Comment / PBR pre-ops clarity needed

Finance managers have called for clarity over the treatment of pre-operative assessments under payment by results after new guidance appeared to contradict existing rules.

The Department of Health guidance was issued as part of a factsheet addressing common queries about outpatient tariffs. It said that where a patient attends a pre-operative assessment clinic prior to admittance (ie not on the same day), the ‘general assumption is that pre-operative assessment costs are included in the inpatient tariff’.

However trust finance managers said this was in conflict with existing Connecting for Health guidance, which clearly states that pre-operative attendances prior to admission should be recorded as part of an out-patient episode, and reference cost guidance.

Managers argued that if the costs of these clinics were collected in outpatients under reference costs exercise, then, unless these costs had been stripped out and added back to the inpatient tariff, they should attract the outpatient tariff. There were no details of such an adjustment when tariff calculation details were published last year.

The Department’s fact sheet provided no further explanation although, in an introduction, it stated: ‘the definition of activity for tariff purposes is not necessarily the same as for reference cost collection’.

Managers said early clarification was needed. One manager said if the guidance really marked a change of approach, then adjustments would also be needed to reference cost guidance, to ensure the costs of pre-op clinics were captured in the inpatient tariff.

He added that if the new guidance was followed it would push trusts to demand patients turn up fit for surgery, making PCTs responsible for pre-assessments, and would threaten local arrangements on MRSA screening.

The factsheet also stressed that appointments needed to be pre-booked to attract the outpatients tariff and that nurse consultant-led clinics did not qualify