Transcript Funding: The Data, the Devil and the Details Feb 03 draft

Patient-Focused Funding
& Payment by Results
The UK Experience
CEO Forum, Kananaskis, Alberta
February 16, 2009
Robert J. Bell – Chief Executive
Royal Brompton & Harefield NHS Trust
London, UK
[email protected]
The NHS (2008)
DEPARTMENT OF HEALTH
STRATEGIC HEALTH AUTHORITIES
PRIMARY CARE TRUSTS
ACUTE CARE TRUSTS
Contract for
(commission) hospital care,
locally
Manage and provide
Medical and Surgical care
in Teaching and District
General Hospitals,
Specialist Hospitals and
DTCs
Manage and integrate
primary care for medical,
dental, pharmaceutical and
optical services
Contract with PCTs for
services to patients on a
local/regional basis
THE LOCAL HEALTH ECONOMY
2
The NHS (2008)

10 STRATEGIC HEALTH AUTHORITIES (SHAs)


152 PRIMARY CARE TRUSTS (PCTs)


For a population of 51 million
Average population of 330,000
230 NHS TRUSTS

Acute, Mental Health, Ambulance
3
The NHS (2008)
MAJOR REFORMS : THE PAST DECADE ……
Key Functions
Examples of discrete reforms
Standard-setting and monitoring
National Institute for Health and Clinical Excellence (NICE)
National Service Frameworks (NSF)
Core and development standards (set by the Department of Health)
Clinical Audit
Target-setting
Public Service Agreements, NHS contract
Clinical governance
Legislation
Regulation
Institutional
Individual
Healthcare Commission (HCC)
Monitor
Audit Commission
National Clinical Assessment Authority
General Medical Council (GMC)
Appraisal and Revalidation
Patient/Public engagement
Patient choice of providers
Expert Patient Programme
Patient and Public Involvement (PPI), LinKS
Patient Advice and Liaison Services (PALS)
Payment and Incentives
Payment by Results (PbR)
GP Contract
Consultants’ contract
Agenda for Change
Public Reporting
Dr Foster
League Tables
Star ratings (now superseded by the annual health check)
Commissioning
NICE Commissioning guides, Practice Based Commissioning
4
Payment by Results
THE NEW WAY OF DOING BUSINESS
BLOCK
FUNDING
PbR
5
Payment by Results
(PbR)
(Payment by Activity)
KEY ELEMENTS
Activity
Payment to provider by PCT
6
Payment by Results
(PbR)
WHY WAS IT INTRODUCED?

TO FACILITATE DECENTRALISED WAITING TIME REDUCTION
(TARGETS)

TO REWARD EFFICIENCY AND QUALITY

TO SUPPORT PATIENT CHOICE (MONEY FOLLOWS THE PATIENT)

TO PROVIDE A TRANSPARENT AND FAIR WAY TO PAY PROVIDERS

TO REDUCE TRANSACTION COSTS AND NEGOTIATION DISPUTES
7
The NHS (2008)
PCT’s and Commissioning
PCT’s
PbR
(Payment by Results)
PRACTICE BASED
Commissioning
• GP’s
PATIENT CHOICE
• National Tariff
• Patient Level Costing
“Choose & Book”
18 WEEK PATHWAYS
• Integrated Care
PLURALITY
• Foundation Trusts
• ISTC’s
• NHS Trusts
• Etc.
8
Payment by Results
(PbR)
THE KEY ELEMENTS
HEALTH RESOURCE GROUPS (HRGs)
NATIONAL TARIFF
• Developed in Australia
• Based on average reference costs
• Implemented in the UK (1992)
• Separate Tariff (Elective vs Emergency)
• Standard Grouping
• Tariff paid according to actual work
• Clinically similar patients
• Trusts compensated through national contracts/local SLA
• Consume similar level of Healthcare
• Used to set a National Tariff (Price/HRG)
BASELINE ACTIVITY
• Agreed level of work between PCT and Trust
FINISHED CONSULTANT EPISODES (FCEs)
•
• Adjustments subject to SLA and risk sharing
HRG’s counted by FCEs
SPELLS
SPECIALIST TOP UPS
• Providers paid for a “spell” that may include several FCE’s
• Complex rules/algoritism
• Specific uplifts for certain combination codes
9
Payment by Results
(PbR)
Has it really worked?
Did the UK get the Balance right
for the NHS and the Taxpayers?
10
Payment by Results
(PbR)
The Combination of PbR and National
Targets has markedly decreased Wait
Time for Admission to hospital
11
Payment by Results
(PbR)
Lower Hospitalisation has been experienced
12
Payment by Results
(PbR)
And: Short stay activity has increased
13
Payment by Results
(PbR)
• Increasing efficiency
• Rewarding and increasing quality
“THE JURY IS STILL OUT”
14
Payment by Results
(PbR)
15
Payment by Results
(PbR)
However,
16
Payment by Results
(PbR)
Data Quality has substantially improved ….
17
Payment by Results
(PbR)
So what does the future look like?
PbR is here to stay
current HRG version 3.5 to be replaced by version 4.0
 PbR has been extended to Mental Health
 HRG unbundling to support PCTs in shifting local
commissioning to community settings and GP’s
 Pay for Performance may be next (linking Quality and
Outcomes)
 PbR may be applied to community and home based services

18