Healthcare tariffs for specialist inpatient neurorehabilitation services: rationale and development of a UK casemix and costing methodology

Abstract

Total unit treatment costs are obtained from retrospective analysis of provider hospitals' budget and accounting statements. Mean bed-day costs (total unit cost/occupied bed days) are divided broadly into 'variable' and 'non-variable' components. In the weighted costing model, the band-weighting factor is applied to the variable portion of the bed-day cost to derive a banded cost, and thence a set of cost-multipliers. Preliminary data from one unit are presented to illustrate how this weighted costing model will be applied to derive a multilevel banded payment model, based on serial complexity ratings, to allow for change over time.

Rehabilitation Complexity Scale: Italian translation and transcultural validation

“…The extended version 12 of the Rehabilitation Complexity Scale (RCS-E) is now adopted as the principal case mix measure within the service commissioning dataset for specialist rehabilitation services in England, where serial rating of the RCS-E scores form the basis of a multi-level weighted per diem payment model where reimbursement changes over time as the patient improves [16].…”

A cost analysis of specialist inpatient neurorehabilitation services in the UK

“…We were therefore not able to break down the bed-day activity by complexity group in order to apply the full weighted costing model. 3 Other weaknesses are that we cannot be certain of the validity of the reported costs or workloads. Even though reported costs were verified as far as possible by site visits and follow-up correspondence from both expert advisors and analysts, the standards of financial and activity monitoring did vary somewhat between service providers.…”

“…A further requirement for both levels is the systematic reporting of the full national data set of benchmarking and outcome data to the UK Rehabilitation Outcomes Collaborative (UKROC) database. 3 …”

“…described the rationale and development of a proposed casemix system for reimbursement of inpatient specialist (level 1 and 2) neurorehabilitation services in the UK. 3 The proposed multilevel weighted per diem payment model is based on serial complexity ratings and is expected to have application in other areas of long-term care, and also for health systems outside the UK. The next step is to establish the service costs associated with the payment model.…”

Journey in trying to achieve eligibility level 1 rehabilitation service

“…tier weighted costing model has been developed based on patient complexity as measured(Turner-Stokes et al, 2011b).B The RCS also previously been shown to separate Level 1 and 2 services on the basis of caseload complexity (Turner-Stokes et al, 2010). B A multi-level weighted bed-day commissioning currency has been developed (TurnerStokes et al, 2011b), based on serial RCS measurements (fortnightly) reported at monthly intervals.B This is currently being applied within the London consortium for specialised neuro-rehabilitation and is expected to be mandated as the commissioning currency for Level 1 and 2a rehabilitation services from 2013/2014.…”