remuneration training pack uda practices
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November 2015
Training pack for practices
Prototype remuneration - capitation and activity
This training pack should be used by practices who have joined the contract reform programme as prototypes.
Contents
• Remuneration – general principals
• Capitation
• Activity
• Process for the calculation of capitation and activity elements for blend A and blend B
• Remuneration year-end adjustments
Prototype remuneration – general principals
This section will cover:
• The key principles underpinning the remuneration mechanism for prototypes
Prototype remuneration general principals (1)
A prototype’s contract value (for general dentistry) will be split between:
1. Capitation: The number of actual patients a practice will be expected to have on their list at year-end
2. Activity: The minimum level of activity that a practice will be expected to deliver
If a practice delivers less than the minimum level of activity, they may compensate for this by caring for more patients
Practices will also be subject to a remuneration adjustment in respect of quality (Dental Quality and Outcomes Framework - DQOF) at year-end.
Prototype remuneration general principals (2)
• The calculation of the actual remuneration for the year is based on a combination of capitation and activity delivered. This process is undertaken at year-end
• Up to 10% of the contract value is at risk where expected capitation and activity levels are not met
• Up to 2% of the contract value will be recognised where expected capitation and activity levels are exceeded
• A further financial adjustment is applicable for DQOF at year-end (up to 10%)
Prototype remuneration general principals (3)
There will be two blends of remuneration tested in the prototypes:
• Blend A: Where the capitation element covers band 1, and the activity element covers bands 2 and 3
• Blend B – Where the capitation element covers band 1 and band 2, and the activity element covers band 3
Practices will be expected to deliver all necessary care to each patient on their list within their overall contract value
• A practice’s expected patient list excludes patients last seen by a foundation trainee (FT) at the practice
• A practice’s minimum activity requirement excludes activity delivered by an FT
Prototype remuneration general principals (4)
Capitation
This section will cover:
• How the expected patient list is calculated
• What are the triggers for people joining / leaving a patient list
• The mechanism of how patient numbers are counted
How expected capitated patient list figures are calculated (1)
• The expected patient list will be based on the number of patients seen by the practice for an NHS appointment in the three year period prior to 31 March 2015, with adjustments to reflect:– referrals– urgent treatment– charge exempt courses of treatment– relevant changes in delivered and commissioned
levels of UDAs
• This figure is referred to as the expected capitated patient list
What triggers capitation?
• A new patient joins the practice patient list when they attend for an oral health assessment (OHA)
• They will remain on this list for a period of three years unless they attend for NHS treatment elsewhere, except where the patient attended another practice for urgent, referral and charge exempt treatment. In these cases the patient remains on your practice list
• The three year capitation clock will re-set:1. At the IC course of treatment (CoT)2. At the oral health review (OHR)
Capitation - practice patient list
OHA
New to practice
Patient list
IC / OHR
Existing patient
Patient added to patient list
Patient 3 year clock reset
Patient treated
elsewhere (excluding
referrals out, urgent
treatment and exempt items)
Patient removed from patient list
Patient lapses after
3 years
Patient lists are defined as all NHS patients treated at a practice within the last 3 years who have not had NHS treatment at another primary care dental practice (except for urgent / referral or charge exempt)
1. Urgent treatmentA new patient treated at practice A does not get added to their patient listPractice A’s patient treated elsewhere remains on their patient list
2. Referral patientsA new patient referred to practice A for specific treatment does not get added to their patient listPractice A’s patient treated elsewhere remains on their patient list
3. Charge exempt items A new patient treated at practice A does not get added to their patient listPractice A’s patients treated elsewhere remains on their patient list
Capitation - exclusions
How patient numbers are counted
• During the year appointment transmissions from OHA / OHR appointments will be used to add and retain patients on a practice’s patient list as well as FP17 information, which will be used at year-end
• Therefore timely appointment transmissions will ensure that the patient list is as accurate as possible throughout the year
How patient numbers are counted (2)
TRIGGERS CAPITATION
FP17 opens FP17 closes FP17 opens FP17 closes
TRIGGERS CAPITATION
TRIGGERS CAPITATION
CoT CoT
Oral Health Assessment /
Review
Treatment&
Stabilisation (if necessary)
ICs at relevant
interval if required
Appointment data (DPMS) Transmitted within 7 days by practice
Capitation scenarios
YES
NO
NO
NO
Fred attends for an OHA on 1 August 2015. Is Fred added to the practice’s patient list?John is a patient of Smiley Dental and has toothache whilst on holiday in Devon. He attends a dental practice for an urgent course of treatment. Does John get removed from Smiley Dental’s list?Wendy gets referred from her own practice to Jones Dental Ltd for treatment. Will she get added to Jones Dental’s patient list?
Doris is a patient at Thompson Dental practice but attends your practice for a denture repair. Does she get added to your practice list?
Activity
This section will cover:
• How the minimum expected activity level is calculated
• What and how activity is counted
How expected activity levels are calculated (1)
• Expected activity levels will be based on 2014/15 delivery with adjustments for:
– referrals– urgent treatment– charge exempt courses of treatment– any changes in commissioned levels of UDAs
How expected activity levels are calculated (2)
• Expected activity levels will depend on the prototype blend the practice is allocated to:
– Blend A: Band 2 and band 3 activity
– Blend B: Band 3 activity
Blend A - Establishing expected activity levels
BAND 1
1 UDA
BAND 2
3 UDAs
BAND 3
12 UDAs
2 UDAs 11 UDAsACTIVITY
CAPITATION
OHA / OHR & prevention = capitation (Band 1)All treatment = activity (Bands 2 and 3)
Blend B - Establishing expected activity levels
BAND 1
1 UDA
BAND 2
3 UDAs
BAND 3
12 UDAs
9 UDAsACTIVITY
CAPITATION
OHA / OHR, prevention and routine treatment = capitation (Band 1 and 2)Complex treatment = activity (Band 3)
How expected activity levels are calculated (3)
• For the prototypes an allowance will also be made to recognise the increased time spent on prevention when following the pathway and a fall in treatment volumes observed in the pilots
• Expected activity levels will be adjusted by:– Up to 20% for Band 2 – Up to 30% for Band 3
• Once all of these adjustments have been made this is the minimum expected activity level for the practice
What activity is counted (1)
• Activity delivered will be submitted and counted via the FP17 at the end of the course of treatment
Blend A• Band 2 = 2 UDAs• Band 3 = 11 UDAs
Blend B • Band 3 = 9 UDAs
Counting of activity for urgent treatment, referral patients and charge exempt courses of treatment will depend on whether this activity is provided to a patient who is on the capitated patient list or not:
• Where the patient is on the practice list: No activity is counted
• Where the patient is not on the practice list: Activity is counted
What activity is counted (2)
Activity scenarios
1.2
YES
0
John is a patient of Smiley Dental and has toothache whilst on holiday in your area. He attends your dental practice for urgent dental treatment. How many UDAs do you receive?
Wendy gets referred to your practice from her own practice for treatment. Will you receive any UDAs for her treatment?
Doris is your patient and turns up at your practice for a denture repair. How many UDAs do you receive?
Process for the calculation of capitation and activity elements for blend A
Blend A
Capitation element This covers the OHA / OHR and prevention, i.e. all band 1 care
Activity element This covers all treatments provided, i.e. all band 2 and band 3 care
Process for calculating the capitation and activity elements for blend A practices
STEP 1• Calculate the number of UDAs to be
allocated to the activity element (band 2 and band 3)
STEP 2• Apply the adjustment for prevention and
treatment volumes to give minimum expected activity level
STEP 3• Calculate the value of the minimum
expected activity level by multiplying the expected UDAs by the UDA value
• The remainder of the contract value is then allocated to the capitation element
Example – blend AA practice has a total contract value of £700,000 made up of:
The UDA value is £25.00 and the baseline expected patient list (based on pre-pilot position) is 10,000
In the baseline year the practice delivered:
• 6,240 Band 1 courses of treatment (6,240 UDAs)• 3,520 Band 2 courses of treatment (3,520*3 = 10,560 UDAs)• 600 Band 3 courses of treatment (600*12=7,200 UDAs)
General dentistry £600,000 24,000 UDAsOrthodontics £75,000 1,250 UOAs
Sedation £25,000 250 CoTs
TOTAL £700,000
Example of how capitation and activity elements for a prototype contract will be established – blend A
Activity levelsVolume of
CoT
UDAs for activity element
Activity level (unadjusted)
Band 2 3,520 * 2 7,040 Band 3 600 * 11 6,600 Minimum activity level (unadjusted) 13,640
Split of contract valueValue of activity level 13,640 * £25.00 £341,000.00Value of capitation level £600,000.00 - £341,000.00 £259,000.00TOTAL £600,000.00
Step 1: Calculate the number of UDAs to be allocated to the activity element (band 2 and band 3)
Example of how capitation and activity elements for a prototype contract will be established – blend A
• The activity element is £256,300.00 for which the practice would be expected to deliver a minimum of 10,252 UDAs
• The capitation element is £343,700.00 for which the practice would be expected to have 10,000 capitated patients
Activity level (unadjusted)
Prevention & treatment volume adjustment
Minimum expected
activity levelBand 2 7,040 - 20% 5,632 Band 3 6,600 - 30% 4,620 Minimum expected activity level 10,252
Value of activity level 10,252 * £25.00 £256,300.00Value of capitation level £600,000.00 - £256,300.00 £343,700.00TOTAL £600,000.00
Step 3 - Calculate the value of the minimum expected activity level and capitation element
Step 2 - Apply the adjustment for prevention and treatment volumes to give minimum expected activity level
Practice 1 Baseline courses of treatment
UDAs Blend A activity (UDAs)
Fall in treatment volumes adjustment
Adjusted Blend A activity (UDAs)
Band 1 3100 3100 0 0Band 2 1100 3300 2200 80% 1760Band 3 300 3600 3300 70% 2310Total 10000 5500 4070
Practice 2 Baseline courses of treatment
UDAs Blend A activity (UDAs)
Fall in treatment volumes adjustment
Adjusted Blend A activity (UDAs)
Band 1 5800 5800 0 0Band 2 600 1800 1200 80% 960Band 3 200 2400 2200 70% 1540Total 10000 3400 2500
Practice 3 Baseline courses of treatment
UDAs Blend A activity (UDAs)
Fall in treatment volumes adjustment
Adjusted Blend A activity (UDAs)
Band 1 1000 1000 0 0Band 2 200 600 400 80% 320Band 3 700 8400 7700 70% 5390Total 10000 8100 5710
Blend A examples
Process for the calculation of capitation and activity elements for blend B
Blend B
Capitation element This covers the OHA / OHR and prevention and routine treatments provided i.e. all band 1 and band 2 care
Activity elementThis covers the more complex treatment provided i.e. all band 3 care
Process for calculating the capitation and activity elements for blend B practices
STEP 1 • Calculate the number of UDAs to be allocated to the activity element (band 3)
STEP 2• Apply the adjustment for prevention and
treatment volumes to give minimum expected activity level
STEP 3• Calculate the value of the minimum
expected activity level by multiplying the expected UDAs by the UDA value
• The remainder of the contract value is then allocated to the capitation element
Example – blend BA practice has a total contract value of £700,000 made up of:
The UDA value is £25.00 and the baseline expected patient list (based on pre-pilot position) is 10,000
In the baseline year the practice delivered:
• 6,240 Band 1 courses of treatment (6,240 UDAs)• 3,520 Band 2 courses of treatment (3,520*3 = 10,560 UDAs)• 600 Band 3 courses of treatment (600*12=7,200 UDAs)
General dentistry £600,000 24,000 UDAsOrthodontics £75,000 1,250 UOAs
Sedation £25,000 250 CoTs
TOTAL £700,000
Example of how capitation and activity elements for a prototype contract will be established – blend B
Activity levelsVolume of
CoT
UDAs for activity element
Activity level (unadjusted)
Band 3 600 * 9 5,400 Minimum activity level (unadjusted) 5,400
Split of contract valueValue of activity level 5,400 * £25.00 £135,000.00Value of capitation level £600,000.00 - £135,000.00 £465,000.00TOTAL £600,000.00
Step 1: Calculate the number of UDAs to be allocated to the activity element
Example of how capitation and activity elements for a prototype contract will be established – blend B
• The activity element is £94,500.00 for which the practice would be expected to deliver a minimum of 3,780 UDAs
• The capitation element is £505,500.00 for which the practice would be expected to have 10,000 capitated patients
Activity level (unadjusted)
Prevention & treatment volume adjustment
Minimum expected
activity levelBand 3 5,400 - 30% 3,780
Minimum expected activity level 3,780
Value of activity level 3,780 * £25.00 £94,500.00Value of capitation level £600,000.00 - £94,500.00 £505,500.00TOTAL £600,000.00
Step 2 - Apply the adjustment for prevention and treatment volumes to give minimum expected activity level
Step 3 - Calculate the value of the minimum expected activity level and capitation
Practice 1 Baseline courses of treatment
UDAs Blend B activity (UDAs)
Fall in treatment volumes adjustment
Adjusted Blend B activity (UDAs)
Band 1 3100 3100 0 0Band 2 1100 3300 0 0Band 3 300 3600 2700 70% 1890Total 10000 2700 1890
Practice 2 Baseline courses of treatment
UDAs Blend B activity (UDAs)
Fall in treatment volumes adjustment
Adjusted Blend B activity (UDAs)
Band 1 5800 5800 0 0Band 2 600 1800 0 0Band 3 200 2400 1800 70% 1260Total 10000 1800 1260
Practice 3 Baseline courses of treatment
UDAs Blend B activity (UDAs)
Fall in treatment volumes adjustment
Adjusted Blend B activity (UDAs)
Band 1 1000 1000 0 0Band 2 200 600 0 0Band 3 700 8400 6300 70% 4410Total 10000 6300 4410
Blend B examples
Remuneration year-end adjustments
Remuneration year-end adjustments
• Practices will receive 1/12th of their contract value each month
• At year-end financial adjustments (if applicable) will be made for:– Capitation (patient numbers) and activity– Quality (DQOF)
Year-end process for capitation and activity
• At year end a practice will be reviewed to assess whether:
– Patient numbers are above or below the expected level (capitation)
– Activity is above or below the expected minimum level
• The value of these year-end delivery positions are calculated and combined to determine the actual remuneration level for the year.
Year-end process for capitation and activity (2)
Combined capitation and activity under-delivery• A practice will be allowed to carry forward the combined
value (£) of under-delivery (for capitation and activity)• The maximum carry forward will be 4% of the contract value• Where the value (£) of under-delivery is greater than 4% the
financial recovery will be applied up to 10% of the contract value
Combined capitation and activity over-delivery • A practice will be allowed to over-deliver by up to 2% of the
contract value (£)• This value may be paid by the commissioner or carried
forward
Year-end process for capitation and activity (3)
• The calculation of the year-end position will be calculated by NHS England and the programme
• This process will be undertaken after all year-end data has been received and processed by NHS BSA
• Practices will be notified of their year-end position and any associated financial adjustment or carry forward by NHS England
• Any financial adjustments will be applied and processed via Payments on Line (PoL) and reflected in a practice’s monthly pay schedule
Year-end delivery • If a practice delivers less than the minimum level of activity
they may compensate for this by caring for more patients
• However, there are limits applied to activity delivery:
1. If patient numbers are less than or equal to 100% of expected levels, then any adjustment relating to activity delivery will be capped at 100%
2. If patient numbers are more than 100% of the expected level, then any adjustment relating to activity will be capped at the same percentage as the achieved level for the patient numbers.
How the year-end process will work
STEP 1 •Calculate the year-end delivery percentage for the capitation and activity elements separately
STEP 2 •Apply rules for adjustments (if required) to activity and capitation delivery
STEP 3 •Calculate the combined value of the year-end achievement for capitation and activity
STEP 4 •Apply the carry forward for the previous year
STEP 5 •Calculate the final position and carry forward (if applicable) for the next year
Year-end mechanism year example 1
Practice informationBlend type BContract value £600,000.00Capitation element £505,500.00Activity element £94,500.00Expected patient list 10,000Expected UDAs 3,780Carry forward from previous year £0.00
Year end deliveryPatient numbers 9,900UDAs 3,818
Year-end mechanism year example 1Step 1 - Year end delivery percentage for capitation and activityCapitation 9,900 / 10,000 99.00%Activity 3,818 / 3,780 101.01%
Step 2 - Apply rules for adjustments for activity elementCapitation 99.00%Activity 100.00%
Capitation 99.00% of £505,500.00 £500,445.00Activity 100.00% of £94,500.00 £94,500.00Total £594,945.00% total £594,945.00 / £600,000.00 99.16%
Step 4 - Apply carry forward from previous yearCarry forward from previous year £0.00
Step 5 - Calculate the final position and carry forward (if applicable) for next yearFinancial adjustment £0.00Carry forward value (99.16% - 100.00%) * £600,000.00 -£5,040.00Carry forward percentage -£5,040.00 / £600,000.00 -0.84%
Step 3 - Calculate the combined value of the year-end achievement for capitation and activity
Year-end mechanism year example 2
Practice informationBlend type BContract value £600,000.00Capitation element £505,500.00Activity element £94,500.00Expected patient list 10,000Expected UDAs 3,780Carry forward from previous year -£5,040.00
Year end deliveryPatient numbers 10,200UDAs 3,893
Year-end mechanism worked example 2Step 1 - Year end delivery percentage for capitation and activityCapitation 10,200 / 10,000 102.00%Activity 3,893 / 3,780 102.99%
Step 2 - Apply rules for adjustments for activity elementCapitation 102.00%Activity 102.00%
Capitation 102.00% of £505,500.00 £515,610.00Activity 102.00% of £94,500.00 £96,390.00Total £612,000.00% total £612,000.00 / £600,000.00 102.00%
Step 4 - Apply carry forward from previous yearCarry forward from previous year -£5,040.00
Step 5 - Calculate the final position and carry forward (if applicable) for next yearFinancial adjustment £0.00Carry forward value (102.00% - 100.00%) * £600,000.00 + -£5,040.00 £6,960.00Carry forward percentage £6,960.00 / £600,000.00 1.16%
Step 3 - Calculate the combined value of the year-end achievement for capitation and activity
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