Q & A: Operating Framework - 30 day readmissions

Q: Dear Donal, we, along with all other Trusts, have been trying to make sense and work out the implications of the new Operating Framework. With regard to the matter of penalties for 30 day re-admissions I am told that patients on regular outpatient haemodialysis, who are admitted 3x per week for their routine treatment, will NOT be excluded from this measure … meaning that, as I understand it, commissioners will be able to refuse to pay for any emergency admissions that these patients require, because when they return a few days later for routine dialysis, they will be ‘re-admitted’. This is (technical term) bonkers. I’m sure that you will already be aware of the issue, but can I ask if you think it’s going to be possible to resolve it sensibly? And is there anything that we can do to help? Regards, Dr John Firth, Deputy Medical Director; Debbie Morgan Commissioning Lead, Addenbrookes Hospital , Cambridge

A: Dear John & Debbie, thanks for raising this issue. My apologies that it is consuming your valuable time. It would be a complete nonsense if people who were regular attenders for haemodialysis were to be included in the emergency re-admissions non payment policy. I have raised the question directly with the Payment by Results team here at the Department and I can confirm that the Department of Health position is that renal dialysis is excluded from the 30 day emergency re-admissions non-payment policy in 2011/12. Therefore, there is no reason for detailed local discussions and negotiations to ensure that “sense prevails”. The exclusion is based on the technicality that dialysis does not have a mandated national tariff in 2011/12 although it does, as you know, have a mandatory currency with a mandatory 50% transition towards a national tariff price in 2011/12. So here the technicalities are working with us and support common sense.

The national tariff for dialysis itself will of course be mandatory in 2012/13 but it is likely that re-admission policy for 2012/13 will be subject to review and, having now flagged the issue of regular dialysis attenders, I expect that to be taken on board when the financial guidance and instructions are written for 2012-13. I will also be making the current position clear to all our Clinical Directors and Specialist Commissioning colleagues so that valuable time addressing quality and productivity is not squandered on unnecessary discussions. Kind regards, Donal