Thursday, 6 March 2008

Payment by Results for Dialysis, the first peice of the jigsaw

This week I wrote to all the Chief Executive Officers and Directors of Finance of the 53 Acute Trusts providing renal services in England and the 10 Specialised Commissioning Groups to update them on the work of the Renal PbR Group and have included copies of the letter and the checklist here (also posted under bedtime reading). Information will be presented in detail at the Clinical Directors forum on 7 March 2008.

The Renal PbR Group was set up following the consultation on the future of PbR last year and brought together clinical directors and finance directors from 16 Acute Trusts. We focussed on dialysis costs as the key revenue driver for the first piece of work. Together the units provide over 40% of the dialysis in England. Reviewing the financial returns that each Trust must make each year revealed a number of anomalies and indeed errors that we hope the template the group developed and the clarification in the frequently asked questions published to complement the reference costs returns manual will help correct.

BUT the success of the PbR project was the bringing together of the clinical and finance leads to work alongside each other on the coding, attribution and costings. AND that’s my message too – closer working arrangements between the finance and renal departments are needed. I hope this will be achieved in the next costing round that Trusts are just embarking on.

Another key part of the Group’s report will be the emphasis at the start, in the middle and at the end that dialysis isn’t the only thing kidney care services provide. The quality of dialysis care and the outcomes are dependent on support and preparation of individuals with kidney disease receive. Kevin Harris (Clinical Vice President of the Renal Association) and Donald Richardson (Consultant Renal Physician, York) are helping me draw up plans to ensure that the “year before replacement therapy” and supportive and palliative care are not forgotten.