Controversial rules restricting the payments hospitals receive for emergency admissions and readmissions are to be kept in place for 2015-14, Monitor and NHS England revealed last week.

Their “tariff engagement” document said that while the pricing authorities will be “considering the future need for the marginal rate rule and 30 day readmission rule” these policies will remain until at least 2016-17.

It added: “We are proposing to retain the existing rules for 2015-16.”

Under the rules, providers receive just 30 per cent of normal payment rates for emergency admissions above 2008-09 levels and no payment at all for many emergency readmissions within 30 days of a patient’s initial attendance.

The acute sector has argued that the rules unfairly penalise hospital providers for circumstances that are not always within their control, such as growth in demand.

Monitor and NHS England also propose to test a “potential new payment approach” to support the recommendations of Sir Bruce Keogh and Keith Willett’s review of urgent and emergency care.

Patient on trolley being wheeled through corridor

The acute sector has argued that the rules unfairly penalise hospital providers for events outside their control

This will look at “the costs of providing urgent and emergency care services following the review by Sir Bruce Keogh” and how much payment levels should “vary with activity levels and/or quality standards”.

The document said: “We see a pressing need to reform payment structures for urgent and emergency care, and want to explore how that could be done with a menu of options available for possible local adoption for 2015-16, to inform potential rollout in 2016-17.”

The organisations acknowledge that “the need to reform the payment system is urgent” but it should be done in “a considered and systematic way”.

Siva Anandaciva, head of analysis at the Foundation Trust Network, called for “more rapid progress on the redevelopment of the payment system for urgent and emergency care, as we cannot continue with approaches, such as the marginal rate that pays providers less, as the number of patients with emergency care needs increases”.

He added: “We welcome the evidence based and consultative approach Monitor and NHS England have taken to determining how NHS services should be paid.”


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