Table 3.
Payment arrangements, 2014/15
| Admitted patients | Outpatients | A&E | Post discharge rehabilitation | Unbundled HRGs | |
|---|---|---|---|---|---|
| Currency | HRG spell | Treatment function code (TFC): attendance by specialty | HRG Attendance | Bed days | Events |
| HRGs: for procedures | |||||
| Structure | Tariffs for: | Tariffs for: | Tariffs vary by: | Tariffs for 4 types of post discharge rehabilitation: | Chemotherapy |
| • electives & day cases | • first attendance | • Type of investigation | • Cardiac | • a core HRG (covering the primary diagnosis or procedure) –national price | |
| • non-electives | • follow-up attendance | • Category of treatment | • Pulmonary | • unbundled HRGs for chemotherapy drug procurement—local currencies and prices | |
| • short-stay elective | • multi-professional/single professional appointments | • Provider type | • Hip replacement | • unbundled HRGs for chemotherapy delivery—national prices | |
| • short-stay emergencies (>2 days) | • separate national prices for diagnostic imaging | • Knee replacement | Radiotherapy: | ||
| • Best practice tariffs | Procedures carried out in outpatient setting subject to non-mandatory tariff based on HRGs | National prices to shift responsibility for patient care following discharge to the acute provider who treated the patient. Applicable only where a single trust provides both acute and community services. | • unbundled HRGs for planning and treatment—national or local prices | ||
| • Pathway payments | Non-mandatory tariff for outpatient appointments not carried out face to face | ||||
| o Maternity care | |||||
| o Cystic fibrosis | |||||
| Long-stay outlier payment triggered at predetermined length of stay (dependent on HRG). | |||||
| Specialized service adjustments | Best practice tariffs for 17 types of care | Local prices for outpatient attendances that are not pre-booked or consultant-led. | Type 3 A&E departments are eligible for the simplest currency only | ||
| Top-up payment for specialized services for children, spinal surgery, neurosciences and orthopaedic activity | NHS Walk-in Centres are paid by local prices, not by the tariff | ||||
| Rules and Flexibilities | Unbundling: see column 5 | Unbundling of care pathway subject to local agreement | Local flexibilities could be applied to support service redesign | ||
| Emergency admissions: the marginal rate emergency rule | |||||
| Emergency readmissions: the 30 day emergency readmission rule |