News / Best practice to fore in 2012/13 PBR rules

An increase in best practice tariffs, confirmation of a shadow pathway tariff for maternity, a major trauma adjustment and a reduction in the top-up for specialised children’s services are the key highlights in proposed changes for payment by results for acute services in 2012/13.

Alongside next year’s introduction of a mental health currency (see below), the Department of Health unveiled high-level details about changes to acute hospital-based tariffs as it launched its tariff sense check exercise last month.

NHS deputy chief executive David Flory said best practice tariffs were having a significant impact in driving best practice models of care. ‘We are increasing the coverage of best practice tariffs and will introduce further best practice tariffs in the areas of improving access to less invasive procedures and promoting the provision of care in an ambulatory, day case or outpatient setting where appropriate,’ he said.

New best practice areas will include: interventional radiology; ambulatory care including deep vein thrombosis and pulmonary embolism; and home haemodialysis.

For major trauma services, a per patient adjustment will reward providers who meet quality criteria, supporting the transition to the major trauma centre plan.

One finance manager from a trust with a trauma centre welcomed the adjustment as a step in the right direction, but said it still left concerns about covering the full cost of major trauma. ‘We really needed this to go further,’ he said.

Having heavily trailed the plan to introduce a maternity pathway tariff, the Department will now introduce this in shadow form. The pathway will cover antenatal, the birth spell and postnatal care.

The top-up for specialised children’s services will be reduced to 50% from the current 60%. This ‘reflects a continuation of the managed transition towards a top-up level more consistent with the outcomes of analysis by the University of York’s Centre for Health Economics’.

Following the York review the Department had originally proposed a 25% top-up for 2010/11 before raising this to 60% following 2010’s sense check.

Last year’s guidance set out the intention to transfer responsibility and funding for patients in the 30 days after discharge – a parallel development to the introduction of penalties for emergency readmissions. The Department has said the post-discharge tariff will be managed progressively – limited in 2012/13 to conditions such as cardiac rehabilitation.