Changes in the way in which private hospitals in the National Health Service will be remunerated are being prepared by the OAU.
< p>In recent days, efforts have been intensified on the part of the Organization so that the final proposal regarding the new remuneration framework reaches the hands of the hospitals by the first week of February at the latest.
What is pending at the moment, is to finalize the financial parameters of the proposal. As long as the private hospitals receive and study the proposal, the OAH will start a new round of consultations.
However, from the OAH side they have set the goal of signing the agreementwith the private hospitals until March 1, 2023.
It is noted that the agreement signed in 2020 by the private hospitals-OAU ended at the end of 2022. In the event that a new agreement is not signed then the existing agreement is automatically renewed for another 6 months, until a new one is signed.
What changes and what are the goals
What changes is the addition of quality criteria based on which the hospitals will be reimbursed.
The OffsiteNews secured the OAU proposal, which aims to:
▪ To reduce any excessive differences in fees (of the same act) between hospitals.
▪ To introduce quality criteria to promote quality and to highlight comparative advantages between hospitals.
▪ To motivate the hospitals to choose the difficult cases as well as the pathological ones.
▪ To reward the hospitals which produce more (money follows the patient).
▪ To promote healthy competition and at the same time operate in a way that does not jeopardize the global budget.
▪ To determine the framework for the inclusion of new hospitals in the System, in view of the announcements for the creation of new large Hospitals.
The 4 pillars
As the proposal states, the main parts that affect the determination of the remuneration of hospitals are the following:
1. Severities of CY – DRG (Diagnostic Related
Groups) list operations
2. List Z consumables
3. Hospital Base Rate
3. Number of hospital units (Casemix)
Specifically the CY – DRG list was revised based on a more recent version of the G – DRG list (2018). Onew directory has a much larger number of processes, allowing for more precise coding. The severities of each DRG are also re-evaluated to correct any initial failures and emphasis is placed on increasing the severities for pathological events.
For List G consumablesn, this >recalculated continuously and recently a number of consumables were also removed.
At the same time, with the new proposal the each hospital, existing or new, will have two instead of one base rate, one for non-qualified incidents and one for qualified incidents. All hospitals will start from the same base. The base rate for specialized incidents will differ from the corresponding base rate for non-specialized ones, so as to reflect their greater complexity/severity as well as the resources required to process them.
Hospitals through the quality criteria will be able to increase their two base rates by approximately 25% – 30%1 (today the difference between the different base rates of the hospitals, before the implementation of the discount rates, reaches 53%).
What are the quality criteria
The basic quality criteria concern the following:
▪Category a hospital falls into based on its infrastructure e.g. intensive care unit, number of specialties, availability of specific infrastructure, etc. – indicative weight X%
▪ Accreditation – indicative weight X%
▪ Correct completion of discharge form – indicative weight X%
▪ Satisfaction of patients via questionnaire – indicative severity X%
▪ Average age of patients – indicative severity X%
▪ % of patients with high comorbidity – indicative severity X%
▪ %of patients over 80 – indicative severity X%
▪ % of pathological operations in relation to interventional operations – indicative weight X%
▪ Providing additional information (reporting) – indicative weight X%
▪ Drug dissolution unit – indicative weight X%
▪ Correct incident coding – indicative weight X%
▪ Medicine Committee – indicative weight X%< /p>
▪ Nosocomial Infections Committee– indicative weight X%
▪ Public Health – indicative weight X%
It is emphasized that in total they should give 100%, that is, a hospital that will fully satisfy all the criteria will receive 100% of the maximum possible increase in the base rate, which as mentioned above will be around 25% – 30%.
What will apply to specialized and non-specialized incidents
The total number of unitsthat the Organization will have for specialized incidents will not be allocated per hospital, but on the basis of the actual data of the previous years (2021 – 2022) a common budget will be determined for all hospitals which will be divided into sub-categories e.g. on the basis of each MDC (Major Diagnostic Categories) separately. Therefore, each hospital will be able to seamlessly participate in the common budgets according to the work it will produce.
The said common annual budget and the total number of units for the special cases will be distributed over the 12 months of the year. Each month, in the case of a total excess of the units, there will be a corresponding percentage reduction in the base rate for the specialized cases of the specific MDC category of each hospital (the same percentage reduction will be applied for all hospitals) so as to maintain the globality of the budget.< /p>
For non-specialized cases each hospital will have an agreed number of units. Its production up to the specified number will be paid with the specified base rate for the non-specialized cases of each hospital, while any excess of the units of the hospital will entail the application of discount rates for the specific hospital.
What differentiates the new proposal in relation to the existing one for non-specialized operations is the end of the staticity of the units of each hospital. The units of each hospital will be determined on the basis of two parameters. One parameter will result from the capabilities of the hospital as follows:
(for a new hospital, a predetermined minimum number of units will be calculated, depending on the category that will fall into tier 1, tier 2, tier 3, since there is no previous production).
This percentage will be applied to total number of agreed units of inpatient care for non-specialized cases which the Organization intends to make available for the year. The participation weight of the above two parameters in the calculation of the agreed units per hospital will vary around 60% (capabilities): 40% (production).
In order to avoid large fluctuations in the distribution of units, maximum percentages of deviations from year to year are determined which will be indicatively as follows:
At the same time, for a new hospital, it does not apply for the first year of participation in the system.
However, as we were told by the Organization, the above is the initial framework put up for discussion, without this excluding variations until the final framework is finalized and agreed upon.
source: Offsite (By Konstantina Hatziandrea)