Chris Newton University Hospital Birmingham NHS Foundation Trust PbR for Renal Services Trust Dialysis Reference Cost Comparisons Project – Workshop 2 Renal Clinical Directors Forum – 7 th 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 LC01AHaemodialysis/Filtration on patient with Hepatitis B 19 years and over LC02AHaemodialysis/Filtration 19 years and over LC03APeritoneal Dialysis on patient with Hepatitis B 19 years and over LC04APeritoneal 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

£24k per year therapy cost

£29k per year therapy cost

£22k per year therapy cost

£17k per year therapy cost

£21k per year therapy cost

£19k per year therapy 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