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> 1. How is everyone capturing this data? If you can't prove you did it > you won't get paid for it. > A good computer system will churn it out. We don't have one, so will have to write it down and have a clerk type it in with inevitable data loss. Means a decent system might pay for itself. > 2. How are we going to manage the changes in activity that this will > provoke? Are radiology suddenly going to be offering to CT stuff we > previously fought to get done? (gasp!) > I'd thought of that. However, how often do you CT a patient who you wouldn't x-ray or cross match (or at a pinch ultrasound or do histology on)? > 3. How does this help the avowed intention of the Government to limit > admissions? The pressure is really going to be on, particularly in > Trusts where money is tight, for admission to be considered more. > Admission doesn't add to what you get paid. Payment for admitted patients is by procedure or ICD10 code (or rather a HRG generated from these). If you don't admit or discharge quicker than average the hospital gets less money but the amount less is set so that they still win out (i.e. if it works you might get 20% less money but because you're not keeping the patient in, save 30% on costs) > 4. How is activity going to be managed? For example; we > 'overperformed' > in the calendar year 2005 by 7.4%. Are the PCTs going to bring the > shutter down at contract end, so we will be working for free in March > 2007 if we overperform again? > I'd thought (and could be wrong) that EDs get paid on what they do and it's up to the PCT to stop the patients from coming. However, PCTs may look at doing just that- put their own person on triage and triage patients away to primary care as much as possible as primary care is paid as a block and EDs on a per case basis. This is happening with elective stuff as well. PCTs are mostly way overspent, so they're looking at ways of making what is currently hospital work into work within the core GP contract. > I think you are naive if you think that the full tarif > payment will come to > the ED. High cost tarifs will be divided between the Trust > coffers, the > other departments concerned (Xray)and a smiggen for us > Nice thought though I may be, but I don't and agree they will. (See below) Not sure about the other departments concerned, though- do they bill separately. > > The money doesn't go to the department, it goes to the > hospital. Everyone > > I've spoken to about it who knows a bit (which is > admittedly a remarkably > > small sample) reckons that acute admissions and EDs will be > effectively > > subsidising the rest of the hospital in many hospitals. What I'd be interested to know is whether procedures done in the ED get paid in addition to the main cost per patient. Makes sense to me if they are as patients admitted get their admission paid in addition; and if we can sort out the patient as a one stop thing within the 4 hours it ought to be to everyone's benefit. But I don't know if they are. Matt Dunn This email has been scanned for viruses by NAI AVD however we are unable to accept responsibility for any damage caused by the contents. The opinions expressed in this email represent the views of the sender, not South Warwickshire General Hospitals NHS Trust unless explicitly stated. If you have received this email in error please notify the sender. The information contained in this email may be subject to public disclosure under the NHS Code of Openness or the Freedom of Information Act 2000. Unless the information is legally exempt from disclosure, the confidentiality of this e-mail and your reply cannot be guaranteed.