In light of the call for a return to activity-based payment mechanisms, Trusts must focus on one crucial area: accurately coded data. Adrian Jones explores how correct coding will be key to maximising NHS income, ensuring proper payments under future activity-based models, and facilitating crucial reforms in line with the 10-Year Health Plan.
Lord Darzi's Independent Investigation into the National Health Service in England generated plenty of headlines, and has since been followed by the launch of the 10-Year Health Plan. The eminent surgeon and former Labour health minister concluded that the NHS "is in serious trouble"; although he also argued the service has "strong vital signs" and can recover with the right "repair." One area for "repair" that should have received more attention than it has is the payment mechanisms the NHS uses.
Lord Darzi points out that "over the past decade there has been a significant shift away from activity-based mechanisms," such as Payment by Results, in favour of block contracting. His report suggests this may have hit productivity. With block contracts, providers are funded for their efforts rather than their outputs," he writes. "It is perhaps not a coincidence that the drop in clinical productivity metrics for the urgent and emergency pathway is nearly double that for outpatients and elective surgery, since it remains on block contracts," (while non-elective care hasn't).
Lord Darzi is not the only NHS leader interested in financial flows and incentives. Health and social care secretary, Wes Streeting, seems to be aware of the issues. In post-Budget comments, he told the BBC: "We have got to improve productivity — and ask some hard questions about where money goes in the system."
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