The way NHS commissioners are acting on the ban on payment for emergency readmissions varies widely, with some declining to impose the controversial new rule, an HSJ investigation has revealed.

The policy, which came into force on 1 April this year, bars primary care trusts from paying hospitals for emergency readmission of patients within 30 days of their admission for all but a handful of elective procedures.

It also expects them to cap the proportion of emergency readmissions they will pay following non-elective admissions at three quarters of their rate for 2010-11.


PCTs that cut the estimated value of readmissions from contracts up front

An analysis of 2009-10 readmission rates by health business intelligence firm SG2 found acute providers stood to lose £600m this year if the rules were strictly applied. But HSJ’s survey of 50 of England’s 151 PCTs over the past six weeks suggests the actual impact on providers will vary depending on where they are in the country (see survey attached right).

Just over half of respondents said they had cut the estimated value of the readmissions from their providers’ contracts up front, another sizeable group said they would adjust their spending during the year based on actual performance, and four said they did not currently plan to penalise their providers at all.


Projected saving for all PCTs

The NHS Sussex cluster of PCTs, which includes West Sussex, Brighton and Hove, East Sussex Downs and Weald, and Hastings and Rother, said at this stage it was “focusing on reducing readmissions in collaboration with partners, rather than implementing the contract levers with the potential significant income loss for trusts”.

A spokeswoman said NHS Sussex’s providers were analysing detailed readmissions data to develop “appropriate improvement options”, and that the cluster “retains the right to use the non-payment policy should readmission trends warrant such an intervention”.

According to SG2’s analysis of 2009-10 figures, if the new readmissions rules were strictly applied in Sussex they would lose Brighton and Sussex University Hospitals Trust £5.1m this year, or 3.2 per cent of its tariff income. East Sussex Hospitals Trust would lose £4.4m, Western Sussex Hospitals Trust £5.3m, and Surrey and Sussex Healthcare Trust £3.1m.


PCTs that had no plans to penalise providers

A further nine PCTs said they had made additional exemptions to the non-payment rules above those sanctioned by the Department of Health. Among them was Wirral, which said it had extended the DH mandated exclusion of readmissions for children under four years old to all those under the age of 17.

The south east London cluster of six PCTs said it had agreed “a limited number of care pathway exclusions” with local providers.

Foundation Trust Network director Sue Slipman said Department of Health guidance allowed commissioners to pay for readmissions that would otherwise be penalised where they believed the readmission was not the fault of the provider. “Clearly what’s happening is some commissioners are reaching agreement with providers on what will and what won’t count as a readmission – i.e. the fault of the provider.”

She added that the policy adopted by NHS Sussex seemed “a very sensible approach”.

She said: “They seem to be saying we need to understand this more, and understand what’s the fault of the provider and what’s readmission for another reason.”

In total 36 respondents gave figures either for the amount they expected to save through the new rules, or the amount they had taken out of contracts in response to them. The PCTs, which collectively commission acute services for a weighted population of 11.5 million people, estimated they would make savings of £91.4m, with savings per head of population ranging from £18.13 in Rotherham to £1.11 in Oldham.

The average saving per head across the group was £7.47, which would suggest that in total PCTs will save £393.1m this year through the readmissions rules. However, some respondents only quoted figures for those contracts on which they were the lead commissioner.

The results of HSJ’s survey come ahead of a planned DH “stock-take” to assess how PCTs are implementing the new readmissions regime, to be carried out once the NHS has reached the end of the first quarter of the financial year. HSJ understands that strategic health authorities will collect data from commissioners in September on readmissions activity, savings on readmissions, and how PCTs plan to spend the money saved.

The DH expects commissioners to spend any money saved on emergency readmissions on improving reablement services, to reduce rates of admission following discharge.