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PT and the Greater Good

Talking His Rehab Language

Published October 5, 2010 10:04 AM by Dean Metz

I received an email with an attachment (www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_119998.pdf) that outlines how "Payment by Results" will work in the new NHS scheme. They spend a lot of time talking about HRGs (health-related groups) and make lots of direct references to Medicare as well as numerous other countries' plans (private, public and socialized plans). There will be one tariff for a particular diagnosis such as hip fragility fracture. They come right out and compare it to DRGs (diagnostic-related groups).

Wow, they're talking my language! There are two other things that influence payment as well. First, the Market Force Factor takes into account the cost of providing care in different areas. For instance London, very much like New York and San Francisco, has ridiculously expensive real estate costs. Therefore NHS providers in London, Manchester and Leeds will be reimbursed at a higher rate than here in the Northeast.

The other influence (finally something that relates to results) will be whether or not treatment was administered in what is considered to be best practice. For instance, if someone goes to the A & E (accident and emergency), is admitted and operated on within 36 hours of admission, the reimbursement rate goes up. If that person is operated on at hour 37, there will be no additional payment.

Cameron's government will try to use financial incentives to improve care while trying to keep a level playing field. This is a fascinating time to live and work here. But as the Chinese curse goes... "May you live in interesting times." We still aren't sure what it will all mean.

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About this Blog


    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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