Mark Skues President - Quality Improvement Hub - afcm - events - day... · ‘Payment by Results’ and Best Practice Tariff for Day ... Day case Laparoscopic Cholecystectomy

British Association of Day Surgery www.bads.co.uk

Pushing the boundaries

Mark Skues

President


English Experience..

• Ongoing success of “Enhanced Recovery Programme”

• BADS Directory of Procedures 4th Edition

• Financial incentivisation

‘Payment by Results’ and Best Practice Tariff for Day

Surgery


Enhanced Recovery Programme

• Evidence based pathways providing shared experience with optimisation of patient care.

• Better quality care

• And.. Reduced length of stay


All hysterectomies Open vs Laparoscopic

Our performance


National performance


• Managing patient expectation (information)

• Pathway management

• Clinician training (+guidelines)

Nurse led discharge when:

• Patient can eat/drink,

• is mobile

• and analgesia provided orally

Simple adjuncts..


Day Surgery and Enhanced Recovery


The Day Surgery Pathway • GP Optimisation &

Referral

• Surgical Outpatient Appointment

• Pre-Op Assessment

• Booking

• ‘On the day’ Care

• Home Discharge

• Home follow-up


Pathway processes

GP Referral: Optimised for surgery?

Patient expectations

OPD: Consistent decision making for Day Surgery intention

Pre-Op assessment: Nurse led, clinician governanced; Patient information

Appropriate selection criteria?

On the day: Anaesthetic management

Nurse led discharge

Post discharge: Patient support


Procedure Directory 4th Edition


National Dataset


NHS Atlas of Variation


Day case Laparoscopic Cholecystectomy


Day/Short Stay Surgery Rate Reporting

- In the public domain


Day/Short Stay Surgery Rate Reporting

- In the public domain

Coming soon... Performance data for every operation in the 4th Edition of the Procedure Directory with “drill

down” facility


Financial incentivisation


Payment by Results / Tariff

One payment for an operation funds everything.


History of Best Practice Tariff

“From patient notes to pound

notes”


Financial Incentivisation

Four years ago;

Approach to BADS by the NHS PbR Team

“How do we provide appropriate payment for Day Surgery activity?”

• Reduce tariff based on reduced cost?

• No... Enhance tariff as a financial incentive


Laparoscopic Cholecystectomy: ‘Best Practice’ Tariff

2009:

Day case: £1365

In-patient: £1365

For 2010-11: Day case: £1694 In-patient: £1369


Day Case Incentivisation

Breast Surgery:

Mastectomy, Axillary Clearance / SNB

ENT:

Septoplasty/Tonsillectomy

Gynaecology:

Incontinence Surgery

General Surgery:

Cholecystectomy / Hernia Repair

Orthopaedics:

Dupuytren’s, Subacromial decompression, “Bunion” ops


Impact

• Additional reimbursement of ~£300 more if the procedure is carried out as a planned day case.

• Books “balanced” by over-reimbursing for day surgery and underfunding inpatient care.

• Perverse incentive for Clinical Commissioning Groups in the future?


The Evidence Base...


Pushing the boundaries

Mark Skues

President

Documents

Mark Skues President - Quality Improvement Hub - afcm - events - day... · ‘Payment by Results’ and Best Practice Tariff for Day ... Day case Laparoscopic Cholecystectomy