This is the amount that a commissioner will pay for a particular package of care including out-patient appointments, spells and procedures. Commissioners now only pay for work that has been done, according to the nationally set tariff with minor local differences when a market forces factor is applied. The tariff is based on a reference cost (see above) created from a large retrospective analysis of average costs incurred by NHS hospital providers, plus an annual increase for inflation. See here. The tariff is defined using an HRG; a currency –a spell rather than an FCE; and a cash amount. The tariff has a different rate for children and adults, emergency and elective care, and first outpatient and follow-up outpatient appointment. The tariff for admissions has trimpoints; that is the length of stay up to which the tariff will be paid, and over which an excess bed day charge can be claimed but at a much lower rate. There is also work underway to “unbundle” care such as stroke rehabilitation from acute care so that it is easier to compare costs of elements that might be provided in the community. 29 August 2009: two papers in the BMJ describe the impact of the tariff: Has payment by results affected the way that English hospitals provide care (compared to Scottish hospitals studied at the same time) doi:10.1136/bmj.b3047 and editorial doi:10.1136/bmj.b3081 The main paper concludes that there has been a reduced length of stay/increased throughput and no increased risk to patients. However, it is important to note the limitations of the study. Although the authors do look at readmissions, this appears to be limited to patients discharged following orthopoedic procedures and it would have been interesting to see whether medical readmission rates went up (by choosing a high volume casemix e.g. COPD). They did look at 30 day mortality which is better than inpatient mortality although neither are particularly good at indicating whether Payment by Results has been beneficial for patients. such studies are very difficult to do and so this has acted as a baseline and further studies might be able to reduce some of the limitations identified. In 2010/11 best practice pathway tariffs will be introduced: cataracts, cholecystectomy, fragility hip fracture and a medical condition - stroke has been chosen. The timescale is for road-testing in November 2009. This has been road-tested. Guidance for 2009/10 is now available here. A summary of COPD tariffs using HRG4 codes (see Appendix 2 and also the BTS Guide to Respiratory Coding). Note that when the market forces factor is applied there will be minor differences, so that the local tariff may not be exactly as listed below.
This is the amount that a commissioner will pay for a particular package of care including out-patient appointments, spells and procedures. Commissioners now only pay for work that has been done, according to the nationally set tariff with minor local differences when a market forces factor is applied. The tariff is based on a reference cost (see above) created from a large retrospective analysis of average costs incurred by NHS hospital providers, plus an annual increase for inflation. See here.
The tariff is defined using an HRG; a currency –a spell rather than an FCE; and a cash amount. The tariff has a different rate for children and adults, emergency and elective care, and first outpatient and follow-up outpatient appointment. The tariff for admissions has trimpoints; that is the length of stay up to which the tariff will be paid, and over which an excess bed day charge can be claimed but at a much lower rate. There is also work underway to “unbundle” care such as stroke rehabilitation from acute care so that it is easier to compare costs of elements that might be provided in the community.
29 August 2009: two papers in the BMJ describe the impact of the tariff: Has payment by results affected the way that English hospitals provide care (compared to Scottish hospitals studied at the same time) doi:10.1136/bmj.b3047 and editorial doi:10.1136/bmj.b3081 The main paper concludes that there has been a reduced length of stay/increased throughput and no increased risk to patients. However, it is important to note the limitations of the study. Although the authors do look at readmissions, this appears to be limited to patients discharged following orthopoedic procedures and it would have been interesting to see whether medical readmission rates went up (by choosing a high volume casemix e.g. COPD). They did look at 30 day mortality which is better than inpatient mortality although neither are particularly good at indicating whether Payment by Results has been beneficial for patients. such studies are very difficult to do and so this has acted as a baseline and further studies might be able to reduce some of the limitations identified.
In 2010/11 best practice pathway tariffs will be introduced: cataracts, cholecystectomy, fragility hip fracture and a medical condition - stroke has been chosen. The timescale is for road-testing in November 2009. This has been road-tested. Guidance for 2009/10 is now available here.
A summary of COPD tariffs using HRG4 codes (see Appendix 2 and also the BTS Guide to Respiratory Coding). Note that when the market forces factor is applied there will be minor differences, so that the local tariff may not be exactly as listed below.
Related Words Payment by Results (PbR)
The full range of non-public, not-for-profit organisations that are non-governmental and ‘value driven’; at is, motivated by the desire to further social, environmental or cultural objectives rather than to make a profit.
This is another GP computer system. See EMIS, TPP, VAMP Vision
Related Words EMIS; TPP
The Phoenix Partnership, is a computer systems company working with Connecting for Health in the Midlands to test Systmone (sic) software that shares records across primary and community care teams. See EMIS, Torex, VAMP Vision.
Related Words EMIS; Torex; VAMP Vision
These are the length of stay up to which an individual tariff applies. They are spell not FCE-based and, like the tariff itself, are calculated from a large retrospective analysis of average length of stays for particular HRGs. There are separate trimpoints for elective and non-elective activity and some non-elective activity is divided into subgroups according to complexity but this is not very sophisticated at present. Trimpoints can provide a perverse incentive for PCTs to reduce the efforts they have previously been making to reduce lengths of stay because they pay the same tariff if a person with COPD without complications stays in hospital 3 days or 16 days. However, from an acute provider’s perspective, their costs relative to the price paid increase each day the patient stays unnecessarily. See here.
These are the length of stay up to which an individual tariff applies. They are spell not FCE-based and, like the tariff itself, are calculated from a large retrospective analysis of average length of stays for particular HRGs. There are separate trimpoints for elective and non-elective activity and some non-elective activity is divided into subgroups according to complexity but this is not very sophisticated at present.
Trimpoints can provide a perverse incentive for PCTs to reduce the efforts they have previously been making to reduce lengths of stay because they pay the same tariff if a person with COPD without complications stays in hospital 3 days or 16 days. However, from an acute provider’s perspective, their costs relative to the price paid increase each day the patient stays unnecessarily. See here.
Transfer of Undertakings (Protection of Employment) Regulations (2006). Designed to protect the rights of employees in a transfer situation (when a new employer takes over). Further information in this complex area: Chartered Institute of Professional Development (CIPD), and The Statutory Instrument
The last printed version (please note the online version is more up to date) of the IMPRESS NHS Jargon Buster (pdf) is available to download here
Appendix 1
Appendix 2