1. 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

2. 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

3. 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

4. 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

5. 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

6. £24k per year therapy cost

13. £29k per year therapy cost

15. £22k per year therapy cost

16. £17k per year therapy cost

19. £21k per year therapy cost

20. £19k per year therapy cost

21. £22k per year therapy cost

22. 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