PbR Pilot Cardiac Electrophysiology

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PbR PilotCardiac Electrophysiology
North of England Cardiovascular Network 15
October 2008
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PbR Pilots

• PbR pilot process
• Shortcomings of the Tariff
• NUTH have four pilots
• Cardiac Electrophysiology
• Paediatric Nephrology
• Paediatric Neurodisability
• Fetal Medicine

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Cardiac Electrophysiology Pilot

• Clinical issues
• Atrial Fibrillation
• Catheter Ablation
• Surgical Intervention
• Process issues
• National capacity problems
• Differing resource use for differing treatments
  but all map to the same tariff under HRG 3.5

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Care Pathway

• John Boukes diagram
• Pathways
• Paroxysmal AF
• Persistent AF
• Permanent AF

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Care Pathway

• Switch to Johns diagram in Excel format
• (This is not going to fit on powerpoint)

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PbR Tariff

• Principles of PbR (HRG3.5 and HRG 4)
• All procedures map to E38 2,420 with specialist
  top up.
• 3d mapping devices charged at 3,525
• MFF
• Critical Care bed days
• Total charge 5,945 plus critical care bed days

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Costing Exercise

• Normative costing exercise not true patient level
  costing
• Expected resource use ignoring the top and bottom
  of the pathway.

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Costing Exercise

• Normative costing exercise not true patient level
  costing
• Expected resource use ignoring the top and bottom
  of the pathway.

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Conclusions

• General Conclusions
• Cost of the original method was close to tariff.
• Methods 2a/2b vary but primarily because we have
  not updated our device cost.
• Surgical cost is far above tariff
• HRG 4 views
• Next steps to involve other sites

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Other Pilots

• Paedaitric Nephrology
• Service line reporting and split of Childrens
  Directorate
• Bottom up costing to split into lines of activity
• Principal issue is the invisible activity
• Paediatric Neurodisability
• Service line approach again (lost neurosurgery
  patients)
• Vast variation in HRGs and resource use
  apparently random variation
• Inadequate out-patient tariff re child
  development centre, home visits etc
• Step down facility
• Fetal Medicine
• Awaiting HRG 4

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PbR PilotElectrocardiology
North of England Cardiovascular Network 15
October 2008