Practice Based Commissioning East Devon PCT – How to Develop an Indicative Budget

Beverly Stretton-BrownDevolved Budgets Project Manager

9 December 2004

Setting Practice Based Budgets

Budget Setting – where did we start?

Established Rules of Engagement for 2004/05

Preparation Year Consultation Referral Information to Practices Validation Programme & Workshops

Historical Budgets – moving to Fair Equity Model

Budgets at Practice Level

Budget Setting – where did we start?

Quickly made friends with Information Dept

Gathered Historical Activity2 Calendar Years In-Patients3 Financial Years Out-Patients

Converted to 2004/05 Spells & Cost Budgets set on Highest Cost Year for each

practice Matched to PCT Affordability – No Uplift

What is included in the budget for 2004/05?

Inpatient ElectiveActivity

Day Case Elective Activity

Non-ElectiveActivity

Out PatientActivityExclusions –

Intensive CareHigh Cost Procedures

A&E, etc

Activity in Secondary Care Charged atNational Tariff

(RDE 92%)

Daycase Activity in Local Community

Hospitals Charged at80% of National Tariff

How does it work?

Optional Sign-up Management Resource to Monitor

Budgets, Manage and Plan Monthly Budget Statements &

Patient Level Data More Detailed Analysis

How does it work?Practice Validation

Paying for “what we get” Influence Commissioning Quality Standards Identify Problem/Opportunity Areas

Clinical Review of Activity/Referrals Consider using/developing alternative

Local Service Developments Purchase most appropriate care to

patients within Budget parameters

Budget Statement

Case Type Provider Volume CostDaycase Elective Main Acute Provider 1146 £683,576

East Devon Community Hospitals 480 £263,845Other Trusts 10 £6,400Total 1636 £953,820

Inpatient Elective Main Acute Provider 618 £1,211,704East Devon Community Hospitals 197 £436,450Other Trusts 26 £106,835Total 841 £1,754,988

Inpatient Non-Elective Main Acute Provider 1129 £2,704,548East Devon Community Hospitals 298 £656,118Other Trusts 19 £77,023Total 1446 £3,437,689

3923 £6,146,498

Agreed Baseline 2004/05

Grand Total

Patient Level Data …

Type of Procedure Place Patient ID HRG HRG Description Nat TariffInpatient Elective Local Hospital xxx xxx xxxx B05 Other Ophthalmic Procedures - Category 2 £628Day Case Elective Local Hospital xxx xxx xxxx C02 Nose Procedures - Category 1 £667Day Case Elective Local Hospital xxx xxx xxxx L21 Bladder Minor Endoscopic Procedure w/o cc £430Day Case Elective Acute Trust xxx xxx xxxx F35 Large Intestine - Endoscopic or Intermediate £475Day Case Elective Local Hospital xxx xxx xxxx B02 Phakoemulsification Cataract Extraction with £786Day Case Elective Acute Trust xxx xxx xxxx H52 Removal of Fixation Device <70 w/o cc £1,088Day Case Elective Acute Trust xxx xxx xxxx H98 Chemotherapy with a Musculoskeletal System Pr £656Inpatient Non-Elective Local Hospital xxx xxx xxxx R15 Thoracic or Lumbar Spinal Disorders >69 or w £2,603Inpatient Non-Elective Acute Trust xxx xxx xxxx E18 Heart Failure or Shock >69 or w cc £2,776Inpatient Elective Acute Trust xxx xxx xxxx S22 Planned Procedures Not Carried Out £543Day Case Elective Acute Trust xxx xxx xxxx F16 Stomach or Duodenum - Diagnostic Procedures £387Day Case Elective Local Hospital xxx xxx xxxx F06 Oesophagus - Diagnostic Procedures £397Inpatient Elective Acute Trust xxx xxx xxxx H21 Muscle, Tendon or Ligament Procedures - Categ £1,925Inpatient Non-Elective Local Hospital xxx xxx xxxx F46 General Abdominal Disorders >69 or w cc £1,802

Detailed Analysis

Non-Elective Admissions to Acute Provider April - July 04, 0 - 2 Days LOS Only

£58,658 £66,654£44,192

£0

£50,000

£100,000

0 Day LOS 1 Day LOS 2 Days LOS

Detailed Analysis – Zero LOS

HRG

Cost @ 92% of Nat Tariff

C17 Mouth, Head, Neck or Ear Diagnoses - Category £869D21 Asthma >49 or w cc £2,062D22 Asthma <50 w /o cc £789E20 Deep Vein Thrombosis >69 or w cc £1,697E20 Deep Vein Thrombosis >69 or w cc £1,697E20 Deep Vein Thrombosis >69 or w cc £1,697E20 Deep Vein Thrombosis >69 or w cc £1,697E32 Syncope or Collapse <70 w /o cc £724E32 Syncope or Collapse <70 w /o cc £724E33 Angina >69 or w cc £1,343E36 Chest Pain <70 w /o cc £546F46 General Abdominal Disorders >69 or w cc £1,658F55 Inflammatory Bow el Disease >69 or w cc £1,945F64 Gastrointestinal Bleed >69 or w cc £1,920H25 Inflammatory Spine, Joint or Connective Tissu £2,935H26 Inflammatory Spine, Joint or Connective Tissu £1,689H27 Non-Inflammatory Back, Bone, or Joint Disorde £3,089

High Users of Secondary Care

Non-Elective Admissions to Local Acute Provider April - July 04 LOSTotal Cost

Patient A D20 Chronic Obstructive Pulmonary Disease or Bron£1,917 27/03/2004 07/04/2004 11

Patient A D20 Chronic Obstructive Pulmonary Disease or Bron£1,917 08/04/2004 12/04/2004 4

Patient A D20 Chronic Obstructive Pulmonary Disease or Bron£1,917 06/05/2004 16/05/2004 10

Patient A D20 Chronic Obstructive Pulmonary Disease or Bron£1,917 17/05/2004 07/06/2004 21

Patient A D20 Chronic Obstructive Pulmonary Disease or Bron£1,917 27/06/2004 06/07/2004 9 £9,586

Patient B Q13 Diagnostic Radiology - Arteries or Lymphatics £4,779 24/04/2004 07/06/2004 44

Patient B E19 Heart Failure or Shock <70 w /o cc £1,887 08/06/2004 08/06/2004 0

Patient B E19 Heart Failure or Shock <70 w /o cc £1,887 22/06/2004 02/07/2004 10 £8,553

Patient C G15 Therapeutic Pancreatic or Biliary Procedures £4,135 18/03/2004 27/04/2004 40

Patient C G15 Therapeutic Pancreatic or Biliary Procedures £4,135 01/05/2004 28/05/2004 27 £8,271

Patient D C54 Mouth or Throat Procedures - Category 6 £7,984 13/04/2004 14/05/2004 31 £7,984

Patient E L51 Chronic Renal Failure £2,516 19/05/2004 20/05/2004 1

Patient E L05 Kidney Intermediate Endoscopic Procedure >69£5,118 20/07/2004 21/07/2004 1 £7,634

Some of the Issues Managing total budget can be over-

whelming & Time consuming Anticipated incentive payment may

not materialise in first year Service Developments frustratingly

slow Acute Provider slow to respond to

validation queries Monthly Outpatient data not available

What Now? Review of 2004/05 scheme Develop Framework for 2005/06 -

Incentives Understand DH Guidance and changing

PbR Environment Understand Impact of new National Tariff Establish Budgets for 2005/06 –

Capitation Based? GP Sharing and Learning workshops Validation Workshops/Training in Excel

Thank You

Beverly Stretton-BrownDevolved Budgets Project Manager

01392 207492beverly.stretton-brown@eastdevon-

pct.nhs.uk