Frequently asked questions about the costing guidance

Transcription

1 Frequently asked questions about the costing guidance We recently published the draft healthcare costing standards for England, minimum software requirements and case for change to PLICS. Here we support these publications by answering your frequently asked questions. We will publish answers to further questions on a regular basis as the costing transformation programme evolves. Draft standards 1. Can we divide the standards into minimum level and aspirational level, with only the minimum level becoming mandatory? All the standards together make up the minimum level to be achieved and you need to work towards fully implementing them all. We recognise that not all organisations will be able to implement at this minimum level in year 1, or in some cases even in year 2, but we expect all to have fully implemented them by year 3, in time for the proposed mandatory collection. We will add to the standards in development years 2 and 3 to include more departments and difficult-to-cost areas, and more patient-level feeds. We propose that all standards will become mandatory. 2. Why do we lose indirect cost? What s the benefit of this change? The countries that lead in patient-level costing, eg Australia and Canada, do not use indirect costs. Costing practitioners have reported they find the classification of indirect costs confusing. The focus of these standards is the costing process, not classification of costs. Organisations are at liberty to class costs as indirect for internal purposes; we will not be providing guidance on this or collect indirect costs. 3. Why do we need to collect critical care data at nurse-shift level? What do we do if our organisation does not collect these data and has no plans to do so? A patient s condition can fluctuate dramatically over 24 hours. Each level of acuity requires a different level of care and thus incurs a different cost. The 1

2 standards ensure costing is detailed enough to capture the change in resources consumed with change in acuity. To provide the necessary detail in critical care costs, the standards require you to cost at shift level (there are up to three shifts in a critical care day), which is a lower level than day level. You need to collect this information to comply with the standards. 4. Can the required data fields match those in other mandatory data submissions, such as the data required by HSCIC (from July 2016, NHS Digital)? Where data fields required by the standards overlap with those required by other data submissions, we have used the same terminology. However, as the data required for costing purposes differ from those required by other bodies, the standards stipulate the feeds that support costing processes in the most appropriate way. 5. Why do we need to cost outpatient did not attends (DNAs)? Will this impact on future tariffs? This information is already collected, but not costed. You need to understand what DNAs cost your organisation. We need to collect this information nationally to inform freedom of information requests to the Department of Health (DH) and answer ministerial questions. There are no plans to report DNAs separately in reference costs and it is reference costs that will inform the tariff at least until Why is direct access costed under other activities? Shouldn t it be costed under own-patient care? Direct access is included in the other activities cost group because it has to be reported separately as some organisations have contracts outside their main commissioner contract for direct access. The decision to cost direct access in this way was originally taken based on direct access radiology and pathology. However, feedback from the service has highlighted that there are other direct access services, such as therapies, so the decision will be reviewed for version 1 of the standards. This does not change how direct access is costed that is, in the same way as own-patient care only where it is reported. 7. Why is it required that activity data are refreshed twice a year when data are collected only once a year? One purpose of the standards is to help organisations to understand their costs. By refreshing data twice a year, your organisation will have more up-to-date and relevant cost information available for decision-making. Also, the refreshed data will include any activity that was not coded or was omitted at the time of the previous load. 2

3 8. Why do the standards mention reference costs and service-line reporting (SLR) when they are about patient-level costing? Why is income included in the standards? Currently there is no statutory requirement to submit income data. The main purpose of the standards is to improve costing as a whole, not just for PLICS collection. As reference costs will be with us for several more years, it makes sense to use the standards to improve the quality of reference costs where appropriate. Using its powers in the provider licence, Monitor (now part of NHS Improvement) requires SLR to be used in the collection and reporting of costs. The standards should help organisations to better understand their costs and, where appropriate, to improve the quality of their SLR. As income is an integral part of SLR, it is appropriate there is a standard to support organisations allocate their income appropriately and make their SLR positions as accurate as possible. 9. Are the acute standards compatible with those we anticipate for the mental health, ambulance and community sectors? The costing process will be the same for all sectors. Each will use resources and activities. Standards will be developed in the same way for other sectors as for the acute sector, providing methodology for key areas of cost and for nationally recognised difficult-to-cost procedures and activities. 10. A number of requirements in the standards would increase the time pressure on costing practitioners, such as maintaining late adjustments after month end and reconciliations. Have you considered this impact on us? The increased burden on you has been a major consideration throughout the development of the standards. As the standards draw on the best practice already in play, we are confident this workload is achievable in time. We anticipate that the setting up of the systems to meet the standards would be time consuming, and that the benefits flowing from greater cost transparency would more than compensate for this. Our roadmap partners will provide real-world experience of the burden of implementing all the standards. We will carry out an impact assessment and revise the standards accordingly. 11. Is the resource list mandatory? Not currently, but we propose that it should become mandatory. 3

4 12. Are the current standards indicative of what the education and training (E&T) standards will be like? Currently, the guidance for collecting E&T overheads is very different from that for patient overhead allocation. Work with Health Education England and the DH cost collection team is beginning this year on E&T. It s too early to comment on what they will look like. 13. Why do the standards ask us to employ never scenarios? These can be difficult to maintain and increase the risk of unmatched activity as patients can defy the scenarios. Matching is critical to building confidence in the accuracy of the costing process. If a clinician sees they have been allocated, for example, a cost for a drug they know they will never prescribe, they may fixate on the accuracy of the overall data rather than the use of the information in their decision-making. Never scenarios can reduce inappropriate matching. We are not proposing a mandatory number of never scenarios they are there to be used when a drug is consistently matched to the wrong episode, contact or attendance. 14. Why is unmatched activity reported under reconciling items? Shouldn t this activity be reabsorbed back into the costing process? Individual patient costs should not be distorted by costs not incurred in delivering their care. Unmatched items are reported under reconciling items so their level can be monitored and steps taken to improve the matching process if necessary. 15. Why is the critical care standard concerned with nursing time and not number of organs supported? Our roadmap partners and other contributors consider this to be the best approach as it most closely reflects how costs are incurred. However, this approach is being tested by our roadmap partners during implementation and analysis of the cost information produced. Collections 1. Much of the success of the standards depends on the availability of suitable software. How are software suppliers preparing for implementation? Suppliers have received early drafts of the minimum requirements and costing standards to help them prepare and plan system developments. Some suppliers are developing their software now to support the new costing method, and others will make the necessary changes shortly. We recommend you talk to your software supplier at the earliest opportunity. 4

5 2. If the standards become mandatory, will we still be required to submit reference costs? Providers are required to submit reference costs until further notice. There may be a period of overlap when we require you to report either PLICS and reference costs, or a period when reference costs need to be extracted from the proposed integrated collection. This will be considered as part of our impact assessment and consultation on the final proposals to make the costing standards mandatory. 3. Is there enough time to implement new systems to comply with the proposed information requirements? Two years is needed to install and capture new costing data. We acknowledge this in making the development cycle of the standards three years for each sector. You will have the full length of this development cycle to collect all the new data. However, we do stress that you should not wait for the standards to become mandatory before implementing them. 4. What s happening to the old collection? The voluntary PLICS collection is continuing this year. Details and an invitation to participate in this will be circulated shortly. 5. When are you proposing the first mandatory collection will be held? In January 2018, we will publish the costing standards we intend to make mandatory for the acute sector. These standards would be forward guidance, applying to the 2018/19 financial year. In July 2019, subject to impact assessment and consultation, collection against the new costing standards would be mandatory for the acute sector. 6. What level of information will be collected? This has still to be decided. The data our roadmap partners submit this year will guide our decision on the level of information to be collected. 7. Will you fund the implementation of the new costing approach? A clear understanding of the costs of providing services is crucial to successful long-term sustainability. This may start to form part of an organisation s use of resources evaluation so should be built into your budget. We are working with DH to support providers in deficit develop their business cases for purchasing PLICS, but the investment will fall to the provider and not be accounted for centrally. 5

6 8. When could data from the cost collection inform the national tariff? The earliest financial years in which the new costing approach could inform the national tariff are: acute services: the 2018/19 cost collection would inform the 2021/22 tariff mental health and ambulance services: the 2019/20 cost collection would inform the 2022/23 tariff community service: the 2020/21 cost collection would inform the 2023/24 tariff. 9. What should we do now if we are in the process of procuring, changing or thinking of implementing a new costing system? We ask any provider that wants to progress its costing model ahead of the pace proposed in the costing proposals, to bear these proposals in mind when choosing a costing supplier. It is important to understand how suppliers are planning to comply with the new costing approach and whether model changes will mean the software that complies with the new standards is more expensive. You may also want to discuss your development plan with your software supplier. 6