Patient Level Costing: EBA September 2009

A presentation on the Patient Level Costing (PLC) pilot results from The Manchester Burn Service was well received at the European Burns Association (EBA) meeting in Lusanne in early September 2009. The paper received and outstanding abstract award and will be published in a supplement of the BURNS journal [Cost of Burn Care in the British Isles & Service Remuneration Options. Rob Duncan and Ken Dunn]. The intention has been to model the consequences of adopting PLC as the commissioning and remuneration methodology for burns care under the Payment by Results (PbR) development within the NHS. The results from the pilot are being used to guide the design of the next version of the iBID software, due for release in early 2010.

Abstract: Cost of burn care in the British Isles and service remuneration options.

Rationale: Escalating healthcare costs is a global problem & threatens the UK National Health Services guiding principle of free at the point of delivery. New management styles & encouragement of inter-service competition have been introduced to gain ef?ciency savings. A new remuneration system numbers amongst the changes, whereby ?xed tariffs are assigned to set diagnostic groups. This is a direct threat to burns services, who are served poorly by this style of remuneration, owing to the heterogeneity, complexity & high cost of burn injuries. A 1% TBSA burn has vastly different cost implications depending on site & a plethora of other factors. We advocate development of a Patient Level Costing system, whereby multiple patient factors inform care requirements/remuneration. A fundamental ?rst step is to develop an understanding of the true cost of UK burn care, which for historical reasons is poorly understood.

Methods: Detailed interrogation has been conducted of the cost of burn care within our University Hospital. Costs were determined through amalgamation of two fundamental methodologies (1) Top-Down costing (from detailed budgetary analysis) & (2) Bottom-Up costing (detailed itemised costing of staff, equipment, drugs, consumables & maintenance). Avoiding duplication, these costs were then merged. All costs have been categorised & traced to speci?c care areas, using various apportionment tools. The resultant costs were then applied to detailed national burn injury data to estimate total UK burn care costs.
Results: An occupied burns intensive care bed day costs 2634 (even just keeping it unoccupied but available for use, costs 2398). High dependency beds cost 1548 per day and standard ward beds 772, whilst burns theatre costs 993 per hour. Current UK burn care provision (by dedicated burns and plastic surgery services only) is estimated at 140 million.

Conclusion: We hope application of this new system of Patient Level Costing to British burn care will avoid the threatened viability of burns services imposed by changes in service remuneration, although it will inevitably be an iterative process. A fuller understanding of the true cost of healthcare, facilitates service development & planning, at both local & national levels. doi:10.1016/j.burns.2009.06.039

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