I've just been told by my finance colleagues that there is new PbR criteria being introduced from April 2019. We need to be able to discuss this with our CCGs now, in the planning round, so we can give them a feel of if the groups will move size wise and if they do, by how much in some kind of monetary or basic count value.
Are EK aware of these changes, and what's the plan to introduce them to the pre-built report?
It would be very helpful if that could be made as a PbR report that we could use for current data now to give the CCGs an idea of what that will look like in terms of shift in categories?
Posting here to make other users aware that PbR changes have been published.
Charlotte Frisby
All,
Having been through the documentation available from NHS Improvement and after the first release of information did not contain any identifiable changes, the following Maternity Factors have been added to PBR 2019/20. These are the new Postnatal Factors - nothing else has been updated in terms of Antenatal Factors.
Intensive
Current Factors
During This Pregnancy
Intermediate
Current Factors
Medical Factors
Whilst these have been identified as the new additional items in the Maternity Factors tab on the Additional Pricing 1920 spreadsheet from NHS Improvement, what hasn't been done (by NHS Improvement) is an update to the Maternity Technical and Maternity Definitions tab to support these changes.
I have raised this as an urgent issue with them to rectify. In the meantime I am putting together a mapping document and clinical update to support these changes and will publish this as soon as possible.
Hi all,
After a bit of tooing and froing with NHSI, they have now confirmed their initial guidance incorrectly omitted the PN factor changes. The correct guidance is now on the website: https://improvement.nhs.uk/documents/4994/1920_Non-mandatory_prices.xlsxI
NHSI haven't yet sent an apology/update so I've let Al know and he's now working on it.
We've received an email link to: https://improvement.nhs.uk/resources/national-tariff-1920-consultation/
I'm looking at the Non-mandatory currencies and prices
The Maternity Factors tab suggests there are no changes. I’m hoping that’s right.
Email today from NHS Improvement that the consultation for the 2019/20 tariff starts TODAY 24th January 2019 and runs until 21st February 2019.
https://engage.improvement.nhs.uk/pricing-and-costing/1920-tariff-consultation/
https://improvement.nhs.uk/resources/national-tariff-1920-consultation/#documents
I'd encourage you all to take a look at the consultation and take part as there is a section regarding the maternity proposals you can comment on however the consultation form assumes you've already read all available documentation....
So for now, I'll go through the information and know we've got until 21st Feb to feedback to NHS Digital regarding any proposed changes to the maternity elements of the tariff.
Courtesy of Charlotte - here are some further proposals for the maternity pathway. NOTE - these are still at the proposal stage - as the opening 3 paragraphs of the guidance document explains:
To support planning for 2019/20, NHS England and NHS Improvement have published draft National Tariff Payment System (NTPS) prices.1 These planning prices are not final. The final proposed prices will be published as part of the statutory consultation on the 2019/20 NTPS in January 2019. We have tried to minimise any changes between the planning prices and those that will be subject to statutory consultation.
2. This note summarises the proposed changes in policy and method since the 2017/19 NTPS that are reflected in the planning prices.
3. All policy proposals for the 2019/20 NTPS will be subject to statutory consultation, starting in January 2019. The statutory consultation will give details of the feedback we have received through earlier engagement and will be accompanied by a detailed impact assessment of the final proposals.
Other maternity changes
23. We propose updates to the postnatal complexity factors used to assign care episodes to the standard, intermediate or intensive postnatal pathways.
24. The factors we propose to add are:
Intermediate
• Aged less than 16
• Neurological disorders
• Systemic lupus erythematosus (SLE)
• OASIS/PN bladder dysfunction
• Acute fatty liver of pregnancy (AFLP)
• Postpartum psychosis (level 2/3 critical care)
• Post intensive care (ITU) admission
Intensive
• BMI over 50
• Fetal anomaly
• Cystic fibrosis
• Pulmonary hypertension
• Peripartum cardiomyopathy
• Transplants
25. We have also added some outpatient prices to the schedule of non-mandatory antenatal prices.
26. As shown in Table 3, we propose to remove specialist fetal medicine and abnormally invasive placenta from the scope of the maternity pathway prices. Designated centres will be directly reimbursed by NHS England Specialised Commissioning.
As I've stated above - I have been chasing NHS Improvement for some absolute timescales regarding the plan for the definitive guidance being published - I will update further when I have more information.
I've been keeping an eye on this with the current tariff criteria due to expire end March 2019.
However all I can find to date is this on the NHS Improvement site:
https://improvement.nhs.uk/resources/201920-payment-reform-proposals/
As far as I can see these are still in the proposal stage. I've copied out the Maternity pathway section from the reform proposals below:
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Maternity pathway
34. The maternity pathway payment involves national prices for the integrated package of care offered to all pregnant women and their newborn babies. The pathway consists of three integrated packages of care covering the antenatal, birth and postnatal phases. The clinical pathways are well described and adhered to and linked to the safe management of the mother and her child.
35. We have become aware that the integrated package may include some public health services, known as Section 7A public health services, which fall outside the scope of national prices in the national tariff.
36. To address this issue, we propose making all maternity prices non-mandatory. We considered removing the conflicting services from Section 7A arrangements, or removing these services from the maternity pathway currency design. However, we felt that changing the specification of Section 7A arrangements would risk the delivery of the public health screening 12 Payment system reform proposals for 2019/20 > Our proposals programmes contained in the maternity pathway. We also felt that the data available on the Section 7A services is not sufficiently detailed to allow for currency redesign.
37. We believe that, in the short-term, making the prices non-mandatory is likely to be the most appropriate way to address the issue and maintain the integrity of the package of care provided to women and their babies. Providers and commissioners would be strongly encouraged to use the non-mandatory prices.
38. It is important to note that we are considering this change to address the current mix of services issue only. The non-mandatory prices would continue to be calculated using the costs associated with the delivery of the maternity pathways.
39. We also propose increasing the number of payment levels for delivery from two (with or without complications) to six or 36. The 36-level payment approach would mean providers are reimbursed on the basis of each of the 36 birth HRGs; the six-level approach groups the HRGs together, reflecting clinical complexity.
40. In addition, we propose the following changes to the maternity pathway:
• Updating the complexity factors for the postnatal phase to better reflect the clinical care women require.
• Removing abnormally invasive placenta from the scope of national prices. Care would be delivered from a number of specialist centres and be directly reimbursed by NHS England Specialised Commissioning.
• Removing specialist fetal medicine from the scope of national prices. NHS England would directly reimburse designated providers, operating a networked hub-and-spoke approach, for the care provided.
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So based on this we could be looking at updates to the 3/4 questions regarding social/POH factors in the PN pathway and potentially more around intrapartum care.
At the present time I cannot locate a definitive guidance to be implemented for April 2019 onwards but I'm chasing up NHS Improvement so find out what the latest is.