Challenges for health managers with MTPF

The new Money Follows The Patient system which has been introduced in shadow form in 38 acute hospitals from the beginning of January this year poses a number of major challenges and concerns for health managers.  Maureen Browne reports.

Maureen Browne
Maureen Browne

Concerns are being raised by health managers regarding the implementation of the Money Follows The Patient system, which is being introduced in shadow form in the country’s 38 acute hospitals this year.

Managers are concerned that to date there does not seem to be any mechanism in place to meet surges in activity, that the MTPF may adversely affect elective cases, that it will not provide any incentive to cut the length of patient stay and that investment will need to be made in coding to meet very tight Department of Health requirements.

They also say that there is little clarity as to how the new scheme will cover the additional costs of academic teaching hospitals, how it will cover day cases which are not covered by HIPE, or if procedures which were outsourced in previous years in a bid to cut waiting lists will be included in establishing base line hospital activity.

Managers are ad idem that a priority will be for managers and clinicians to work together.

Said one Manager: “The Department will want all completed coded information on procedures carried out in a particular month submitted at the end of that month, which will be quite challenging, particularly in the case of co-morbidities and where procedures are carried out in the last days of the month. We will be very dependent on clinicians to get this done and we will also require additional resources to ensure that this coding can be carried out on a timely basis. The Department has stated that it considers it vital that hospitals bring HIPE coding up to date with existing coding timelines and maintain that work.

The MTPF will also have to find ways to deal with surges in hospital activity, particularly in hospitals which are tertiary referral centres for expensive specialties.

Another manager raised the question of how hospitals will be expected to deal with the introduction during a year of new procedures. The manager said that with the current state of research, new procedures were constantly being introduced and consultants regularly developing special or sub specialty interests, of which patients were seeking to avail.

The new payment system will also have to find ways to deal with surges in hospital activity, particularly in hospitals which are tertiary referral centres for expensive specialities.

The MTPF was piloted in a number of orthopaedic services last year. The pilot covered four DRGs – normal and revision hip and knee replacements, the most expensive procedures.  Calculations were made about the cost of these procedures in a base year; this was deducted from the hospitals’ budgets at the beginning of the year and paid back to them as the procedures were carried out.  The hospitals notified the HSE each month of the number of the procedures carried out and the money was paid to them promptly.

Some hospitals completed all their agreed numbers of joint replacements by August or September. They had reduced their average length of stay in the expectation that they would get funding to carry out additional procedures to try and meet demand. “However we found out that we were left in the situation of trying to prise more money from the HSE to deal with our waiting lists,” said one disillusioned hospital manager.

The HSE is undertaking a shadow funding exercise this year for a number of selected hospitals (one from each Hospital Group) to compare actual 2013 activity against target activity and to assess variance.  These hospitals have received numerical and casemix targets and will be told on a quarterly basis what they would have earned. This year hospitals received their 2014 budget as normal. However, a proportion of that budget was ‘earmarked’ as MFTP using inpatient and day case activity multiplied by a price for each DRG.

The MFTP Steering Group is deliberating on the consequences which will apply in 2014 for hospitals which do not deliver planned activity targets.

At the end of each month hospitals will be required to provide details of the activity they have carried out during the period by coding activity to HIPE in the normal manner and timescales. The HIPE team will carry out their standard validation checks and pass this data on the National Casemix Programme (NCP) for review.

They will be informed quarterly what they would have earned on an MFTP basis enabling them to compare it with what they have spent, said the Department.

The HSE has warned that it is important to keep close examination on activity for any potential change in the mix of DRGs as this may impede delivery of planned activity levels.

A HSE Implementation Team –  which has been established  and under which a commissioning framework will be developed – says it is important for hospitals to understand that they will not receive any additional funding for any activity performed which exceeds the agreed activity commitment. They will receive their normal budget in 2014 and there will be no additional funding. Equally, they were told to ensure that delivery of activity was undertaken and phased appropriately across the 12 calendar months.

Hospitals in delivering their volume activity must ensure as well achievement of national access wait targets for scheduled care. An MFTP Steering Group is deliberating on the consequences which will apply in 2014 for hospitals which do not deliver planned activity targets.