More on Payment by Results
- Read John Appleby's blog: Payment by Results: time for a rethink?
- Read our press release on this report: Current payment systems not suited to current challenges facing the NHS, new report by The King’s Fund finds
Du kender muligvis arbejdet i NHS om PbR
I have a nice example of the improved data definitions that are needed for payment systems like PbR to keep up with clinical innovation. Ambulatory emergency care (patients seen and discharged from hospital on the same day) activity is being recorded variously as inpatient or outpatient activity. The latter is probably more within the spirit of the pathway but Trusts that do so face a stiff financial penalty because they will only get reimbursed the standard outpatient tariff of £100-£150 or so. In contrast inpatient activity attracts the short stay emergency tariff (if there is one) or the full inpatient tariff (if not). This can be up to a factor of 10 higher. And in neither case can the commissioner identify these patients from the regular commissioning datasets. What is really needed of course is a new definition somewhat akin to the way that elective day cases can be identified separately from elective inpatients. However that is not even a glint in the eye of the NHS Data Standards team. In the meantime enlightened providers and commissioners negotiate a locally agreed tariff to reflect the work done to treat these patients.
We shouldn't underestimate the important role that PbR plays in getting clinical engagement to the economics of providing health care. In combination with PLICS (Patient Level Information and Costing Systems), PbR enables us to ask questions such as "patient X's treatment cost 50% more than the revenue that was earned - why?". These are far more powerful questions than "why was your budget overspent by 10% this month?". Any changes to the funding system have to retain the potential to link treatment revenues to costs at a patient level in a way that is easy for clinicians to understand. Since PLICS is in its infancy in many parts of the NHS, I don't believe we have seen anything like the full opportunity of this approach yet.
I agree with what has been written above - especially the comment regarding high quality and low service provision as that is exactly what happened back in the 80's and 90's and we do not want to return to that at all or we will have totally wasted tax payers money that was spent upgrading the whole system over the past 10 years.
Completely agree with the reports findings - in particular the need to gather robust data. But gathering data is not enough. Often larger organisations simply do not understand what to do with the data or how the data can be used to improve services & reduce costs...that's what's going to be interesting to follow in the next year or so.