Using Payment by Results to commission better quality clinical care Eileen Robertson Payment by Results (PbR) Development Team

Outline

 What is Payment by Results?

 Using PbR to commission better quality care  Supporting best practice: Fragility hip fractures 2

What is Payment by Results?

The aim of PbR is to provide a transparent rules-based system for paying providers in England  a system in which PCTs pay hospitals for the number and complexity of patients treated, using a price list – the national tariff – for all activity within the scope of PbR  covers admitted patients, outpatients and A&E  new way of funding NHS activity introduced in 2003-04  replaced block contracts based on historic costs  part of a group of payment systems known internationally as casemix funding 3

At a basic level the tariff is…

A

fixed price

Priced at

national average cost

Published

annually

Tariff

Paid

per patient

Per

HRG

At

spell

level 4

Using PbR to commission better quality care

 PbR focuses negotiations between commissioners and providers away from price and towards

quality

 Introduction of best practice tariff to better support improved quality  Is better quality clinical care more efficient?

    Reduce length of stay Reduce re-admissions Improved outcomes Wider health and social care impact 5

Supporting better quality care: Fragility Hip Fracture

From April 2010 PbR will be introducing a “Best Practice Tariff” for fragility hip fractures.

 High Quality Care for All (HQCFA) report  

High volume

service area Significant

variation

in clinical practice  Improve both quality and

value

 Excellent source of

clinical data

(NHFD)  Support

existing work

on fragility hip fracture care 6

The best practice tariff aims to…

Reduce unexplained variation in quality and universalise best practice.

 Key clinical characteristics: Surgery within 36 hours

AND

Involvement of an (ortho) geriatrician  Characteristics are best practice – they go beyond the standard 7

Definition of characteristics

1.

2.

Time to surgery

 Arrival in A&E or diagnosis if an inpatient to start of anaesthesia

Involvement of an (ortho)-geriatrician:

All 4 required a) Admitted under the joint care of a Consultant Geriatrician and a Consultant Orthopaedic Surgeon b) Admitted using an assessment protocol agreed by geriatric medicine, orthopaedic surgery and anaesthesia c) Assessed by a Geriatrician * in the perioperative period **   * Geriatrician defined as Consultant, NCCG, or ST3+ ** Perioperative period defined as within 72 hours of admission d) Postoperative Geriatrician-directed:   Multiprofessional rehabilitation team Fracture prevention assessments (falls and bone health) 8

Best practice care costs less…

Cost profile of meeting best practice unit cost invest save

Tariff to reflect this profile over time

time

“Looking after hip fracture patients well is a lot cheaper than looking after them badly.”

The ‘Blue Book’ (p. 10) 9

The tariff will be paid in two parts…

Payment per patient

National average cost Reduction in base tariff for

national

compliance rate Additional payment for best practice Base tariff for each HRG  National Hip Fracture Database captures compliance with clinical practice  PCTs to monitor and make additional payments quarterly 10

Summary of best practice tariff

 Aim is to

universalise best practice

around two key characteristics with hip fracture care  Payment to be a

2-part tariff

with compliance to be monitored through NHFD 

Additional funding

to providers of best practice care  PCTs

reap financial benefits

through savings in super-spell and future reductions in tariff 

2010/11

is an

opportunity

to change practice 11