Abstract
Introduction
The Best Practice Tariff (BpT) for primary THR / TKR was established in 2014 and rewards good clinical practice with a £550 uplift on the £5000 basic reimbursement. For an ‘average unit’ performing 220 primary THR and 260 eligible knee surgeries (NJR data) this equates to £265,000 per year or over £1million since its inception. The aim of this study was to investigate why Chelsea & Westminster Hospital NHS Trust was not receiving this reimbursement.
Materials & Methods
BpT is dependent on four factors (NHS England, PROMS): (i) the provider not having an average health gain significantly below the national average, (ii) a minimum National Joint Registry compliance rate of 85%, (iii) an NJR unknown consent rate below 15%, and (iv) a PROMs participation rate of 50%.
Results
Data from NHS Digital confirmed that the Trust's health gains were not significantly below average. Our NJR data was exemplary with 95% compliance rate and an unknown consent rate of only 3%. Based on HES data our PROMS returns were found to be considerably below the 50% target each month (Table 1).
The HES data being compared against (269 hip replacement, 334 knee replacement) was far greater than our hospital NJR figures (165 hips, 151 knees). NHS England (PROMs) confirmed that BpT was collated on a Trust not hospital level. Our investigation established that PROMs data for the other hospital within our Trust was not being submitted under the correct ‘ODS’ code and was therefore not contributing to the Trust totals.
Discussion
This investigation has precipitated resubmission of all data to NHS Digital under the correct Trust code. This will ensure compliance with the 50% target for PROMs Q1 submission, overall conformity with the BpT standards and a reimbursement of £370,000 to the Trust.
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