scholarly journals Payment by volume (not results)

2007 ◽  
Vol 13 (1) ◽  
pp. 7-9 ◽  
Author(s):  
Femi Oyebode
Keyword(s):  
Mental Health ◽  
Resource Use ◽  
Healthcare Resource ◽  
Case Mix ◽  
Hospital Funding ◽  
Resource Group ◽  
Related Group ◽  
Consistent Basis ◽  
Healthcare Resource Groups ◽  
Healthcare Resource Group

Payment by results, a system for paying healthcare trusts, is intended as a fair and consistent basis for hospital funding. It relies on a national tariff structured around a case-mix measure known as healthcare resource groups. It is often argued that if payment by results works as planned, the National Health Service will become more efficient and productive. However, the use of a case-mix measure, the healthcare resource group, which derives from the diagnostic related (or diagnosis-related) group, has attendant problems. These include the risk that the payment structure will be inaccurate, unfair and liable to cause the financial destabilisation of trusts. There is also the risk that healthcare institutions will falsify patient classifications (‘up-coding’) to ensure higher remuneration. It has been argued that payment by results may be particularly unsuited to psychiatry. The ability of healthcare resource groups to accurately predict resource use in psychiatry is doubtful. In conclusion, mental health trusts will need to adapt to payment by results but there will inevitably be losers.

scholarly journals Healthcare resource use and costs for people with type 2 diabetes mellitus with and without severe mental illness in England: longitudinal matched-cohort study using the Clinical Practice Research Datalink

2021 ◽  
pp. 1-8
Author(s):  
Han-I. Wang ◽  
Lu Han ◽  
Rowena Jacobs ◽  
Tim Doran ◽  
Richard I. G. Holt ◽  
...  
Keyword(s):  
Mental Health ◽  
Diabetes Mellitus ◽  
Resource Use ◽  
Healthcare Resource ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Matched Cohort ◽  
Healthcare Resource Use ◽  
Lifetime Costs

Background Approximately 60 000 people in England have coexisting type 2 diabetes mellitus (T2DM) and severe mental illness (SMI). They are more likely to have poorer health outcomes and require more complex care pathways compared with those with T2DM alone. Despite increasing prevalence, little is known about the healthcare resource use and costs for people with both conditions. Aims To assess the impact of SMI on healthcare resource use and service costs for adults with T2DM, and explore the predictors of healthcare costs and lifetime costs for people with both conditions. Method This was a matched-cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics for 1620 people with comorbid SMI and T2DM and 4763 people with T2DM alone. Generalised linear models and the Bang and Tsiatis method were used to explore cost predictors and mean lifetime costs respectively. Results There were higher average annual costs for people with T2DM and SMI (£1930 higher) than people with T2DM alone, driven primarily by mental health and non-mental health-related hospital admissions. Key predictors of higher total costs were older age, comorbid hypertension, use of antidepressants, use of first-generation antipsychotics, and increased duration of living with both conditions. Expected lifetime costs were approximately £35 000 per person with both SMI and T2DM. Extrapolating nationally, this would generate total annual costs to the National Health Service of around £250 m per year. Conclusions Our estimates of resource use and costs for people with both T2DM and SMI will aid policymakers and commissioners in service planning and resource allocation.

Assessing the Accuracy of Clinical Coding in Orthopaedic Day Surgery Patients

2013 ◽  
Vol 95 (1) ◽  
pp. 14-16 ◽  
Author(s):  
A Razik ◽  
V Venkat-Raman ◽  
FS Haddad
Keyword(s):  
Healthcare Resource ◽  
Day Surgery ◽  
Clinical Coding ◽  
Resource Group ◽  
Healthcare Resource Group

The NHS is funded via a 'payment by results' system, whereby hospitals are paid for the work they do instead of being allocated a certain amount to spend each year. Every patient treated in hospital is coded to a Healthcare Resource Group (HRG) based on the specifics of his or her admission. There are numerous HRGs, with each one reflecting particular levels of resources that would have been used.

Alberta's Acute Care Funding Project

1992 ◽  
Vol 5 (3) ◽  
pp. 4-11 ◽  
Author(s):  
Philip Jacobs ◽  
Edward M. Hall ◽  
Judith R. Lave ◽  
Murray Glendining
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Performance Index ◽  
Inpatient Care ◽  
Hospital Performance ◽  
Performance Measure ◽  
Case Mix ◽  
Global Budget ◽  
Hospital Funding ◽  
Related Group

Alberta initiated the Acute Care Funding Project (ACFP) in 1988, a new hospital funding system that institutes case mix budgeting adjustments to the global budget so that hospitals can be treated more equitably. The initiative is a significant departure in principle from the former method of funding. The ACFP is summarized and critiqued, and focuses on the inpatient side of the picture. The various elements of the project are discussed, such as the hospital performance index, the hospital performance measure, the Refined Diagnostic Related Group, case weights, typical and outlier cases, and the costing mechanisms. Since its implementation, the ACFP has undergone substantial changes; these are discussed, as well as some of the problems that still need to be addressed. Overall, the system offers incentives to reduce length of stay and to increase the efficiency with which inpatient care is provided.

scholarly journals Case-Mix Classification for Mental Health Care in Community Settings: A Scoping Review

2019 ◽  
Vol 12 ◽  
pp. 117863291986224 ◽  
Author(s):  
Nam Tran ◽  
Jeffrey W Poss ◽  
Christopher Perlman ◽  
John P Hirdes
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Community Mental Health ◽  
Mental Health Care ◽  
Resource Use ◽  
Health Care Resource ◽  
Case Mix ◽  
Community Mental Health Care ◽  
Community Settings ◽  
Input Variables

As mental health care transitions from facility-based care to community-based services, methods to classify patients in terms of their expected health care resource use are an essential tool to balance the health care needs and equitable allocation of health care resources. This study performed a scoping review to summarize the nature, extent, and range of research on case-mix classifications used to predict mental health care resource use in community settings. This study identified 17 eligible studies with 32 case-mix classification systems published since the 1980s. Most of these studies came from the USA Veterans Affairs and Medicare systems, and the most recent studies came from Australia. There were a wide variety of choices of input variables and measures of resource use. However, much of the variance in observed resource use was not accounted for by these case-mix systems. The research activity specific to case-mix classification for community mental health care was modest. More consideration should be given to the appropriateness of the input variables, resource use measure, and evaluation of predictive performance. Future research should take advantage of testing case-mix systems developed in other settings for community mental health care settings, if possible.

Does a coding sticker for percutaneous nephrolithotomy improve clinical coding accuracy and increase financial remuneration?

2017 ◽  
Vol 10 (5) ◽  
pp. 435-439
Author(s):  
JF Donati-Bourne ◽  
R Bodalia ◽  
D Muthuveloe ◽  
JA Inglis ◽  
NJ Rukin
Keyword(s):  
Retrospective Study ◽  
Percutaneous Nephrolithotomy ◽  
Healthcare Resource ◽  
Single Centre ◽  
Clinical Coding ◽  
Resource Group ◽  
Operation Note ◽  
Healthcare Resource Group

Objective: This study aimed to evaluate whether a coding sticker for percutaneous nephrolithotomy (PCNL), completed by the surgeon after the operation note, improved the accuracy of clinical coding and the financial remuneration for PCNL. Patients and methods: A retrospective study was undertaken including all PCNLs performed in a single centre between October 2014 and June 2016. PCNL clinical coding was obtained and applied to yield a Healthcare Resource Group (HRG) code, which was in turn used to calculate the tariff the Trust received for the case. Remuneration and clinical coding accuracy were compared pre- and post-coding sticker introduction. Results: Thirty-three cases were included in the study. Eleven patients were reviewed before the introduction of the sticker and 22 after the introduction of the PCNL sticker. Overall mean clinical coding accuracy improved from 65% to 94% after the stickers’ introduction. This resulted in an overall mean increase in remuneration of £501 per case (from £2946 to £3447). Conclusion: The implementation of a simple coding sticker for completion after a PCNL improves clinical coding accuracy and increases the financial remuneration.

scholarly journals Predictors of poor health and functional recovery following road trauma: protocol of a British Columbian inception cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e049623
Author(s):  
Leona K Shum ◽  
Herbert Chan ◽  
Shannon Erdelyi ◽  
Lulu X Pei ◽  
Jeffrey R Brubacher
Keyword(s):  
Resource Use ◽  
Healthcare Resource ◽  
Healthcare Providers ◽  
Healthcare Resource Use ◽  
Physical And Mental Health ◽  
Inception Cohort ◽  
Policy Makers ◽  
Productivity Costs ◽  
Poor Outcome ◽  
Lost Productivity

IntroductionRoad trauma (RT) is a major public health problem affecting physical and mental health, and may result in prolonged absenteeism from work or study. It is important for healthcare providers to know which RT survivors are at risk of a poor outcome, and policy-makers should know the associated costs. Unfortunately, outcome after RT is poorly understood, especially for RT survivors who are treated and released from an emergency department (ED) without the need for hospital admission. Currently, there is almost no research on risk factors for a poor outcome among RT survivors. This study will use current Canadian data to address these knowledge gaps.Methods and analysisWe will follow an inception cohort of 1500 RT survivors (16 years and older) who visited a participating ED within 24 hours of the accident. Baseline interviews determine pre-existing health and functional status, and other potential risk factors for a poor outcome. Follow-up interviews at 2, 4, 6, and 12 months (key stages of recovery) use standardised health-related quality of life tools to determine physical and mental health outcome, functional recovery, and healthcare resource use and lost productivity costs.Ethics and disseminationThe Road Trauma Outcome Study is approved by our institutional Research Ethics Board. This study aims to provide healthcare providers with knowledge on how quickly RT survivors recover from their injuries and who may be more likely to have a poor outcome. We anticipate that this information will be used to improve management of all road users following RT. Healthcare resource use and lost productivity costs will be collected to provide a better cost estimate of the effects of RT. This information can be used by policy-makers to make informed decisions on RT prevention programmes.

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