A business critical briefing from HSJ’s Payment by Results conference 

Key themes

  • The importance of payment by results in managing resources and making commissioning plans
  • The need to improve the quality of data to ensure providers are accurately paid and commissioners understand the health services provided to their residents
  • The implementation of patient level information and costing and how it will help to involve clinicians and improve data quality
  • The future extension of payment by results to mental health and community services, and also the incorporation of best practice in the tariff
  • The use of payment by results to create some of the efficiency savings required by the NHS
  • The importance of patient experience and quality

Action points

  • Involve clinicians in the development of payment by results.
  • Ensure high quality data is available. Monitor and strive to improve data quality.
  • Train and develop coders effectively.
  • Be clear on the reasons for implementing patient level information and costing and get buy-in from clinicians and managers.
  • Understand community service spending and develop pathways that consider outcomes.

Key questions and answers

Q Will CQUIN continue?

  • CQUIN will continue and the percentage payment will increase to 1 per cent. This payment includes non-tariff aspects. With best practice tariffs it will be necessary to review CQUIN.

Q What percentage of services are covered by payment by results?

  • At present 30 per cent of primary care trust funds are spent using payment by results; the remaining 70 per cent is in the “challenging” areas of mental health, community, etc where there is some work in developing appropriate tariffs. However, because of the drive to demonstrate efficiency and quality in the current fiscal environment there will be more focus, resources and effort put into developing these tariffs.

Q Will payment by results be applied to everything?

  • In relation to specific services, for example pathology test pricing, it was noted that the payment by results tariff cannot answer every question.

Q Who pays for improving the quality of coding data?

  • In improving the quality of data there may be short term gains for providers to code all activity accurately. It is accepted that commissioners will have to pay for this activity and it does help improve the quality of coding and data. In general when improving data quality the trust is correcting past mistakes and there is no evidence of upcoding.

Q For community services, how is the responsible commissioner determined?

  • The issue of responsible commissioner is a problem in some areas. Appropriate currencies may help with the transfer of patients, but for part-completed care there will need to be practical solutions. Tracking patients through social care is difficult, because of boundaries, and there are a lot of differences in the care provided by local authorities.

Derek Miller is an independent consultant, currently working at South West London Acute Commissioning Unit. 

Payment by Results