One-year tariff proposed as part of changes for 2019/20

Payment system reform proposals for 2019/20 sets out the tariff plans for next year ahead of a formal consultation. The two bodies believe setting a tariff for a longer period would limit the ability to make changes to support the long-term plan currently in development. A blended payment approach is being proposed for emergency care, comprising a fixed amount (linked to expected activity) and a volume-related element that reflects actual activity.

The model would cover A&E attendances, non-elective admissions and, possibly, ambulatory emergency care. If adopted as the default mechanism for emergency care, the existing marginal rate emergency tariff and the 30-day readmission rule would be abolished – although the briefing says this will need to be on a ‘financially neutral basis between providers and commissioners.

Different options are still being decided. The fixed element could be set at 100% of costs based on healthcare resource group prices, with a 20% rate used for activity above (or below) the forecast level. Alternatively, the fixed element could be set at 80% of expected revenues with the 20% element paid for all activity. Other issues still to be decided include whether to define a tolerance within which no additional payment or deduction is triggered and whether the level of activity should be decided locally or defined nationally.

There would also be a ‘break glass’ clause that would apply when activity was significantly higher or lower than assumed, which could lead to payments being renegotiated.

As part of changes to outpatient tariffs, the publication proposes setting non-mandatory prices for non-face-to-face follow-ups for specialties with national prices. There are also plans to pilot a single price for all outpatient attendances for a specialty, regardless of whom the appointment is led by and whether it is delivered face-to-face or not.

The market forces factor will also be updated under the proposals, with a four-year transition path to help health economies to cope with changes in income and allocations. The briefing also covers proposals for centralised procurement, the maternity pathway payment and mental health.

The national bodies have asked for feedback on the engagement document by the end of October.