Specialist heart hospitals are lobbying Monitor to speed the introduction of new tariffs for aortic surgery, arguing the current national pricing is losing large sums on some complex procedures.
The Liverpool Heart and Chest Hospital Foundation Trust and the Royal Brompton and Harefield FT said they had been unable to get confirmation as to when a more-refined approach to costing these procedures – which are already adopted by the Health and Social Care Information Centre – would be fed into national payment by results prices.
Liverpool Heart and Chest chief finance officer David Jago said his trust estimated it was losing just over £1m a year on complex aortic surgery, due to a combination of the current pricing structure and inaccuracies in the costing data used to set present national prices.
Under PBR, services deemed to require similar amounts of resources are grouped together in “healthcare resource groups”.
The price of an HRG has historically been based on an average of the reported costs of all trusts carrying out procedures in the group.
Mr Jago told HSJ that the current PBR tariff grouped a number of the most complex cases performed at cardiothoracic specialists alongside less expensive procedures, obscuring the much higher costs of the complex work.
He added that this had been acknowledged by the HSCIC, which collects costing data from trusts, leading to the adoption in 2012 of new HRGs for the purpose of costing.
The £112m turnover trust estimates it would gain more than £0.5m per annum if these new HRGs were introduced into national pricing.
Mr Jago had hoped this would happen in 2015-16, but now does not believe it will come before 2016-17.
“The national challenge facing the specialised commissioning budget is huge,” he said.
“We’re not naive enough to think somebody’s going to add to that problem by saying you know what guys, you’ve not been paying your specialist providers the right amount of money through the tariff and we’re going to increase that challenge.”
A spokesman for the Royal Brompton said it had been working with LHCH to “provide information in support of the development of new healthcare resource groups to reflect the complexity of aortic surgery”.
He added: “Both centres have been working to provide evidence to [HSCIC’s National Casemix Office] but as yet there has not been a timetable agreed as to when new HRGs will be introduced.
“It is disappointing that trusts like ours will continue to provide these services without full reimbursement, at a time when innovation funding associated with implementing new practices has also been squeezed, and any flexibilities which did exist to top up tariffs locally have been refused.”
Sam Higginson, director of strategic finance at NHS England said a discussion paper which in April set out its preference for the 2015-16 tariff had noted that “the newer HRG4+ model [used by the HSCIC] would represent a risk, given that only one year’s worth of cost data is available”.
He added: “The majority of stakeholders supported this preference as reasonable”.