In’s & Out’s of Emergency Admissions

1. In’s & Out’s of Emergency Admissions 2011/12 Operating Framework: SWL ACU proposed approach to 30 day readmissions Dominic Conlin Managing Director, SWL ACU

2. Introduction • 2010/11 Revised Operating Framework re-enforced existing kpi and contract standard on entitlement to withold payment for additional treatment incurred for emergency readmissions within 14 days • Flagged extension to the 14 day threshold to 30 • 2011/12 Operating Framework confirmed this

3. 2011/12 Operating Framework • In 2011/12 hospitals will not be reimbursed for emergency readmissions within 30 days of discharge following an elective admission, and all other readmissions within 30 days of discharge will be subject to locally agreed thresholds, set to deliver a 25% reduction, where possible. This is to ensure that, wherever possible, hospitals have good discharge arrangements in place to avoid readmissions. PCT’s should work with providers, GP’s and local authorities to manage the savings arising from non-payment of emergency readmissions to fund reablement and post discharge support.

4. SWL ACU process & proposal • Two pools of activity identified: • Original spell source of admission as elective • Original spell source of admission as non-elective: • Where re-admission occurs as failure in discharge • Where re-admission occurs as failure in out of hospital services • Where re-admission occurs as result of known complication/risk • Latter pool to be realigned to map same specialty (from original admission) as an indicator of ‘related condition’

5. Indicative Impact

6. Indicative Reablement Funding for SWL in 2011/12 Source: Derived from £150m national allocation: NHS Operating Framework and LAC (2010) 6

7. Key Questions • Does this methodology provide indicated 25% reduction on emergency re-admissions? • Does this methodology provide a minimum reinvestment opportunity to support reablement funds? • SWL approach is to seek to align ‘failure of out of hospital services’ bucket with reablement funds and requirement to redesign and/or extend these services to support care for patients in the community

8. Implementation, Phasing and Potential Exclusions • Proposed as a KPI in 2011/12 contracts • Opportunity to ramp up (beyond 25%) in future years consistent with QIPP plans and with proposals to double Reablement Funds from 2012/13. This would indicate up to 50% ‘target’ in future years. • The Operating Framework indicates that exclusions will be set out in PbR Guidance for 2011/12 (SWL modelling currently based on existing exclusions)

9. Questions to consider • KPI to be underpinned by audit • Patient management to be complemented by ‘best practice’ discharge checklist. • Commissioning and extension of reablement services to be based on evidence of effectiveness • Should we consider penalty/withold of reablement funds where they do not deliver reduced readmissions

10. Other Issues • Key Issues to consider include: • How to make the system sufficiently simple, measurable and least prone to avoidance measures • What speed of impact is required – given current QIPP and health economy rebalancing, yet consistent with the need for whole-systems solutions to be practical • Whether a claims process is envisaged for provider to provider issues to allow Trusts to dispute impact of commissioner deductions when readmission occurs at other Trusts