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Chris NewtonUniversity Hospital Birmingham NHS Foundation Trust
PbR for Renal Services
Trust Dialysis Reference Cost Comparisons Project – Workshop 2
Renal Clinical Directors Forum – 7th March 2008
Project Background
• RAG response to the DoH consultation on “The Future of Payment by Results”
• More robust costing data required for renal services – wide variation appears to exist
• Project group established to examine dialysis costs and their construction
Dialysis Project Summary
• 16 participant Trusts representing 41% of adult HD and 35% of adult PD nationally
• A standard cost template to identify cost components and categories for dialysis
• Based on 2006/07 Reference Costs (June 2007) using HRG Version 4 definitions
• Data based on second cut incorporating costing and activity adjustments from some Trusts
HRG Version 4 – Adult Dialysis
LC01A Haemodialysis/Filtration on patient with Hepatitis B 19 years and over
LC02A Haemodialysis/Filtration 19 years and over
LC03A Peritoneal Dialysis on patient with Hepatitis B 19 years and over
LC04A Peritoneal Dialysis 19 years and over
Project Issues
• Reconciliation with June 2007 Ref Cost data– Service labels – HD/PD with/without HepB– Activity data, particularly PD therapy days vs
exchanges
• Allocation of costs to service components– Limitations of costing models– Primary cost data collection– IS satellite costs
2006/07 All Haemodialysis: Adult - Average Unit Cost
104
210
153
0
50
100
150
200
250
1 2 11 7 6 14 3
Proje
ct Ave
rage 17 8 9 16 13 15 4 12 10
Un
it C
ost
£
2006/07 Ref Cost
£24k per year therapy cost
Market Forces Factor by Trust
1
1.05
1.1
1.15
1.2
1.25
1.3
1.35
1.4
Trust
3
Trust
10
Trust
16
Trust
13
Trust
2
Trust
15
Trust
11
Trust
12
Trust
9
Trust
17
Trust
4
Trust
14
Trust
6
Trust
8
Trust
7
Trust
1
MF
F A
dju
stm
ent
Fac
tor
2006/07 All Haemodialysis: Adult - MFF Adjusted Average Unit Cost
130
97
178
0
20
40
60
80
100
120
140
160
180
200
2 11 3 1 7 6 14 16 9
Projec
t Ave
rage 17 13 15 8 4 12 10
Un
it C
ost
£
2006/07 Total Adult HD by Cost Category
0
50
100
150
200
250
1 2 11 7 6 14 3 17 8 9 16 13 15 4 12 10
Un
it C
ost
£
CC & OHs
Facilities
Non Clin
Clin Support
Non Pay
Staff
2006/07 Total Adult HD - Average Staff Costs per Dialysis
0
10
20
30
40
50
60
70
80
90
100
1 2 11 7 6 14 3 17 8 9 16 13 15 4 12 10
Un
it C
ost
2006/07 Total Adult HD - Average Non Pay per Dialysis
0
10
20
30
40
50
60
70
80
90
1 2 11 7 6 14 3 17 8 9 16 13 15 4 12 10
Un
it C
ost
£
2006/07 Total Adult HD - Capital Charges & Overheads per Dialysis
0
10
20
30
40
50
60
70
80
1 2 11 7 6 14 3 17 8 9 16 13 15 4 12 10
Un
it C
ost
£
2006/07 Hospital Haemodialysis: Adult - Average Unit Cost
104
288
185
0
50
100
150
200
250
300
350
1 14 7 2 4 8 6 11
Projec
t Ave
rage 3 9 17 16 12 15 13 10
Un
it C
os
t £
2005/06 Ref Cost
2006/07 Ref Cost
£29k per year therapy cost
2006/07 Hospital Haemodialysis: Adult - MFF Adjusted Average Unit Cost
97
210
159
0
50
100
150
200
250
1 14 2 3 11 4 16 7
Projec
t Ave
rage 6 9 8 17 12 15 13 10
Un
it C
os
t £
2007/08 Indicative Tariff - £159
2006/07 Satellite Haemodialysis: Adult - Average Unit Cost
193
86
142
0
50
100
150
200
250
1 11 2 7 13
Projec
t Ave
rage 3 17 6 16 9 15 8 14 12 10 4
Un
it C
os
t £
2006/07 Ref Cost
2005/06 Ref Cost
£22k per year therapy cost
2006/07 Home Haemodialysis: Adult - Average Unit Cost
33
189
83
0
20
40
60
80
100
120
140
160
180
200
11 15 8 3 10 16 13
Projec
t Ave
rage 7 1 9 2 12 4 14 6 17
Un
it C
os
t £
2005/06 Ref Cost
2006/07 Ref Cost
£17k per year therapy cost
2006/07 Hospital HepB Haemodialysis - Average Unit Cost
210202
175
112
197
0
50
100
150
200
250
7 8 Project Average 17 10
Un
it C
ost
£
2006/07 Ref Cost
2006/07 Satellite HepB Haemodialysis: Adult - Average Unit Cost
139
0
20
40
60
80
100
120
140
160
11
Un
it C
ost
£
2006/07 Total PD: Adult - Average Unit Cost
36
104
57
0
20
40
60
80
100
120
10 16 11 8 17
Proje
ct Ave
rage 9 13 15 14 3 12 2 6 1 4 7
Un
it C
ost
£
2006/07 Ref Cost
£21k per year therapy cost
2006/07 CAPD: Adult - Average Unit Cost
52
30
104
0
20
40
60
80
100
120
10 16 11 9 17 8
Proje
ct Ave
rage 15 14 3 12 2 1 6 7 13 4
Un
it C
ost
£
2006/07 Ref Cost
2005/06 Ref Cost
£19k per year therapy cost
2006/07 APD: Adult - Average Unit Cost
104
36
60
0
20
40
60
80
100
120
10 16 4 8 11 13 17
Proje
ct Ave
rage 6 15 3 14 12 9 7 1 2
Un
it C
ost
£
2006/07 Ref Cost
2005/06 Ref Cost
£22k per year therapy cost
• Improving 2008 Reference Cost collection– Activity measures– Costing models– Tariff exclusions
• HRGV4 Tariff Structure– Hospital/Satellite/Home vs HepB/non-HepB?– PD with HepB?
• Links with other Renal tariff development
Issues for Consideration
