News / Report backs changes to PBR cancer tariff

The Department of Health must address 16 areas, including introducing a separate cancer outpatient tariff for some specialties and fair payment for highly-complex procedures, to ensure payment by results supports effective cancer services.

That was the conclusion of a review of PBR tariffs and their impact on cancer services, commissioned by the Department. The PA Consulting report said that while HRG4 will establish new national currencies for radiotherapy, chemotherapy and specialist palliative care, issues remained to be addressed.

Six issues were vital. As well as a separate outpatient tariff and fair payments for complex procedures, the report said there should be fair payment for multi-disciplinary team services, better coding and the cost of investment in new radiotherapy bunkers should be separated from the tariff. Concern that HRG4 reference costs may not cover drugs associated with chemotherapy should also be addressed.

The Department said the report had already informed the cancer reform strategy and other recommendations were being considered.

In a separate report the Department provided more details on how a care pathways approach to mental health funding – its chosen currency for a tariff – would work. The key to the integrated packages approach is a standard needs assessment, the assignment of ‘care clusters’, such as substance misuse and first episode in psychosis, and care packages are then attached for each cluster.

The document, which was based on discussions between three experts on mental health PBR and tariffs, said the approach would cover most adult mental health services. Services provided by general hospitals, GPs and specialist secure units were outside the scope of the study. Yorkshire and the Humber’s experience with care pathways is covered.