Before PbR, it was common practice for commissioners to have block contracts with hospitals where the amount of money received by the hospital was fixed irrespective of the number of patients treated.
PbR was introduced to:
- support patient choice by allowing the money to follow the patient to different types of provider
- reward efficiency and quality by allowing providers to retain the difference if they could provide the required standard of care at a lower cost than the national price
- reduce waiting times by paying providers for the volume of work done
- re-focus discussions between commissioner and provider away from price and towards quality and innovation
PbR was introduced to support healthcare policy and the strategic aims of the NHS. As these have changed and developed over time, so has PbR. The tariff is now seen increasingly as a vital means of supporting quality outcomes for patients and delivering additional efficiency in the NHS.
PbR is not unique to England. Many other countries in Europe, North America and Australasia operate similar payment systems.
SUS PbR view
SUS PbR is a collection of rules and processes to support implementation of national tariff policy. Derivations, tariffs and business rules, agreed with NHS England and NHS Improvement, provide a common and consistent mechanism to support reconciliation of activity and payment between providers and commissioners.
Scheduled extracts of processed data are generated at two specified cut-off points to produce static snapshots.
These cut-off points are known as:
- reconciliation - first reconciliation point
- post-reconciliation - final reconciliation point
The system also provides a ‘current’ view which provides a view of the data held at that time. Scheduled and ad-hoc extracts can be configured and run via the portal.
Finished spells
SUS PbR supports national tariff payment and therefore only contains data for finished spells (where a patient has been discharged) because reimbursement is made at spell-level. For example, an episode-level extract will only contain episodes for completed spells.
Standard Extract Mart (SEM) view
The SEM view reflects how data would have appeared in the legacy SUS Standard Extract Mart. SEM view data contains a limited number of additional derivations and is updated by each subsequent version of activity data submitted, it reflects the position within SUS at the time the extract is taken and thus provides a changing view over time.
Data extracted using SEM view reflects the same position as PbR but is not restricted to PbR completed spells. Instead it contains all episode level information submitted to SUS up to the point at which the extract is run, regardless of whether the patient has been discharged and the spell has been completed.
PbR Data in SUS+
SUS+ supports two previous historical years plus the current financial year (currently 2015/16, 2016/17 and 2017/18).
2015/16 and 2016/17 data has been reprocessed by SUS+. Due to changes in processing (such as simplified spell creation) marginal differences in results obtained by SUS and SUS+ may occur.
Multi tariff processing
Multi tariff processing allows the user to choose the financial year for a PbR extract. Both pricing reference data and the grouper for the selected year will be applied. The extract format and column structure will be the same as that for the current financial year and users can construct their own extract.
SUS+ changes to extracts
The structure of the SUS+ extracts is very similar to its legacy SUS predecessor in order to support established user routines and processes. Expect to see development of extracts as SUS+ continues to streamline and improve.
Additional data items
New data items have been added to the appropriate extracts to support Prescribed Specialised Services (PSS) and National Programme of Care (NPoC).
Obsolete data items
Certain data items have been identified as obsolete. This means that they are either surplus to user requirements or are no longer required. In SUS+, obsolete data items continue to be available in the extract specification but will not be populated. Data items identified as obsolete are expected to be removed in future.
Format changes
A small number of minor format changes have been made to accommodate more efficient processing. These changes are not expected to impact on user routines and processes.