APPENDIX 1
EXAMPLES OF IMPACT OF PAYMENT BY RESULTS
ON MEDICAL TECHNOLOGY
Example 1
UNCODED ACTIVITY: CARDIAC RESYNCHRONISATION
THERAPY
Example: Impact Analysis, Elective Procedures
Only
HRG
(a)
| Tariff, 2005-06, Electives
(b)
| Specialised
Uplift 2005-06? (Yes: 19%)
(c)
| MFF Adjustment:
Low
(88.5%)
(d)
| MFF Adjustment: High (128.4%)
(e)
| Industry Estimate: Total Cost
of Care
(f)
| Payment Shortfall, (Low
MFF)
(g)
| Payment Shortfall, (High
MFF)
(h)
|
| E07 | 2,909 | 3,462
| 3,462 | 4,843 | 8,483
| -5,021 | -3,640 |
| E08 | 2,975 | 3,540
| 3,540 | 4,952 | 8,483
| -4,943 | -3,531 |
| E09 | 2,623 | N/A
| 2,623 | 3,670 | 5,081
| -2,458 | -1,411 |
| | |
| | | |
|
Example 2
UNCODED ACTIVITY: IMPLANTABLE LOOP RECORDERS
Example: Impact Analysis for Implantable Loop Recorders,
Elective Procedures Only
HRG
(a) | Tariff, 2005-06, Electives
(b)
| Specialised
Uplift 2005-06? (Yes: 19%)
(c)
| MFF Adjustment:
Low
(88.5%)
(d)
| MFF Adjustment: High (128.4%)
(e)
| Industry Estimate: Total Cost
of Care
(f)
| Payment Shortfall, (Low
MFF)
(g)
| Payment Shortfall, (High
MFF)
(h)
|
| E31 | 949 | 1,129
| 1,129 | 1,580 | 2,000
| -871 | -420 |
| E32 | 542 | 645
| 645 | 902 | 2,000
| -1,355 | -1,098 |
| | |
| | | |
|
Example 3
UNCODED ACTIVITY: VAGAL NERVE STIMULATORS
Example: Impact Analysis for Vagal Nerve Stimulators,
Elective Procedures Only
HRG
(a) | Tariff, 2005-06, Electives
(b)
| Specialised
Uplift 2005-06? (Yes: 12%)
(c)
| MFF Adjustment:
Low
(88.5%)
(d)
| MFF Adjustment: High (128.4%)
(e)
| Industry Estimate: Total Cost
of Care
(f)
| Payment Shortfall, (Low
MFF)
(g)
| Payment Shortfall, (High
MFF)
(h)
|
| A01 | 1,580 | 1,770
| 1,770 | 2,476 | 13,000
| -11,230 | -10,524 |
| A02 | 3,456 | 3,871
| 3,871 | 5,415 | 13,000
| -9,129 | -7,585 |
| A06 | 4,285 | 4,799
| 4,799 | 6,714 | 13,000
| -8,201 | -6,286 |
| | |
| | | |
|
Hospitals typically charge £11,000 to £15,000 for the
complete service.
This product is sold by a sole-product manufacturer and would
likely cease to be available in the English market under the tariff
for 2005-06.
Example 4
UNCODED ACTIVITY: NEUROSTIMULATORS
Example: Impact Analysis for Neurostimulator of the
Brain
HRG
(a) | Tariff, 2005-06, Electives
(b)
| Specialised
Uplift 2005-06? (No)
(c)
| MFF Adjustment:
Low
(88.5%)
(d)
| MFF Adjustment: High (128.4%)
(e)
| Industry Estimate: Total Cost
of Care
(f)
| Payment Shortfall, (Low
MFF)
(g)
| Payment Shortfall, (High
MFF)
(h)
|
| A03 | 4,849 | N/A
| 4,849 | 6,784 | 22,750
| -17,901 | -15,966 |
| A04 | 7,126 | N/A
| 7,126 | 9,969 | 22,750
| -15,624 | -12,781 |
| A06 | 4,285 | N/A
| 4,285 | 5,995 | 22,750
| -18,465 | -16,755 |
| | |
| | | |
|
Example 5
CODED ACTIVITY: ENDOSCOPIC PROCEDURES
Example: Impact Analysis for Endoscopic Procedures,
Elective Procedures Only
HRG
(a) | Tariff, 2005-06, Electives
(b)
| Specialised
Uplift 2005-06?
(???)
(c)
| MFF Adjustment:
Low
(88.5%)
(d)
| MFF Adjustment: High
(128.4%)
(e)
| Payment Shortfall,
Partial Estimate
(Low MFF)
(f)
| Payment Shortfall,
Partial Estimate
(High MFF)
(g)
|
| M14 | 502 | 502
| 502 | 702 | -1,413
| -1,413 |
| | |
| | | |
Other endoscopic procedures are used in HRGs F04, F15, F35 and
G15 and have similar payment shortfalls.
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