Next Steps: Phase Two of Work Plan The CCCFWG is now ready to examine the data from Phase one to determine if any cost adjustments are needed. The committee s approach is to start by examining those adjustment factors that have been found to be significant cost drivers for acute care and to determine which, if any, are cost drivers for complex continuing care. Additional factors are being addressed by another JPPC Sub-Committee called the JPPC Rate Sub-committee such as revenue and other potential factors that may impact the way in which hospitals are funded such as availability of community resources. The CCCFWG will be liaising with the Rate Subcommittee to determine if any of these additional factors may impact funding for complex continuing care. The CCCFWG also plans to examine how each proposed funding methodology would affect specific patient populations such as palliative care, geriatric rehabilitation, dialysis, and ventilator patients. The CCCFWG will address any material inconsistencies in the methodology s impact on equitable funding of these patient populations and make recommendations accordingly. Cost Per Case-Mix Weighted Activity For Complex Continuing Care In Ontario (RD#8-11) page 5

10 RUG Group APPENDIX A: Ontario RUG-III Groups and Case-Mix Indices RUG ADL CMI NOTE: Using the "Index Maximizing" C Resident qualifies for Clinically Complex Care category on the basis of clinical indicators: Index score (weight) method for classification, a patient Qualifications (any one sufficient): REHAB ULTRA HIGH would be classified into a lower 1. Feeding tube WITH high parenteral/intake. RUC group in the RUG hierarchy if that 2. Comatose AND not awake AND ADL dependent. RUB group has a higher CMI than that of a 3. Septicemia. RUA group higher in the hierarchy for which 4. Burns--second or third degree. REHAB VERY HIGH the patient also qualified. 5. Dehydration. RVC Hemiplegia/hemiparesis and ADL score of 10 or more. RVB KEY: 7. Internal bleeding. RVA RU Resident qualifies for Ultra High Intensity Rehab. if 8. Pneumonia. REHAB HIGH (1) 720+ minutes received across all types AND 9. Chemotherapy. RHC (2) 5+ days received for 1 type of therapy AND 10. Dialysis. RHB (3) 3+ days received for a second type of therapy 11. Physician order changes on 4 or more days AND physician visits on 1 or more days. RHA Physician order changes on 2 or more days AND physician visits on 2 or more days. REHAB MEDIUM RV Resident qualifies for Very High Intensity Rehab. if 13. Diabetes AND injections on 7 days AND physician order changes on 2 or more days. RMC (1) 500+ minutes received across all types AND 14. Transfusions. RMB (2) 5+ days received for 1 type of therapy 15. Oxygen therapy. RMA Infection on foot OR open lesion on foot AND application of dressings to foot. REHAB LOW RH Resident qualifies for High Intensity Rehab. if 17. End stage disease, 6 months or less to live RLB (1) 325+ minutes received across all types AND RLA (2) 5+ days received for 1 type of therapy I Resident qualifies for the Impaired Cognition category based on the MDS Cognitive EXTENSIVE Performance Scale and the RUG-III ADL Index: SE3 N/A RM Resident qualifies for Medium Intensity Rehab. if Qualifies for Impaired Cognition groups if: SE2 N/A (1) 150+ minutes received across all types AND Cognitive Performance Scale is 3 or higher and ADL Index score of 10 or less and SE1 N/A (2) 5+ days received across all types of therapy does not qualify for above groups SPECIAL Cognitive Performance Scale (CPS) Levels: SSC LH Resident qualifies for Low Intensity Rehab. if 0 = intact 1 = borderline 2 = mild impairment 3 = moderate impairment SSB (1) 45+ minutes received across all types AND 4 = moderately severe impairment 5 = severe impairment 6 = very severe impairment SSA (2) 3+ days received across all types of therapy AND CLINICAL COMPLEX (3) 2+ nursing rehab activities at 6+ days each B Resident qualifies for Behavior Problems category if: CC D Has Behavior Problems indicators (any one sufficient) and ADL Index of 10 or less and CC SE Resident qualifies for Extensive Care category not qualified for any of the above groups: CB D on the basis of clinical indicators: Behaviour Problems indicators: CB Parenteral/IV feedings OR IV medication OR suctioning 1. Wandering occurred on 4 or more days. CA D OR tracheostomy care OR ventilator or respirator 2. Verbally abusive behavior occurred on 4 or days. CA Physically abusive behavior occurred on 4 more days. IMPAIRED COG. SS Resident qualifies for Special Care category on the basis 4. Socially inappropriate/disruptive occurred on 4 or more days. IB D of clinical indicators: 5. Resident resisted care on 4 or more days. IB Qualifications (any one sufficient): 6. Hallucinations. IA2 4-5 D Two or more ulcers of any type OR stage 3 or 4 pressure 7. Delusions. IA ulcer AND two or more selected skin care treatments. BEHAV. ONLY 2. Feeding tube WITH parenteral/enteral intake AND aphasia. P Residents qualify for Reduced Physical Function if they do not qualify BB D Surgical wounds OR open lesions other than ulcers, rashes, for any above groups. BB cuts AND surgical wound care (OR application of dressings BA2* 4-5 D OR application of ointments. BA1* Respiratory therapy for 7 days. PHYSICAL FUNCTION 5. Cerebral palsy AND ADL score of 10 or more PE D Fever AND vomiting OR weight loss OR tube feeding WITH PE high parenteral/enteral intake OR pneumonia OR dehydrated. PD D Multiple sclerosis AND ADL score of 10 or more PD Quadriplegia AND ADL score of 10 or more PC D Radiation therapy. PC PB2 6-8 D PB PA2 4-5 D PA Cost Per Case-Mix Weighted Activity For Complex Continuing Care In Ontario (RD #8-11)

11 APPENDIX B: Calculation of Hospital-Specific 1997/98 Total Cost per RUG-III-weighted Patient Day A B C D E F (=B/A) (=D/B) Hosp MDS Total RUG-weighted Hospital TOTAL Percent TOTAL COST No. Hospital Name Patient Days Patient Days Case-mix Cost Indirect per RWPD (RWPD) Weight Cost 857 TORONTO NY Sunnybrook 129, , $32,037, % $ HAMILTON Health Sciences Corp 53,737 62, $15,496, % $ HAMILTON St Joseph's 9,886 9, $2,230, % $ ACUTE TEACHING* TOTAL/AVERAGE 193, , $49,764, % $ MARATHON Wilson Mem 1, $587, % $ SIOUX LOOKOUT District HC 1, $520, % $ SEAFORTH Community 2,195 2, $833, % $ RED LAKE Marg Cochenour Mem 1,675 1, $696, % $ MATHESON Bingham Memorial 1,942 1, $581, % $ INGERSOLL Alexandra 1,783 1, $735, % $ CLINTON Public $257, % $ WINGHAM & District 2,820 2, $1,000, % $ EXETER South Huron 1,154 1, $421, % $ WALLACEBURG Sydenham Dist 1,325 1, $435, % $ PALMERSTON & District $19, % $ ARNPRIOR District Memorial 4,768 4, $1,568, % $ NIAGARA-ON-THE-LAKE Gen Hosp 3,463 4, $1,454, % $ ESPANOLA General 2,900 2, $820, % $ ,649,691,869 SOUTH BRUCE GREY Health Centre 9,265 9, $3,115, % $ PICTON Prince Edward County Mem $31, % $ MATTAWA General $190, % $ PARIS The Willett 15,022 15, $5,111, % $ GODERICH Alexandra Marine & Gen 2,333 2, $766, % $ STURGEON FALLS West Nipissing 6,490 4, $1,608, % $ WAWA North Algoma Health Org 4,224 3, $1,205, % $ HEARST Notre Dame 7,735 6, $1,885, % $ ATIKOKAN General 2,789 2, $727, % $ SOUTHAMPTON Saugeen $142, % $ HALDIMAND West Haldimand Gen 5,604 5, $1,561, % $ PORT PERRY and UXBRIDGE North Durham Hosp 4,738 4, $1,166, % $ GERALDTON District 2,190 2, $640, % $ TERRACE BAY McCausland 3,137 2, $791, % $ DUNNVILLE Haldimand War Mem 3,410 3, $829, % $ ENGLEHART & District 4,473 3, $876, % $ BLIND RIVER St Joseph's 3,627 3, $817, % $ MEAFORD General 5,130 4, $1,191, % $ NAPANEE Lennox & Addington 2,353 2, $666, % $ DRYDEN District 3,640 3, $845, % $ BARRY'S BAY St Francis 5,991 5, $1,428, % $ ALEXANDRIA Glengarry 5,192 4, $1,079, % $ NEWBURY Four Counties 2,963 3, $767, % $ LISTOWEL Memorial 9,140 8, $1,992, % $ CAMPBELLFORD Mem 2,950 2, $580, % $ MT FOREST Louise Marshall $53, % $ IROQUOIS FALLS Anson General 4,395 4, $1,068, % $ KEMPTVILLE District 7,028 6, $1,388, % $ PETROLIA CE Englehart 7,251 7, $1,479, % $ NIPIGON District Mem 2,504 2, $464, % $ ALMONTE General 8,850 8, $1,638, % $ HANOVER & District 9,064 9, $1,759, % $ SMOOTH ROCK FALLS General 1, $160, % $ DEEP RIVER & District $57, % $ WIARTON Bruce Peninsula $16, % $ ST MARY'S Memorial 1,717 2, $197, % $ COCHRANE Lady Minto 2,615 2, $241, % $ ACUTE SMALL* TOTAL/AVERAGE 186, , $48,482, % $ *Facilities grouped by historical typology for convenient reference only. INFORMATION FOR INTERNAL PURPOSES ONLY -- DATA NOT MEANT TO SUGGEST PROPOSED FUTURE FUNDING ALLOCATIONS Page 1

12 APPENDIX B: Calculation of Hospital-Specific 1997/98 Total Cost per RUG-III-weighted Patient Day A B C D E F (=B/A) (=D/B) Hosp MDS Total RUG-weighted Hospital TOTAL Percent TOTAL COST No. Hospital Name Patient Days Patient Days Case-mix Cost Indirect per RWPD (RWPD) Weight Cost 850 TORONTO Runnymede 23,355 24, $8,588, % $ LONDON Parkwood -St. Joseph's H C 108, , $31,524, % $ TORONTO SA Grace Chronic 33,198 35, $11,252, % $ TORONTO West Park 57,462 58, $17,783, % $ KINGSTON St Mary's-of-the-Lake 49,332 52, $15,308, % $ ST CATHARINES Shaver 27,867 28, $8,333, % $ , 895 THUNDER BAY St Joseph's Care Group 69,774 69, $19,864, % $ TORONTO Rehab Institute-QEH & Dunn 95, , $29,370, % $ OTTAWA Sisters of Charity 203, , $56,198, % $ TORONTO Baycrest 84,944 87, $23,886, % $ PENETANGUISHENE General 12,641 11, $3,099, % $ TORONTO Providence 79,879 79, $21,296, % $ TORONTO Riverdale 147, , $35,763, % $ BROCKVILLE Providence Continuing Care Ctr 12,039 10, $2,705, % $ HAMILTON St Peter's 88,775 93, $22,306, % $ CHRONIC/REHAB* TOTAL/AVERAGE 1,093,757 1,094, $307,281, % $ FORT FRANCES Riverside HC 7,853 7, $3,954, % $ STRATFORD General 9,800 9, $3,475, % $ OTTAWA Queensway Carleton 6,041 5, $2,230, % $ WHITBY General (Lakeridge Health) 3,111 3, $1,239, % $ ELLIOT LAKE St Joseph's 2,696 2, $1,001, % $ KAPUSKASING Sensenbrenner 3,495 3, $1,345, % $ TORONTO Scarb Grace 5,458 5, $1,918, % $ TRENTON Memorial 8,738 10, $3,127, % $ SARNIA St Joseph's 30,927 31, $10,854, % $ NORTH BAY General Hospital 3,263 3, $1,007, % $ TILLSONBURG District 7,515 7, $2,529, % $ NEW LISKEARD Temiskaming 7,351 6, $2,209, % $ NEWMARKET York County 5,980 6, $1,991, % $ ST CATHERINES General 9,629 9, $2,987, % $ SMITH FALLS Perth & Smith Falls 7,295 7, $2,380, % $ HAWKESBURY District 6,578 7, $2,130, % $ TORONTO Scarb General 8,294 8, $2,555, % $ LEAMINGTON District 7,662 8, $2,131, % $ WOODSTOCK General 5,238 6, $1,855, % $ ORANGEVILLE Dufferin Caledon HC 6,962 7, $2,075, % $ ST THOMAS Elgin General 34,503 34, $9,944, % $ BURLINGTON Joseph Brant 9,130 9, $2,640, % $ KIRKLAND LAKE & District 8,015 6, $1,900, % $ TORONTO St Joseph's HC 22,187 24, $6,703, % $ MARKHAM Stouffville 10,304 11, $3,084, % $ TORONTO Scarb Centenary 28,196 30, $7,881, % $ SAULT STE MARIE General 21,026 19, $5,335, % $ CLARINGTON Mem. Bowmanville North Dur. H.S. 9,697 10, $2,556, % $ TIMMINS & District 14,678 18, $4,765, % $ BELLEVILLE General 9,231 10, $2,612, % $ BRAMPTON Peel Memorial 14,345 15, $3,780, % $ SUDBURY Laurentian 18,078 19, $4,862, % $ BRACEBRIDGE South Muskoka 8,538 8, $1,973, % $ BRANTFORD St Joseph's 19,863 21, $5,368, % $ KENORA Lake-of-the-Woods 10,922 10, $2,678, % $ RICHMOND HILL York Central 5,797 6, $1,578, % $ ORILLIA Soldier's Memorial 11,019 10, $2,294, % $ KITCHENER Grand River 93,834 87, $21,202, % $ MILTON District 10,719 9, $2,178, % $ MISSISSAUGA Credit Valley 14,463 14, $3,451, % $ PEMBROKE General 8,539 7, $1,830, % $ *Facilities grouped by historical typology for convenient reference only. INFORMATION FOR INTERNAL PURPOSES ONLY -- DATA NOT MEANT TO SUGGEST PROPOSED FUTURE FUNDING ALLOCATIONS Page 2

13 APPENDIX B: Calculation of Hospital-Specific 1997/98 Total Cost per RUG-III-weighted Patient Day A B C D E F (=B/A) (=D/B) Hosp MDS Total RUG-weighted Hospital TOTAL Percent TOTAL COST No. Hospital Name Patient Days Patient Days Case-mix Cost Indirect per RWPD (RWPD) Weight Cost 940 COBOURG The Northumberland HCC 11,266 11, $2,556, % $ GRIMSBY West Lincoln 5,592 5, $1,344, % $ HALTON HILLS Georgetown 13,076 12, $2,897, % $ WELLAND County General 32,805 30, $7,141, % $ PORT COLBORNE Gen 8,205 6, $1,452, % $ CAMBRIDGE Memorial 32,582 31, $7,181, % $ PARRY SOUND West PS HC 22,745 21, $4,896, % $ GUELPH St Joseph's 32,536 30, $6,998, % $ OTTAWA Hopital Montfort 6,039 5, $1,309, % $ SIMCOE Norfolk General 16,351 15, $3,477, % $ FORT ERIE Douglas Mem 5,638 5, $1,274, % $ CHATHAM Public General 7,722 9, $2,166, % $ STRATHROY Middlesex Gen 8,687 10, $2,194, % $ CORNWALL Hotel Dieu 23,243 21, $4,699, % $ FERGUS Groves Memorial 6,640 6, $1,377, % $ WINDSOR Hotel Dieu/Grace 7,716 6, $1,469, % $ MISSISSAUGA General Hospital 31,251 33, $7,089, % $ NIAGARA FALLS Greater Niagara 16,809 17, $3,726, % $ OSHAWA General 41,903 44, $9,248, % $ WINDSOR Regional Hospital 25,338 23, $4,837, % $ RENFREW Victoria 9,263 8, $1,829, % $ WINCHESTER District Memorial 8,897 8, $1,803, % $ PETERBOROUGH Civic 19,587 21, $4,407, % $ LINDSAY Ross Memorial 17,913 21, $4,035, % $ OAKVILLE Trafalgar 12,825 12, $2,281, % $ BARRIE Royal Victoria 14,624 13, $2,422, % $ HUNTSVILLE District 7,664 8, $1,410, % $ COMMUNITY* TOTAL/AVERAGE 983, , $247,158, % $ GRAND TOTAL/AVERAGE 2,457,243 2,448, $652,685, % $ Acute Teaching 193, , $49,764, % $ Acute Small 186, , $48,482, % $ Chronic/Rehab 1,093,757 1,094, $307,281, % $ Community 983, , $247,158, % $ *Facilities grouped by historical typology for convenient reference only. INFORMATION FOR INTERNAL PURPOSES ONLY -- DATA NOT MEANT TO SUGGEST PROPOSED FUTURE FUNDING ALLOCATIONS Page 3