practice based commissioning east devon pct – how to develop an indicative budget beverly...
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![Page 1: Practice Based Commissioning East Devon PCT – How to Develop an Indicative Budget Beverly Stretton-Brown Devolved Budgets Project Manager 9 December 2004](https://reader035.vdocument.in/reader035/viewer/2022062619/55151663550346a80c8b5dd4/html5/thumbnails/1.jpg)
Practice Based Commissioning East Devon PCT – How to Develop an Indicative Budget
Beverly Stretton-BrownDevolved Budgets Project Manager
9 December 2004
![Page 2: Practice Based Commissioning East Devon PCT – How to Develop an Indicative Budget Beverly Stretton-Brown Devolved Budgets Project Manager 9 December 2004](https://reader035.vdocument.in/reader035/viewer/2022062619/55151663550346a80c8b5dd4/html5/thumbnails/2.jpg)
Setting Practice Based Budgets
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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
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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
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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
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How does it work?
Optional Sign-up Management Resource to Monitor
Budgets, Manage and Plan Monthly Budget Statements &
Patient Level Data More Detailed Analysis
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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
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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
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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
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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
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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
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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
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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
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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
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Thank You
Beverly Stretton-BrownDevolved Budgets Project Manager
01392 207492beverly.stretton-brown@eastdevon-
pct.nhs.uk