Robert J. Bell – Chief Executive Royal Brompton & Harefield NHS Trust London, UK
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Transcript of Robert J. Bell – Chief Executive Royal Brompton & Harefield NHS Trust London, UK
Patient-Focused Funding Patient-Focused Funding & Payment by Results & Payment by Results
The UK ExperienceThe UK Experience
CEO Forum, Kananaskis, AlbertaCEO Forum, Kananaskis, AlbertaFebruary 16, 2009February 16, 2009
Robert J. Bell – Chief ExecutiveRobert J. Bell – Chief Executive
Royal Brompton & Harefield NHS TrustRoyal Brompton & Harefield NHS Trust
London, UKLondon, UK
[email protected]@rbht.nhs.uk
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The NHS (2008)The NHS (2008)
DEPARTMENT OF HEALTH
STRATEGIC HEALTH AUTHORITIES
PRIMARY CARE TRUSTS
Manage and provide Medical and Surgical care in Teaching and
District General Hospitals, Specialist Hospitals and DTCs
Contract with PCTs for services to patients on a
local/regional basis
ACUTE CARE TRUSTS
THE LOCAL HEALTH ECONOMY
Contract for (commission)
hospital care, locally
Manage and integrate primary care for medical,
dental, pharmaceutical and
optical services
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The NHS (2008)The NHS (2008)
10 STRATEGIC HEALTH AUTHORITIES 10 STRATEGIC HEALTH AUTHORITIES
(SHAs)(SHAs) For a population of 51 millionFor a population of 51 million
152 PRIMARY CARE TRUSTS (PCTs)152 PRIMARY CARE TRUSTS (PCTs) Average population of 330,000 Average population of 330,000
230 NHS TRUSTS230 NHS TRUSTS Acute, Mental Health, Ambulance Acute, Mental Health, Ambulance
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The NHS (2008)The NHS (2008)MAJOR REFORMS : THE PAST DECADE ……MAJOR REFORMS : THE PAST DECADE ……
Key FunctionsKey Functions Examples of discrete reformsExamples 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)MonitorAudit CommissionNational Clinical Assessment AuthorityGeneral Medical Council (GMC)Appraisal and Revalidation
Patient/Public engagement Patient choice of providersExpert Patient ProgrammePatient and Public Involvement (PPI), LinKSPatient Advice and Liaison Services (PALS)
Payment and IncentivesPayment and Incentives Payment by Results (PbR)Payment by Results (PbR)GP ContractConsultants’ contractAgenda for Change
Public Reporting Dr FosterLeague TablesStar ratings (now superseded by the annual health check)
Commissioning NICE Commissioning guides, Practice Based Commissioning
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Payment by ResultsPayment by Results
THE NEW WAY OF DOING BUSINESS
PbRBLOCK
FUNDING
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Payment by Results Payment by Results (PbR) (PbR)
KEY ELEMENTS(Payment by Activity)
HRGs
Activity
Health
reso
urc
e
groups
National Tariff
Payment to provider by PCT
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Payment by Results Payment by Results (PbR) (PbR)
TO FACILITATE DECENTRALISED WAITING TIME TO FACILITATE DECENTRALISED WAITING TIME
REDUCTION (TARGETS)REDUCTION (TARGETS) TO REWARD EFFICIENCY AND QUALITYTO REWARD EFFICIENCY AND QUALITY TO SUPPORT PATIENT CHOICE (MONEY FOLLOWS THE TO SUPPORT PATIENT CHOICE (MONEY FOLLOWS THE
PATIENT)PATIENT) TO PROVIDE A TRANSPARENT AND FAIR WAY TO PAY TO PROVIDE A TRANSPARENT AND FAIR WAY TO PAY
PROVIDERSPROVIDERS TO REDUCE TRANSACTION COSTS AND NEGOTIATION TO REDUCE TRANSACTION COSTS AND NEGOTIATION
DISPUTESDISPUTES
WHY WAS IT INTRODUCED?
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The NHS (2008)The NHS (2008)
PCT’s and Commissioning
PCT’s
PRACTICE BASEDCommissioning
• GP’s
18 WEEK PATHWAYS
• Integrated Care
PATIENT CHOICE
“Choose & Book” PLURALITY
PbR(Payment by Results)
• National Tariff• Patient Level Costing
• Foundation Trusts• ISTC’s• NHS Trusts• Etc.
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Payment by Results Payment by Results (PbR)(PbR)
THE KEY ELEMENTS
FINISHED CONSULTANT EPISODES (FCEs)• HRG’s counted by FCEs
HEALTH RESOURCE GROUPS (HRGs)
• Developed in Australia
• Implemented in the UK (1992)
• Standard Grouping
• Clinically similar patients
• Consume similar level of Healthcare
• Used to set a National Tariff (Price/HRG)
NATIONAL TARIFF
• Based on average reference costs
• Separate Tariff (Elective vs Emergency)
• Tariff paid according to actual work
• Trusts compensated through national contracts/local SLA
BASELINE ACTIVITY
SPELLS
• Agreed level of work between PCT and Trust
• Adjustments subject to SLA and risk sharing
• Providers paid for a “spell” that may include several FCE’s
SPECIALIST TOP UPS
• Complex rules/algoritism
• Specific uplifts for certain combination codes
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Payment by Results Payment by Results (PbR)(PbR)
Has it really worked?Has it really worked?
Did the UK get the Balance right Did the UK get the Balance right for the NHS and the Taxpayers?for the NHS and the Taxpayers?
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Payment by Results Payment by Results (PbR)(PbR)
The The CombinationCombination of PbR and National of PbR and National Targets has Targets has markedlymarkedly decreased Wait decreased Wait Time for Admission to hospitalTime for Admission to hospital
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Payment by Results Payment by Results (PbR)(PbR)
Lower Hospitalisation has been Lower Hospitalisation has been experiencedexperienced
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Payment by Results Payment by Results (PbR)(PbR)
And: Short stay activity has increasedAnd: Short stay activity has increased
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Payment by Results Payment by Results (PbR)(PbR)
• Increasing efficiency
• Rewarding and increasing quality
“THE JURY IS STILL OUT”
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Payment by Results Payment by Results (PbR)(PbR)
However,
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Data Quality has substantially improved ….
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So what does the future look like? PbR is here to stay PbR is here to stay
current HRG version 3.5 to be replaced by version current HRG version 3.5 to be replaced by version 4.04.0
PbR has been extended to Mental HealthPbR has been extended to Mental Health HRG unbundling to support PCTs in shifting local HRG unbundling to support PCTs in shifting local
commissioning to community settings and GP’scommissioning to community settings and GP’s Pay for Performance may be next (linking Quality Pay for Performance may be next (linking Quality
and Outcomes)and Outcomes) PbR may be applied to community and home based PbR may be applied to community and home based
servicesservices