Part of SUS+ PbR reference manual

Best practice

Best Practice Tariffs (BPTs) are national tariffs that have been structured and priced to incentivise and adequately reimburse care that is both high quality and cost effective.

Although Best Practice Tariffs may be indicated within SUS+, what this actually identifies is candidate activity for best practice. SUS+ PbR does not indicate whether best practice has taken place, simply that the activity may qualify. Often the factors for deciding best practice are not submitted in the CDS so SUS+ can’t apply additional logic to allocate a Best Practice Tariff. Such checks will often refer to other database systems in national use but some cases may require verification from discharge summaries or other clinical notes.

SUS+ will do one of the following:

allocate the base national tariff, which applies to an HRG whether potential best practice is indicated or not
allocate a Best Practice Tariff, which may be further adjusted with the addition of local knowledge, that is, evidence that best practice was followed

When originally implemented SUS created Best Practice Tariffs by using an adjustment to the normal tariff as that type of functionality already existed. Over the years the scope of best practice was extended but without reviewing how this was applied in the system. The SUS+ build offered an opportunity to change and it now checks for and assigns a Best Practice Tariff where this applies. If not, the normal tariff is assigned.

Best practice indicator codes are a grouper output. They are generally driven by clinical code combinations used together with other factors, such as age and length of stay, to differentiate best practice activity from base activity for the same HRG.

Best Practice Tariffs in extracts

Columns in the extracts to support best practice are:

BPT indicator 1-5
BPT indicator 1-5 action
BP combination indicator

Best practice in SUS is identified by placing grouper output in a Best Practice Tariff indicator, for example, code BP01 indicates a candidate for fragility hip fracture best practice. As a result of historical processing there are places for up to 5 Best Practice Tariff indicators in the extracts. Grouper processing has changed such that now only one is output.

In 2012/13 (R11), the following corresponding BPT indicator actions were introduced in a new column to identify if tariff adjustment was applied:

Adj tariff

Activity has been allocated a BPT indicator by the grouper and a tariff adjustment has been made. This includes activity that has had a BPT indicator derived by SUS and for which best practice tariff has been applied through an HRG tariff.

No tariff

Activity has been allocated a BPT indicator by the grouper but SUS+ has not adjusted the tariff

Invalid

No longer used and included for completeness.

An ineligible combination of BP Indicators, which was “Invalid”, was possible and this could not be used for tariff processing.

Action against a tariff for 2019/20 is shown below.

Best Practice Tariffs 2019/20	SUS+ action
Acute stroke care	Incudes unbundled tariff for alteplase with defined stroke HRGs - BP allocation not SUS
Adult renal dialysis	Not SUS BP
Day cases	Best Practice Tariff where BP flag applies (BP28, BP32, BP63, BP65, BP66, BP68, BP69, BP73, BP77, BP78, BP79, BP87, BP88, BP90, BP91, BP92, BP93)
Diabetic ketoacidosis and hypoglycaemia	Best Practice Tariff where BP flag applies (BP52)
Early inflammatory arthritis	Not SUS BP
Endoscopy procedures	SUS applies national tariff - BP allocation not SUS
Fragility hip fracture	Best Practice Tariff where BP flag applies (BP01)
Major trauma	Not SUS BP (uses TARN ISS)
Outpatient procedures	SUS applies national tariff - BP allocation not SUS
Paediatric diabetes year of care	Not SUS BP
Paediatric epilepsy	SUS applies national tariff - BP allocation not SUS
Parkinson's disease	Not SUS BP
Pleural effusion	SUS applies national tariff - BP allocation not SUS
Primary total hip and knee replacements	SUS applies national tariff - BP allocation not SUS
Transient ischaemic attack	SUS applies national tariff - BP allocation not SUS
Heart failure	SUS applies national tariff - BP allocation not SUS
COPD exacerbation	SUS applies national tariff - BP allocation not SUS
NSTEMI: Timely access to coronary angiography	SUS applies non-best practice tariff (For BP50 only so not same as national tariff) - BP allocation not SUS
Emergency laparotomy	SUS applies national tariff - BP allocation not SUS
Spinal surgery	SUS applies national tariff for all HRGs (including HC64C) where BP flag is used - BP allocation not SUS

SUS+ has many approaches:

In most cases SUS+ applies the national tariff.
For day cases, diabetics and fragility hip fracture SUS+ will apply a Best Practice Tariff.
For acute stroke care alteplase is added as an unbundled tariff.
For NSTEMI a non-best practice tariff that is different to the national tariff is applied.
Some lines are outside the scope of SUS+ - the data to identify best practice is not submitted.

The clinical codes on a record may indicate the activity could qualify for more than one BPT indicator. Prior to SUS+, reference data would assign one indicator from those assigned for use by tariffing. The BP combination indicator either showed the chosen indicator or that the combination was ineligible and could not be used for tariff processing. This indicator is no longer used by SUS+.

Best practice and short stay emergency

In some cases, the combination of the HRG and the spell length of stay (LoS) means a record qualifies for the Short Stay Emergency tariff.

A short-stay Best Practice Tariff is applied if a record is valid for a Short Stay Emergency tariff and:

has a BPT flag - the matching short-stay emergency best practice tariff will be applied if one exists
has a BPT flag but no matching short-stay emergency best practice tariff exists - the combination of HRG and BPT will be used to apply a best practice tariff, but if no BPT tariff is applicable the short-stay emergency tariff for the HRG will apply
has no BPT indicator on the record - the Short Stay Emergency tariff will be applied to the spell

BPT and SSC flags

Historically SUS used flag codes based on 2 numeric characters (n2) for both Best Practice Tariffs and Specialised Service Codes. This led to confusion, particularly as the number of possible outputs increased. The grouper now not only outputs Specialised Service Codes and Best Practice Tariff flags as separate data items but also distinguishes them by applying a revised code structure and length. The codes are prefixed and structured as follows:

Specialised Service Codes = SSnn

Best Practice Tariff = BPnn

Last edited: 6 June 2022 3:50 pm

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