Transcript People out of work through ill health
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