Tuesday, 2 March 2010

A further step towards a best practice tariff for haemodialysis

The Department of Health published confirmation of Payment by Results arrangements for dialysis in adults on 22 February 2010. No changes have been made to the tariff price or trim points following road testing but the guidance has been clarified in a number of areas including dialysis in response to the feedback received in January.

The introduction of a non-mandatory tariff for adult dialysis is an initial step towards a best practice tariff. Children’s renal services are not covered by Payment by Results. The best practice tariff will encourage haemodialysis via a fistula and providing access to home dialysis, whenever clinically appropriate. The non-mandatory prices for 2010-11 are set in order to signal the intention for mandatory pricing of dialysis in subsequent years, which will bring dialysis into the scope of Payment by Results.

The haemodialysis tariff covers a session of dialysis, defined as each session of dialysis treatment on a given day for each patient. Identifying the actual number of sessions may be problematic if units do not currently use their patient administration system (PAS) for activity recording. If that’s the case work should start to address now so systems are in place for April 2011. The peritoneal dialysis tariff covers a day of treatment.

The guidance recommends applying the prices per haemodialysis session to each session of home haemodialysis while acknowledging that patients dialysing at home may wish to have 4 or 5 sessions of dialysis a week, as opposed to the 3 sessions a week in a hospital or clinic that are recommended as minimum practice by the Renal Association. This recommendation is intended to incentivise an increase in the provision of home dialysis options for patients. The guidance also outlines which high cost drugs are not included in the tariff and discusses mechanisms for agreeing reimbursement. The tariffs may also be used in agreeing reimbursement for dialysis away from base.

If you want to know more, read the Frequently Asked Questions on the website of NHS Kidney Care.