News / Health economies share risk on PBR

Several health economies have agreed risk-sharing mechanisms around the new readmissions policy introduced as part of the payment by results rules for 2011/12, according to  an HFMA survey.

The new policy means commissioners do not pay for the costs of emergency readmissions within 30 days of discharge from an elective admission.

Providers have raised concerns that the blanket approach to the policy means that they will face penalties even when the readmission is unrelated to the original episode of care.

However, a small survey of 25 commissioners and providers, undertaken by the HFMA’s Payment by Results Special Interest Group, shows that some health economies have put measures in place to share the risk created by the policy.

Just over half of the small sample – which included mostly NHS trusts and foundation trusts with a few commissioners – said they had put risk sharing arrangements in place.

These included a fixed cap on the amount of readmissions that the PCT would not pay for, a fixed block adjustment and the ‘blocking back’ of ‘fortuitous PCT gains’ as transitional support. Two organisations said that all penalties would be reinvested or recycled.

The survey also revealed examples of joint working to understand the reasons for and eliminate unnecessary readmissions. One foundation trust said it had undertaken a joint audit of 500 sets of notes and was now in the process of ‘redesigning services jointly to target some of the underlying reasons for readmissions’.

The survey also revealed some use of other variations to tariff prices, including caps and collars on contract prices and marginal rates about agreed thresholds for elective activity.

One trust said that caesarean section rates had been capped at 22% of all births, with additional activity paid at normal delivery rates. Within maternity more generally, nearly half the sample had introduced mechanisms to manage the costs of non-delivery events (healthcare resource groups NZ04 – NZ09). In some cases payment for NZ codes was tied to a set percentage of births. Others had agreed rules for when events should be recorded (and paid for) as outpatient attendances.

• The full results of the HFMA survey are to be published in the coming weeks