How to break the enigma of the OPAT code Debbie Cumming How to break the enigma of the OPAT code...
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Transcript of How to break the enigma of the OPAT code Debbie Cumming How to break the enigma of the OPAT code...
![Page 1: How to break the enigma of the OPAT code Debbie Cumming How to break the enigma of the OPAT code Debbie Cumming.](https://reader036.fdocuments.in/reader036/viewer/2022062408/56649ee65503460f94bf6323/html5/thumbnails/1.jpg)
How to break the enigma of the
OPAT code
Debbie Cumming
![Page 2: How to break the enigma of the OPAT code Debbie Cumming How to break the enigma of the OPAT code Debbie Cumming.](https://reader036.fdocuments.in/reader036/viewer/2022062408/56649ee65503460f94bf6323/html5/thumbnails/2.jpg)
How to break the enigma of the OPAT code!
Debbie Cumming
![Page 3: How to break the enigma of the OPAT code Debbie Cumming How to break the enigma of the OPAT code Debbie Cumming.](https://reader036.fdocuments.in/reader036/viewer/2022062408/56649ee65503460f94bf6323/html5/thumbnails/3.jpg)
OPAT works…..
• in delivering good clinical outcomes…• whilst releasing bed days
BUT……must not forget the need for cost effectiveness:• See: Chapman et al JAC 64: 1316-1324 (2009)
![Page 4: How to break the enigma of the OPAT code Debbie Cumming How to break the enigma of the OPAT code Debbie Cumming.](https://reader036.fdocuments.in/reader036/viewer/2022062408/56649ee65503460f94bf6323/html5/thumbnails/4.jpg)
So what am I going to talk about:
• Current NHS challenges
• Data capture and coding
• How to think about costing for your OPAT service
• Can we break the enigma of the OPAT code?
![Page 5: How to break the enigma of the OPAT code Debbie Cumming How to break the enigma of the OPAT code Debbie Cumming.](https://reader036.fdocuments.in/reader036/viewer/2022062408/56649ee65503460f94bf6323/html5/thumbnails/5.jpg)
Current challenges?
• Hospitals trying to close beds• Emphasis on treating patients in community (McKinsey report and e.g. Start Smart then Focus)• So more emphasis on OPAT
Until now……From now on……
• Need to move to sustainable & correctly funded
But currently, no nationally recognised coding or data capture mechanism
for specifically funding OPAT
![Page 6: How to break the enigma of the OPAT code Debbie Cumming How to break the enigma of the OPAT code Debbie Cumming.](https://reader036.fdocuments.in/reader036/viewer/2022062408/56649ee65503460f94bf6323/html5/thumbnails/6.jpg)
Remember you only get paid for what’s been coded:
Healthcare Resource Groups (HRG)
Cellulitis
Diabetic Foot Ulcer
Prosthetic Joint Infection
Resistant UTI
… Hospital Coders use HRG codes
![Page 7: How to break the enigma of the OPAT code Debbie Cumming How to break the enigma of the OPAT code Debbie Cumming.](https://reader036.fdocuments.in/reader036/viewer/2022062408/56649ee65503460f94bf6323/html5/thumbnails/7.jpg)
Remember you only get paid for what’s been coded:
HRG Tariff
Cellulitis £795
Diabetic Foot Ulcer
£2,651
Prosthetic Joint Infection
£2,787
Resistant UTI £1,502
… Each HRG carries a specific tariff
![Page 8: How to break the enigma of the OPAT code Debbie Cumming How to break the enigma of the OPAT code Debbie Cumming.](https://reader036.fdocuments.in/reader036/viewer/2022062408/56649ee65503460f94bf6323/html5/thumbnails/8.jpg)
Remember you only get paid for what’s been coded:
HRG Tariff DurationTrim Point
XS Bed Day Fee
Cellulitis £795 5 days £180
Diabetic Foot Ulcer
£2,651 27 days £200
Prosthetic Joint Infection
£2,787 18 days £232
Resistant UTI £1,502 12 days £214
If your patient stays longer than the trim point
then the hospital receives an XS bed day fee
for every extra day – but NB it’s not profit making!
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Knowing a bit more about coding, can you optimise your
OPAT income?
• Short term patient =
£OPAT HRG + £new hospital HRG
• Long term patient =
(£OPAT HRG + XS day payment) + £new hospital HRGsss
It is all in the coding….
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We’ve introduced coding.. Now let’s talk about data capture….
• How is OPAT activity captured? ….. Otherwise you still won’t get paid….!
• What are the recognised pathways that OPAT patients might travel to capture the activity? ….
• What are the various pros and cons for each pathway?
![Page 11: How to break the enigma of the OPAT code Debbie Cumming How to break the enigma of the OPAT code Debbie Cumming.](https://reader036.fdocuments.in/reader036/viewer/2022062408/56649ee65503460f94bf6323/html5/thumbnails/11.jpg)
Patient: Admit… Discharge …then OPAT
Pros:
•New patient into bed ... so new HRG gained by Trust
•Length of stay (LOS) figures … appear low
Cons:
•No payment for OPAT (H@H)
•No XS bed day fee (past trim point)
•Readmission figures compromised if patient bounces back in
![Page 12: How to break the enigma of the OPAT code Debbie Cumming How to break the enigma of the OPAT code Debbie Cumming.](https://reader036.fdocuments.in/reader036/viewer/2022062408/56649ee65503460f94bf6323/html5/thumbnails/12.jpg)
Patient: Admit … Home Leave for OPAT
Pros:
•An established NHS method for data collection – Coders are happy!
•HRG reflects the Consultant episode past the Trim point
•LOS a true reflection
Cons:
•The bed needs to remain open … so no new HRG payment
![Page 13: How to break the enigma of the OPAT code Debbie Cumming How to break the enigma of the OPAT code Debbie Cumming.](https://reader036.fdocuments.in/reader036/viewer/2022062408/56649ee65503460f94bf6323/html5/thumbnails/13.jpg)
Patient: Admit … Day Attender for OPAT
Pros:
• LOS kept short
Cons:
• Clinical governance reduced as not under 24/7 OPAT care
• Not charged for 24/7 cover given by OPAT team
• Only for actual iv administration
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Patient: Admit … Virtual Ward for OPAT
Pros:
• LOS can be calculated
• Appropriate clinical governance achieved
• Readmission not compromised
• Allows money to follow patient including XS bed day fees (£?????K)
Cons:
• Coders unhappy because data dictionary does not allow virtual wards
• Skews figures … more patients than beds
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Patient: Admit …Transfer to Local Tariff
for OPAT (4.6 code)
Pros:
• Accepted data capture system
• Maximum income for Providers – HRG and Local Tariff
Cons:
• Could be expensive for the Commissioners
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St Elsewhere Patients
• Don’t forget you need to charge St. Elsewhere ….(or lose £???)
• As They will be getting the HRG (and XS bed day fee if patient not technically discharged) …
• And You are going to deliver their intravenous antibiotics… ... for free!!!
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So what do you think?
• Will the NHS data capture systems evolve with us?
• … And are the coders on our side?
• To allow a sustainable and financially viable OPAT service ... to reach its full potential.
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How to cost your own OPAT service:
![Page 19: How to break the enigma of the OPAT code Debbie Cumming How to break the enigma of the OPAT code Debbie Cumming.](https://reader036.fdocuments.in/reader036/viewer/2022062408/56649ee65503460f94bf6323/html5/thumbnails/19.jpg)
How do you cost OPAT?1. Start working out the individual activities that go into making a successful OPAT outcome …
2. Allocate a time for each
3. Allocate how many times during the OPAT episode that happens
Let’s begin with a few examples…. Cost:
££
££
a) Risk Assessment
b) Insertion of Mid lines
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How do you cost OPAT?• And then continue: Cost:
££
££
££
££
££
c) Consumables
d) Average 20 day OPAT duration,
e) 10 visits by District Nurses, 10 by IV Nurse Specialist
f) Travel time and costs
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How do you cost OPAT?• And then continue:
Cost: ££
££
££
££
££
££
££
££
££
££
££
££
f) Virtual Ward Rounds, g) Appointments, h) Audits etc…
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How do you cost OPAT?• Till you have your complete list!
Cost: ££
££
££
££
££
££
££
££
££
££
££
££
££££££
Total Cost
Per Day Cost
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But there is more:
• Think from a different angle….
• Let’s think about staffing for the whole year….
• Who do you need to pay to deliver your service?
• What are your capacity brackets? 1000, 1500, 2000, 10,000….
• How many bed days can you manage with that many staff? How many bed days released per year?
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The costs just discussed relate to delivering
the iv OPAT treatment but also need to work out your
costing for the staff needed:
Staff needed
Patient mixIndicative daily tariff
Number of OPAT bed daysExpected income
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So: OPAT does work … but• You need to understand about coding and data capture
• You mustn’t presume that you are getting paid - correctly
• You do need to be aware of how much your hospital’s OPAT service costs….
• So that you can be cost effective within….whatever capacity bracket(s) you want to work
• So that you can deliver a sustainable service
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Last but one slide!
What is your preferred option …
… to adopt nationally for OPAT?
…. Virtual Ward? … Local Tariff?
…..National Tariff (excluding ….?)
Will we solve the enigma of the OPAT code?
![Page 27: How to break the enigma of the OPAT code Debbie Cumming How to break the enigma of the OPAT code Debbie Cumming.](https://reader036.fdocuments.in/reader036/viewer/2022062408/56649ee65503460f94bf6323/html5/thumbnails/27.jpg)
Questions to ponder?
• Do you pay your district nurses?• Who pays for the antibiotics?• Do you charge for St Elsewhere patients?• What pathway do you follow? Virtual ward, day attender, local tariff, … or
other?• Do you have capacity brackets built into your model?• Does the money follow the patient?• Do you have any problems with finance?• Yet they want more and more:
Acute Care in the Community…..• What about ambulatory care models … ?
The future is challenging but remember OPAT is a solution not a problem