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HRGs, PBR and Tariffs for IR Dr Erika Denton

HRGs, PBR and Tariffs for IR Dr Erika Denton. Working in partnership with. HRGs, PbR and Tariffs for IR Erika Denton National Clinical Director for Imaging 22 nd November 2010. Coding and Costing IR. Currently no accurate annual or monthly IR data

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HRGs, PBR and Tariffs for IR Dr Erika Denton

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  1. HRGs, PBR and Tariffs for IRDr Erika Denton Working in partnership with

  2. HRGs, PbR and Tariffs for IR Erika Denton National Clinical Director for Imaging 22nd November 2010

  3. Coding and Costing IR • Currently no accurate annual or monthly IR data • OPCS 4.3 and HRGs historically inadequate in IR • New IR HRG chapter for 2010/11 will result in reference costs in 2011 • SNOMED CT complete for IR

  4. Healthcare Resource Groups • HRG4 developed by The Information Centre since 2003, previously HRG version 3.5 • NHS IC, impartial, independent but accountable to NHS and DH • Clinically meaningful casemix classification • Generated from primary ICD diagnostic codes and OPCS procedure codes • Basis for tariff development

  5. Interventional Radiology HRG Design

  6. HRGs and OPCS Eg: for UFE HRG: RC41Z OPCS: L713 percutaneous transluminal embolisation of artery Y53 approach to organ under image control Z966 uterine artery

  7. Priorities for Tariff Setting • To incentivise quality and better patient outcomes. • To embed efficiency within it • To expand the scope of tariffs

  8. Tariffs for IR • PbR only for direct access in imaging not IR, currently non-mandatory • Would be possible to develop tariffs from reference costs against IR HRGs, new for 2010/11

  9. Tariffs for IR • Best Practice Tariffs (BPT’s) for EVAR and UAE for 2011/12 • ‘Penalties’ in tariff eg renal dialysis via I.V. line • Proposed new HRG pricing structure for multiple trauma to promote use of IR

  10. Best Practice Tariffs • Encourage uptake of innovative evidence based procedures • Increase visibility in the payment system • No inappropriate incentivisation • Decision re surgery or IR remains clinical

  11. Best Practice Tariff for EVAR • Current HRG is Aortic or Abdominal surgery • new IR HRGs, RC 12A-E and RC13A-E for non-ruptured AAA with branched, fenestrated & up to 3 grafts • BPT for EVAR will not apply to ruptured AAA’s • Will be ~ £5400, excluding stent costs of approx £6000 • Surgery tariffs: QZ01A - Aortic Surgery with CC: £7,612 OZ01B - Aortic Surgery no CC: £5,558

  12. Best Practice Tariff for UAE • New HRG created, RC41Z - IR - O&G - Uterine Fibroid Embolisation • will be £2500 • Hopeful study suggested £1,617 but bottom up costs have proved higher • Hysterectomy/myomectomy tariff £2,736 (MA07B)

  13. The cost of infection, basis for dialysis Best Practice Tariff

  14. 20000 HD patients 70% Fistula 30% Lines Assume £10k per bacteraemia Assume all bacteraemia rate 2-3x access rates published 0.1 episode/annum AVF 2 episodes/annum catheter 14000 Fistulas 1400 systemic infections 6000 catheters 12000 systemic infections Total cost: £134 million Approximate Cost to UK

  15. The future? • HRGs • OPCS • PbR • Patient and commissioner choice of provider • Networked services

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