Abstract
Aim: We studied the payments received by our hospital for 109 elective lower limb arthroplasty cases to see if this was fair and consistent under Payment by Results.
Methods: A cohort of patients who had Total Hip Replacement (THR), Total Knee Replacement (TKR), Resurfacing Hip Arthroplasty and Unicompartmental Knee Replacements were taken from the departmental database. Their diagnostic codes, operation details and comorbidities were established and compared with the payment the trust received using the Dr Foster database. This was confirmed with their hospital notes and the finance department.
Results: Twenty THRs and twenty TKRs were paid the standard tariff with one exception. Fifteen Hip Resurfacing arthroplasties showed variable payment from £4690 to £6673 per case. Most interesting were the Unicompartmental Knee Replacements. Despite having almost the same operative and diagnostic codes 46 out of 54 cases were significantly underpaid. During one financial year the trust lost more than £70,000 from this operation alone. This does not meet the Department of Health’s stated aim of being fair and consistent. Out of 109 cases reviewed 51 could have been coded differently and 47 of these were “underpaid”.
Conclusion: In an NHS increasingly driven by financial pressures it is vital that surgeons understand how Payment by Results works. There are significant financial gains to be made by those trusts who pay attention to the small print.
Correspondence should be addressed to Mr T Wilton, c/o BOA, BASK at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.
