News / Department to take stock on readmissions policy at Q1

The Department of Health is to review the impact of its policy of not paying trusts for most emergency readmissions within 30 days of discharge, according to Foundation Trust Network director Sue Slipman.

Since April, primary care trusts have been able to withhold payment for emergency readmission within 30 days of discharge after elective procedures. The saving, at full tariff rate, should be used to invest in reablement and post-discharge support.

The stocktake, based on quarter one figures, was welcomed by Ms Slipman, though she insisted the policy should be abandoned. Healthcare consultancy CHKS has estimated the readmission policy will cost trusts £790m this year.

‘The government has agreed to review this policy at the end of the first quarter. We welcome that, but we think the policy is wrong in principle,’ Ms Slipman said. ‘We don’t think it is wrong that any organisation should pay to get right the things it is responsible for, but the problem with the policy is that most readmissions have nothing to do with the original complaint.’

The Department has taken steps to limit the impact of the policy – the final payment by results (PBR) guidance for 2011/12 widened the list of exclusions. PCTs can continue to reimburse providers where they accept the reason for readmission is unrelated to the initial admission. Commissioners and providers can agree local thresholds for emergency readmissions following a non-elective admission.

Ms Slipman said the FTN wanted a change in the policy itself rather than to mitigate it. ‘We don’t know how many mitigation schemes are in place, but it is going to be patchy. We won’t know until the end of the first quarter, but my understanding is that quite a lot of contracts have not been signed off, so trusts aren’t clear what the arrangements are.’

She added trusts would not be able to hold off on making tough decisions, such as those on staffing levels, for much longer.

Understandably, Monitor would ‘push trusts hard’ if local mitigation and national moves following the review were insufficient and a foundation looked like it would not meet its savings target at the first quarter, she said.

The readmissions policy was identified as one of the key risks for foundations in 2011/12 in an FTN survey of its members.

In a commentary accompanying the survey results, it said the CHKS figure translated to an average loss of £5m per acute hospital trust or a requirement of 1%-2% additional savings. It added that anecdotal reports suggested many PCTs were diverting withheld payments to meet their own savings targets, rather than reinvesting the funds in community and post-discharge services.

The survey found FTN members faced an average cost improvement programme (CIP) of 5.7% of income in 2011/12, while the average ‘worst case’ CIPs were 6.7%.