Post on 05-Oct-2020
3rd National Conference for Radiology Managers
Unbundling of Tariffs understanding how this will affect your business
Ian Francis
Consultant Radiologist BSUH NHS Trust Founder/Director Medical Imaging Partnership
OrganisaFon logo to be added here if desired
Unbundling of Tariffs -‐ ObjecFves
• Outline what the new NHS means
• How PBR may/may not work
• Radiology Business Development
• Thinking the unthinkable
The New NHS Structure
MeeFng the Financial and Quality Challenges
▪ Take out “unnecessary” costs
▪ Reduce procurement spend
▪ Reduce pathway inefficiencies
▪ Increase operaFng hours
▪ “Use the user”
▪ Exploit technology
▪ Skill mix changes
▪ Consider verFcal or horizontal integraFon across acute, community and primary care services
▪ Begin operaFng networks across sites to improve quality of care
▪ Redesign paFent pathways with clinical teams
▪ Reconfigure services across mulFple sites to significantly reduce the physical asset base
▪ Not all services delivered on all sites
Efficiency Gains
Change operaFng Models
VerFcal and Horizontal IntegraFon
RaFonalisaFon of Sites and Services
New NHS -Creation of Market Economy
Create the Market Create the CompeFFon NHS April 2013
FoundaFon Trusts Choose & Book Unbundling Tariffs
AQP Clinical Commissioning Groups
Mandate Choice Increase expectaFon
Compe&&on AQP/PBR
Limited compe&&on AQP/PBR
Compe&&on for the market OUTSOURCING
Uncontested monopoly
Ter&ary and specialist care
On-‐call/IP complex hospital care
Out-‐pa&ent hospital care
Out of hospital care (Simple; high vol)
Radiology Market Economy
Unbundling of Tariffs -‐ PBR
• Designed to promote health policy objecFves
• EffecFve in elecFve care where there is a desire to increase acFvity
• Allows aspects of care to be delivered by different providers
PBR for OutpaFent DiagnosFcs
• “Sense Check” Exercise • PotenFal Financial risks
• Need to be assured: • Clinical Benefit • Mindful of unexpected Side Effects
CCGs
• “Unbundling of diagnosFc imaging major challenge”
• Increase volume • Poor control/duplicaFon requests • Delivery of diagnosFcs in a community se^ng
PBR
• Not fit for purpose • Does not promote conFnuity of care
• Monitor and NHSCB: • need to promote local experimentaFon within a naFonal framework of benchmark tariffs
• Approve and analyse deviaFons
• Develop to become part of blend payment systems
What to do?
Get Business Ready
“Standard” Radiology Business Development
• Need to take ownership • Visible leaders • Customer Engagement
• PaFents • Clinicians • Commissioners
• CEOs • “True” Gatekeepers • Deliver enhanced paFent pathways
14
“Standard” Radiology Business Development
• OpFmal uFlisaFon of exisFng resources
• Scanners • Staff
• SegmentaFon of radiology work streams
• ConFnue to deliver secondary care/specialist terFary services
• Improved access for primary care • Dedicated resources – “hot seat” • A community based team
Leap of Faith
Leap of Faith
Think the Unthinkable
Radiology Community/Partnerships
• UnificaFon of radiology services around local groups
• Remove imaging services from existing NHS providers – place in regional umbrella organisations
• Acquire ALL NHS staff groups but with incentivised T&Cs
• “Fee for service” structure based on unbundled National or Direct Access tariffs
• Streamline management - services, financial and business development management team
18
Radiology Partnerships
IT Connected – Locally Owned
• Improved access and choice for primary and secondary care pts
• PACS, RIS and VNAs • establish 7-‐day working • PromoFon of super-‐specialisaFon and training
In-‐sourcing
20
Radiology Community/Partnerships
• UnificaFon of radiology services around local groups
• Remove imaging services from exisFng NHS providers – place in regional umbrella organisaFons
• Acquire ALL NHS staff groups but with incenFvised T&Cs
• “Fee for service” structure based on unbundled NaFonal or Direct Access tariffs
• Streamline management -‐ services, financial and business development management team
21
Radiology Community/Partnerships
• UnificaFon of radiology services around local groups
• Remove imaging services from exisFng NHS providers – place in regional umbrella organisaFons
• Acquire ALL NHS staff groups but with incenFvised T&Cs
• “Fee for service” structure based on unbundled NaFonal or Direct Access tariffs
• Streamline management -‐ services, financial and business development management team
22
Radiology Community/Partnerships
• UnificaFon of radiology services around local groups
• Remove imaging services from exisFng NHS providers – place in regional umbrella organisaFons
• Acquire ALL NHS staff groups but with incenFvised T&Cs
• Fiscal Independence -‐“Fee for service” structure based on unbundled NaFonal or Direct Access tariffs.
• Streamline management -‐ services, financial and business development management team
23
Radiology Community/Partnerships
• UnificaFon of radiology services around local groups
• Remove imaging services from exisFng NHS providers – place in regional umbrella organisaFons
• Acquire ALL NHS staff groups but with incenFvised T&Cs
• Fiscal Independence -‐ “Fee for service” structure based on unbundled NaFonal or Direct Access tariffs
• Streamline management -‐ SINGLE operaFng service, financial and business development team
24
“Quality” focused imaging business
• Customer buy-‐ in/markeFng
• “Use the users”
• InformaFon – Workflow/financial management • “RIS/PACS real-‐Fme dashboards”
• Contract and performance management • Adherence to and establishment of clear KPIs
3rd National Conference for Radiology Managers
Unbundling of Tariffs: Opportunity or Threat?
OrganisaFon logo to be added here if desired
Grow an Imaging Business
Thank You
28 www.medicalimaging.org.uk