Costing for Hospitals - How to arrive at service level cost ?Manivannan S
Costing hospital Services poses serious challenges in identifying the basis of allocation of costs and the allocation itself. This PPT gives you the entire methodology
The Anatomy of Incident-To and Split/Shared BillingPYA, P.C.
PYA Senior Manager Valerie Rock, along with Jana Kolarik from Foley & Lardner, presented “The Anatomy of Incident-To and Split/Shared Billing.” They discussed:
- Compliant use of nurse practitioners and physician assistants.
- The elements of incident-to and split/shared provider services.
- Evaluation of manual guidance and the laws that impact interpretation of the provision.
- Best practice application in common scenarios.
Much is being discussed about evidence based Ayurveda or Ayurveda doesn't has quality standards, neither has protocols or SOPs for drugs, treatment, hospitals and its procedural specialties like Panchkarma and Ksharsutra.
Now Department of ayush engaged quality council of India and NABH for voluntary certification of quality for- ASU products on the basis of third party evaluation. NABH- National accreditation board for health services laid down certain accreditation standards for Ayurveda Hospitals.
Costing for Hospitals - How to arrive at service level cost ?Manivannan S
Costing hospital Services poses serious challenges in identifying the basis of allocation of costs and the allocation itself. This PPT gives you the entire methodology
The Anatomy of Incident-To and Split/Shared BillingPYA, P.C.
PYA Senior Manager Valerie Rock, along with Jana Kolarik from Foley & Lardner, presented “The Anatomy of Incident-To and Split/Shared Billing.” They discussed:
- Compliant use of nurse practitioners and physician assistants.
- The elements of incident-to and split/shared provider services.
- Evaluation of manual guidance and the laws that impact interpretation of the provision.
- Best practice application in common scenarios.
Much is being discussed about evidence based Ayurveda or Ayurveda doesn't has quality standards, neither has protocols or SOPs for drugs, treatment, hospitals and its procedural specialties like Panchkarma and Ksharsutra.
Now Department of ayush engaged quality council of India and NABH for voluntary certification of quality for- ASU products on the basis of third party evaluation. NABH- National accreditation board for health services laid down certain accreditation standards for Ayurveda Hospitals.
As large purchasers search for strategies to improve the
quality and affordability of health care for their members,
a growing number are working directly with providers
or through their health plans to offer Accountable Care
Organizations (ACOs). This toolkit provides strategies and steps employers should take to assess if an ACO is getting the most value.
Measuring & Monitoring Clinical Quality Measures Using Practice FusionPractice Fusion
Review CMS quality measures, how to capture the data in Practice Fusion, and how this data can be used to earn incentive payments through quality reporting programs, including Meaningful Use and PQRS.
Modern Relationships Between Physicians, Hospitals, and Long-Term Care Provid...PYA, P.C.
PYA Consulting Manager Aaron Elias co-presented “Modern Relationships Between Physicians, Hospitals, and Long-Term Care Providers in a Time of Risk-Based Contracting,” along with Jeanna Palmer Gunville, a shareholder at Polsinelli.
NYU Langone Medical Center’s TJA BPCI Experience: Lessons in How to Maximize ...Wellbe
The Bundled Payments for Care Improvement (BPCI) Initiative began generating data in January of 2013. Dr. Iorio will outline the challenges and benefits of implementing BPCI for Total Joint Arthroplasty at an urban, tertiary, academic medical center with a hybrid compensation model. Early results from the implementation of a Medicare BPCI Model 2 primary TJA program demonstrate cost-savings with an improvement in quality of care metrics and continued cost savings through year 3 of our experience. Changes in patient optimization, care coordination, clinical care pathways, and evidence-based protocols are the key to improving the quality metrics and cost effectiveness within the implementation of the Bundled Payment for Care Initiative, thus bringing increased value to our TJA patients.
Maximizing Value in a Bundled Environment – Keys to Success:
• Evidence based, cost effectiveness analysis
• Standardized protocol adoption
• Transparent data
• Perioperative Patient Optimization
• Care management
• Physician-hospital alignment with Gain sharing
• Enhanced pain relief and rehabilitation protocols
• Blood management and rational VTED prophylaxis
About the Speaker:
Richard Iorio, MD, is the William and Susan Jaffe Professor of Orthopaedic Surgery at New York University Langone Medical Center Hospital for Joint Diseases and Chief of Adult Reconstruction at NYU Langone HJD. He co-founded Labrador Healthcare Consulting Services, Responsive Risk Solutions, and the Value Based Healthcare Consortium in 2015. He is a member of the Board of Directors for LIMA, the Lifetime Initiative for the Management of Arthritis. Dr. Iorio is a national expert in physician and hospital quality and safety and a leader in the implementation of alternate payment paradigms in orthopaedic surgery.
Part II Record Financial Operations CHAPTER 5 EXPEtwilacrt6k5
Part II: Record Financial
Operations
CHAPTER 5: EXPENSES: (OUTFLOW)
Overview: The Distinction Between
Expense and Cost
• Expenses are expired costs that have been
used up, or consumed, while carrying on
business.
• Expense in the broadest sense includes every
expired (used up) cost that is deductible from
revenue.
Overview: The Distinction Between
Expense and Cost
• “Cost” is the amount of cash expended* in
consideration of goods or services received (or
to be received).
*(or property transferred, services performed,
or liability incurred)
• Costs can either be expired or unexpired.
• Expired costs are used up in the current
period and are matched against current
revenues.
• Unexpired costs are not yet used up and will
be matched against future revenues.
Overview: The Distinction Between
Expense and Cost
• Confusion also exists over the term “cost”
versus the term “charges”.
• Charges are revenue, or inflow
• Costs are expenses, or outflows
• Charges add; costs take away.
Overview: Confusion Over Other
Terminology
Disbursements for Services
• Disbursements for services represent an
expense stream (an outflow)
• Disbursements for services can trigger
payment either:
– when the expense is incurred; or
– after the expense is incurred.
Disbursements for Services
• Payment when the expense is incurred does
not require the expense to enter the Accounts
Payable account.
• Payment after the expense is incurred requires
the expense to be recorded in the Accounts
Payable account.
• It is then cleared from Accounts Payable when
payment is made.
Grouping Expenses for Planning and
Control
• Grouping by Cost Center
• One form of responsibility center.
• Study examples in Exhibits 5-1 and 5-2.
Exhibit 5–2
General
Services and
Support
Services Cost
Centers
Grouping by Diagnoses and Procedure
• Beneficial because is matched costs and
common classifications of revenues
• Study examples in Exhibits 5-3, 5-4, 5-5 &
Table 5-1
Exhibit 5–5 Example of Hospital
Departmental Costs Classified by
Diagnoses, MDC, and DRG
Table 5–1 Example of Radiology Department
Costs Classified by Procedure Code
• By care settings recognizes different sites
where service is delivered
• Care settings were discussed in the previous
chapter.
Grouping by Care Settings
• By service lines would be used for grouping
costs if revenues were divided by service line.
• Service lines were discussed in the previous
chapter.
Grouping by Service Lines
• Distinguishes projects that posses their own
objectives, funding, and indicators.
• Study the example in Exhibit 5-6.
Grouping by Programs
Exhibit 5–6 Program Cost Center:
Southside Homeless Intake Center
Cost Reports As Influencers Of
Expense Formats
• Since the mid-1960s Annual Cost Reports are
required by the Medicare Program and the
Medicaid Program.
Cost Reports As Influencers Of
Expense Formats
• The arrangement of c ...
Involving patients in outcomes based commissioning in community services, pop...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
PYA Consulting Manager Linda ClenDening helped connect the dots between the data at the 2013 AHIMA Convention and Exhibit in Atlanta. She spoke during the Innovation educational track on the topic: “Beyond Meaningful Use: Connecting Quality Data Requirements to Business Operational Improvements.”
As large purchasers search for strategies to improve the
quality and affordability of health care for their members,
a growing number are working directly with providers
or through their health plans to offer Accountable Care
Organizations (ACOs). This toolkit provides strategies and steps employers should take to assess if an ACO is getting the most value.
Measuring & Monitoring Clinical Quality Measures Using Practice FusionPractice Fusion
Review CMS quality measures, how to capture the data in Practice Fusion, and how this data can be used to earn incentive payments through quality reporting programs, including Meaningful Use and PQRS.
Modern Relationships Between Physicians, Hospitals, and Long-Term Care Provid...PYA, P.C.
PYA Consulting Manager Aaron Elias co-presented “Modern Relationships Between Physicians, Hospitals, and Long-Term Care Providers in a Time of Risk-Based Contracting,” along with Jeanna Palmer Gunville, a shareholder at Polsinelli.
NYU Langone Medical Center’s TJA BPCI Experience: Lessons in How to Maximize ...Wellbe
The Bundled Payments for Care Improvement (BPCI) Initiative began generating data in January of 2013. Dr. Iorio will outline the challenges and benefits of implementing BPCI for Total Joint Arthroplasty at an urban, tertiary, academic medical center with a hybrid compensation model. Early results from the implementation of a Medicare BPCI Model 2 primary TJA program demonstrate cost-savings with an improvement in quality of care metrics and continued cost savings through year 3 of our experience. Changes in patient optimization, care coordination, clinical care pathways, and evidence-based protocols are the key to improving the quality metrics and cost effectiveness within the implementation of the Bundled Payment for Care Initiative, thus bringing increased value to our TJA patients.
Maximizing Value in a Bundled Environment – Keys to Success:
• Evidence based, cost effectiveness analysis
• Standardized protocol adoption
• Transparent data
• Perioperative Patient Optimization
• Care management
• Physician-hospital alignment with Gain sharing
• Enhanced pain relief and rehabilitation protocols
• Blood management and rational VTED prophylaxis
About the Speaker:
Richard Iorio, MD, is the William and Susan Jaffe Professor of Orthopaedic Surgery at New York University Langone Medical Center Hospital for Joint Diseases and Chief of Adult Reconstruction at NYU Langone HJD. He co-founded Labrador Healthcare Consulting Services, Responsive Risk Solutions, and the Value Based Healthcare Consortium in 2015. He is a member of the Board of Directors for LIMA, the Lifetime Initiative for the Management of Arthritis. Dr. Iorio is a national expert in physician and hospital quality and safety and a leader in the implementation of alternate payment paradigms in orthopaedic surgery.
Part II Record Financial Operations CHAPTER 5 EXPEtwilacrt6k5
Part II: Record Financial
Operations
CHAPTER 5: EXPENSES: (OUTFLOW)
Overview: The Distinction Between
Expense and Cost
• Expenses are expired costs that have been
used up, or consumed, while carrying on
business.
• Expense in the broadest sense includes every
expired (used up) cost that is deductible from
revenue.
Overview: The Distinction Between
Expense and Cost
• “Cost” is the amount of cash expended* in
consideration of goods or services received (or
to be received).
*(or property transferred, services performed,
or liability incurred)
• Costs can either be expired or unexpired.
• Expired costs are used up in the current
period and are matched against current
revenues.
• Unexpired costs are not yet used up and will
be matched against future revenues.
Overview: The Distinction Between
Expense and Cost
• Confusion also exists over the term “cost”
versus the term “charges”.
• Charges are revenue, or inflow
• Costs are expenses, or outflows
• Charges add; costs take away.
Overview: Confusion Over Other
Terminology
Disbursements for Services
• Disbursements for services represent an
expense stream (an outflow)
• Disbursements for services can trigger
payment either:
– when the expense is incurred; or
– after the expense is incurred.
Disbursements for Services
• Payment when the expense is incurred does
not require the expense to enter the Accounts
Payable account.
• Payment after the expense is incurred requires
the expense to be recorded in the Accounts
Payable account.
• It is then cleared from Accounts Payable when
payment is made.
Grouping Expenses for Planning and
Control
• Grouping by Cost Center
• One form of responsibility center.
• Study examples in Exhibits 5-1 and 5-2.
Exhibit 5–2
General
Services and
Support
Services Cost
Centers
Grouping by Diagnoses and Procedure
• Beneficial because is matched costs and
common classifications of revenues
• Study examples in Exhibits 5-3, 5-4, 5-5 &
Table 5-1
Exhibit 5–5 Example of Hospital
Departmental Costs Classified by
Diagnoses, MDC, and DRG
Table 5–1 Example of Radiology Department
Costs Classified by Procedure Code
• By care settings recognizes different sites
where service is delivered
• Care settings were discussed in the previous
chapter.
Grouping by Care Settings
• By service lines would be used for grouping
costs if revenues were divided by service line.
• Service lines were discussed in the previous
chapter.
Grouping by Service Lines
• Distinguishes projects that posses their own
objectives, funding, and indicators.
• Study the example in Exhibit 5-6.
Grouping by Programs
Exhibit 5–6 Program Cost Center:
Southside Homeless Intake Center
Cost Reports As Influencers Of
Expense Formats
• Since the mid-1960s Annual Cost Reports are
required by the Medicare Program and the
Medicaid Program.
Cost Reports As Influencers Of
Expense Formats
• The arrangement of c ...
Involving patients in outcomes based commissioning in community services, pop...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
PYA Consulting Manager Linda ClenDening helped connect the dots between the data at the 2013 AHIMA Convention and Exhibit in Atlanta. She spoke during the Innovation educational track on the topic: “Beyond Meaningful Use: Connecting Quality Data Requirements to Business Operational Improvements.”
The Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted an introduction webinar about the Oncology Care Model (OCM) on Thursday, February 19, 2015 from 12:00pm – 1:00pm EST. The webinar focused on introducing core concepts of OCM and application instructions. Advance registration was not required.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Demystifying Shared Care and "Incident To" Billing: 2024 UpdatesConference Panel
This webinar aims to elucidate the changes for the year 2024 concerning billing for shared and incident care services. Furthermore, it will delineate the requisite documentation requirements essential for both shared and incident care billing scenarios.
By attending this webinar, healthcare providers can gain a comprehensive understanding of the evolving CMS policies and the intricacies of billing for shared and incident care. Armed with this knowledge, they can adopt proper billing practices and uphold the requisite documentation standards, thereby minimizing the risk of audits, paybacks, and reimbursement delays.
Register,
https://conferencepanel.com/conference/secrets-to-correctly-billing-shared-care-and-incident-to-services-in-2024
The CMS Innovation Center held the fourth in a series of webinars for potential applicants interested in applying to Health Care Innovation Awards Round Two. The webinar held on Thursday, June 20, 2013 from 1:00–2:00pm EDT, focused on how to achieve lower costs through improvement. This webinar also reviewed the components of the Financial Plan.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare and Medicaid Innovation hosted a series of two webinars on Wednesday, July 15 and Thursday, July 16, 2015. These webinars focused on providing an overview of the model and provided an opportunity for attendees to ask questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
PRIMARY CARE Scenario
Type of care provided
Scenario
Question 1
Question 2
Care in this type of setting is delivered by physicians, physician assistants, nurse practitioners, and ad-
vanced practice professionals. This area of health care is the most widely used, and it is a major focus
of the Affordable Care Act of 2010, focusing on primary care providers and decreasing the focus on the
utilization of specialty providers.
As an administrator, you need to assess this situation: How would you determine if there was a true need
for another receptionist? Do you need to reinstate the position or can you retrain the current number of
employees? Why?
As an administrator, describe the effects that labor shortages of key personnel and rising costs of labor
have on profitability. How would you determine how to allocate your money? Be sure to think critically
about the impact that quality outcomes and patient outcomes have on financial resources.
A primary care clinic can be an individual-physician practice or a multiple-physician practice organized
as a nonprofit or a for-profit facility. Multiple-physician practices generally specialize in cardiac, women’s
health, pediatrics, or related services. You are the administrator of a local for-profit, multiple-physician
community clinic owned by five local physicians, specializing in internal medicine, women’s health, pe-
diatrics, orthopedics, and oncology. The clinic sees an average of 50 patients per day. Scheduling is
centralized with two receptionists, and each specialty has four staff members to assist the physicians.
All the physicians have visiting privileges at the area hospitals and frequently speak at local and national
conferences on numerous preventative health care topics. The clinic is noted for its use of technology
and has agreements in place with the local hospitals for web-based exchanges of health information on
shared patients.
Action Required:
Your office just underwent an organizational change and one office receptionist was eliminated, saving
the office $25, 000 per year in labor costs. However, there have been a number of complaints that all
patients cannot be processed due to the increased flow of patients. Two weeks later you begin to hear
that wait times for appointments have increased, and one specific patient was not able to be seen. That
patient now has developed an infection and requires surgery.
Question 3
Based on what you have learned so far in this course, what would be your plan of action for the next 30
days? What types of reports would you use to help support your decisions?
Budget Considerations
Operational Budget – This budget focuses on a broader view of the total operations of the organization in which
all departments are reviewed for both their income potential and the costs associated with the work activities used
to generate projected revenues. Each department will have its own budget for the managers to follow and on
wh.
Chandrima Spa Ajman is one of the leading Massage Center in Ajman, which is open 24 hours exclusively for men. Being one of the most affordable Spa in Ajman, we offer Body to Body massage, Kerala Massage, Malayali Massage, Indian Massage, Pakistani Massage Russian massage, Thai massage, Swedish massage, Hot Stone Massage, Deep Tissue Massage, and many more. Indulge in the ultimate massage experience and book your appointment today. We are confident that you will leave our Massage spa feeling refreshed, rejuvenated, and ready to take on the world.
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This document is designed as an introductory to medical students,nursing students,midwives or other healthcare trainees to improve their understanding about how health system in Sri Lanka cares children health.
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
INFECTION OF THE BRAIN -ENCEPHALITIS ( PPT)blessyjannu21
Neurological system includes brain and spinal cord. It plays an important role in functioning of our body. Encephalitis is the inflammation of the brain. Causes include viral infections, infections from insect bites or an autoimmune reaction that affects the brain. It can be life-threatening or cause long-term complications. Treatment varies, but most people require hospitalization so they can receive intensive treatment, including life support.
About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
Rate Controlled Drug Delivery Systems, Activation Modulated Drug Delivery Systems, Mechanically activated, pH activated, Enzyme activated, Osmotic activated Drug Delivery Systems, Feedback regulated Drug Delivery Systems systems are discussed here.
Feeding plate for a newborn with Cleft Palate.pptxSatvikaPrasad
A feeding plate is a prosthetic device used for newborns with a cleft palate to assist in feeding and improve nutrition intake. From a prosthodontic perspective, this plate acts as a barrier between the oral and nasal cavities, facilitating effective sucking and swallowing by providing a more normal anatomical structure. It helps to prevent milk from entering the nasal passage, thereby reducing the risk of aspiration and enhancing the infant's ability to feed efficiently. The feeding plate also aids in the development of the oral muscles and can contribute to better growth and weight gain. Its custom fabrication and proper fitting by a prosthodontist are crucial for ensuring comfort and functionality, as well as for minimizing potential complications. Early intervention with a feeding plate can significantly improve the quality of life for both the infant and the parents.
DECODING THE RISKS - ALCOHOL, TOBACCO & DRUGS.pdfDr Rachana Gujar
Introduction: Substance use education is crucial due to its prevalence and societal impact.
Alcohol Use: Immediate and long-term risks include impaired judgment, health issues, and social consequences.
Tobacco Use: Immediate effects include increased heart rate, while long-term risks encompass cancer and heart disease.
Drug Use: Risks vary depending on the drug type, including health and psychological implications.
Prevention Strategies: Education, healthy coping mechanisms, community support, and policies are vital in preventing substance use.
Harm Reduction Strategies: Safe use practices, medication-assisted treatment, and naloxone availability aim to reduce harm.
Seeking Help for Addiction: Recognizing signs, available treatments, support systems, and resources are essential for recovery.
Personal Stories: Real stories of recovery emphasize hope and resilience.
Interactive Q&A: Engage the audience and encourage discussion.
Conclusion: Recap key points and emphasize the importance of awareness, prevention, and seeking help.
Resources: Provide contact information and links for further support.
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
ALKAMAGIC PLAN 1350.pdf plan based of door to door delivery of alkaline water...rowala30
Alka magic plan 1350 -we deliver alkaline water at your door step and you can make handsome money by referral programme
we also help and provide systematic guideline to setup 1000 lph alkaline water plant
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
2. Contents
• Remuneration – general principals
• Capitation
• Activity
• Process for the calculation of capitation and
activity elements
• Remuneration year-end adjustments
• The modelling tool
3. Prototype remuneration – general
principals
This section will cover:
• The key principles underpinning the
remuneration mechanism for prototypes
4. Prototype remuneration
general principals (1)
A prototype’s contract value (for mandatory
services) will be split between:
1. Capitation: The number of actual patients a
practice will be expected to have on their list at
year-end
2. Activity: The minimum level of activity that a
practice will be expected to deliver
Practices are able to see more patients where
lower activity is delivered due to the treatment
needs of the practice population. This is referred to
as the exchange mechanism
5. Prototype remuneration general
principals (2)
• The value of the capitation and activity elements
are based on the value of the mandatory
services provided under the contract
• A practice may also have additional services
included in their GDS contract /PDS agreement,
for example orthodontics, sedation, domiciliary
services
• These elements do not form part of the
calculation for capitation and activity values and
should continue to be delivered as per the
contract
6. Prototype remuneration
general principals (3)
• Contract values remain the same as your UDA
contract value and practices are paid 1/12th each
month
• The calculation of the actual remuneration for the
year is based on a combination of capitation and
activity delivered. This process is undertaken at
year-end
• Up to 10% of the contract value is at risk where
expected capitation and activity levels are not met
• Up to 2% of the contract value will be recognised
where expected capitation and activity levels are
exceeded
7. Prototype remuneration
general principals (4)
There are two blends of remuneration being tested
in the prototypes:
• Blend A – the capitation element covers band 1
care and the activity covers band 2 and band 3
care
• Blend B – the capitation element covers band 1
and band 2 care and the activity covers band 3
care
Practices will be expected to deliver all necessary
care to each patient on their list within their overall
contract value
8. Prototype remuneration
general principals (5)
• A practice’s expected patient list excludes
patients last seen by a foundation trainee
(FT) at the practice
• A practice’s minimum activity requirement
excludes activity delivered by an FT
9. Capitation
This section will cover:
• How the expected patient list is
calculated
• What are the triggers for people joining /
leaving a patient list
• The mechanism of how patient numbers
are counted
10. • The expected patient numbers (capitation list) will be
based on the number of patients seen by the
practice for an NHS appointment in the three year
period prior to 31 March 2017, with adjustments to
reflect:
– referrals
– urgent treatment
– charge exempt courses of treatment
– relevant changes in delivered and commissioned
levels of UDAs
• This figure is referred to as the contractor’s
expected capitated population (CECP)
How expected capitated patient
list figures are calculated
11. What triggers capitation?
• A new patient joins the practice patient list when
they attend for an oral health assessment (OHA)
• They will remain on this list for a period of three
years unless they attend for NHS treatment
elsewhere, except where the patient attended
another practice for urgent, referral and charge
exempt treatment. In these cases the patient
remains on your practice list
• The three year capitation clock will re-set:
1. At the IC course of treatment, where treatment
is provided (CoT)
2. At the oral health review (OHR)
12. Capitation - practice patient list
OHA
New to practice
Patient list
IC / OHR
Existing patient
Patient
added to
patient list
Patient 3
year clock
reset
Patient
treated
elsewhere
(excluding
referrals out,
urgent
treatment and
exempt items)
Patient
removed
from patient
list
Patient
lapses after
3 years
Patient lists are defined as all NHS patients treated at a practice within the
last 3 years who have not had NHS treatment at another primary care
dental practice (except for urgent / referral or charge exempt)
13. • Urgent treatment
A patient treated for an urgent course of treatment at practice A
does not get added to their patient list
Practice A’s patient treated elsewhere remains on their patient
list
• Referral patients
A patient referred to practice A for specific treatment does not
get added to their patient list
Practice A’s patient treated elsewhere remains on their patient
list
• Charge exempt items
A patient treated at practice A does not get added to their
patient list
Practice A’s patients treated elsewhere remains on their
patient list
Capitation - exclusions
14. How capitated patient numbers are
counted (1)
• During the year appointment transmissions from OHA /
OHR appointments will be used to add and retain
patients on a practice’s patient list as well as FP17
information
• Therefore timely appointment transmissions will ensure
that the patient list is as accurate as possible throughout
the year
• Timely data transmissions are essential for prototype
practices
– FP17 submissions received within two months of completion of
course of treatment
– Appointment transmissions received within seven calendar days
15. How capitated patient numbers are
counted (2)
TRIGGERS
CAPITATION
FP17 opens FP17 closes FP17 opens FP17 closes
TRIGGERS
CAPITATION
TRIGGERS
CAPITATION
CoT
CoT
Oral Health
Assessment /
Review
Treatment
&
Stabilisation
(if necessary)
ICs at
relevant
interval if
required
Appointment data (DPMS)
Transmitted within 7 days by practice
16. Capitation scenarios
YES
NO
NO
NO
Fred attends for an OHA on 1 August 2018. Is Fred
added to the practice’s patient list?
John is a patient of Smiley Dental and has toothache
whilst on holiday in Devon. He attends a dental
practice for an urgent course of treatment. Does
John get removed from Smiley Dental’s list?
Wendy gets referred from her own practice to Jones
Dental Ltd for treatment. Will she get added to Jones
Dental’s patient list?
Doris is a patient at Thompson Dental practice but
attends your practice for a denture repair. Does she
get added to your practice list?
17. Activity
This section will cover:
• How the minimum expected activity level
is calculated
• What and how activity is counted
18. How expected activity levels are
calculated (1)
• Expected activity levels will be based on your
UDA delivery in the financial year 1 April 2016
to 31 March 2017 (2016/17) with adjustments
for:
– referrals
– urgent treatment
– charge exempt courses of treatment
– any changes in commissioned levels of
UDAs
19. How expected activity levels are
calculated (2)
• Expected activity levels will depend on the
prototype blend the practice is allocated to:
– Blend A: Band 2 and band 3 activity
– Blend B: Band 3 activity
• For prototype practices the activity element is
known as a prototype UDA
20. Blend A - Establishing expected
activity levels
BAND 1
1 UDA
BAND 2
3 UDAs
BAND 3
12 UDAs
2 UDAs 11
UDAs
ACTIVITY
CAPITATION
OHA / OHR and prevention = capitation (Band 1)
All treatment = activity (Bands 2 and 3)
21. Blend B - Establishing expected
activity levels
BAND 1
1 UDA
BAND 2
3 UDAs
BAND 3
12 UDAs
9 UDAsACTIVITY
CAPITATION
OHA / OHR, prevention and routine treatment = capitation
(Band 1 and 2)
Complex treatment = activity (Band 3)
22. • The programme recognises that prevention takes
time and fewer treatments will be delivered as a
result. Therefore an adjustment is applied to reflect
this
• Expected activity levels will be reduced by:
– 20% for Band 2
– 30% for Band 3
• Once all of these adjustments have been made this
is then applied to the 2018-19 level of commissioned
UDAs to establish the expected minimum activity
(EMA) level for the practice
How expected activity levels are
calculated (3)
23. What activity is counted (1)
• Activity delivered will be submitted and
counted via the FP17 at the end of the course
of treatment
Blend
A
• Band 2 = 2 UDAs
• Band 3 = 11 UDAs
Blend
B
• Band 3 = 9 UDAs
24. What activity is counted (2)
Counting of activity for urgent treatment,
referral patients and charge exempt courses of
treatment will depend on whether this activity is
provided to a patient who is on the capitated
patient list or not:
• Where the patient is on the practice list:
No activity is counted
• Where the patient is not on the practice list:
Activity is counted
25. Activity scenarios
1.2
YES
0
John is a patient of Smiley Dental and has toothache
whilst on holiday in your area. He attends your
dental practice for urgent dental treatment. How
many UDAs do you receive?
Wendy gets referred to your practice from her own
practice for treatment. Will you receive any UDAs
for her treatment?
Doris is your patient and turns up at your practice
for a denture repair. How many UDAs do you
receive?
26. Calculation of capitation and activity
This section will cover:
• Process for the calculation of contractors
expected capitation population (CECP) and
expected minimum activity (EMA) elements
27. Introduction to the prototype
finance schedule
• The prototype finance schedule sets out how
a practice’s contract value will be split under
the prototype arrangements
• It also includes the expected delivery
requirements for capitation and activity
– Contractors expected capitated population
(CECP)
– Expected minimum activity (EMA)
• Webinar training has been provided for
practices and this training is now available on
the webpages
28. Process for calculating the
capitation and activity elements
STEP 1
• Calculate the CECP using the practice’s historic data (three years prior to
31 March 2017) applying the necessary adjustments
STEP 2
• Calculate the expected activity levels using the UDA delivery in the
2016/17 financial year applying the count of UDAs relevant for the blend
type
• Apply the adjustment for prevention and treatment volumes
• Calculate the activity percentage for the prototype blend
• Apply the activity percentage for the prototype blend to the commissioned
UDAs for 2018/19 to identify the EMA for the practice
STEP 3
• Multiply the value of the contract value associated with mandatory
services (AAPV) by the activity percentage for the prototype blend to
identify the value of the contract associated with activity
• The remainder of the contract value associated with mandatory services
(AAPV) is then allocated to the capitation element
29. Activity
calculation
Prototype Finance Schedule (Blend A) 28 June 2018
Provider name or company name The Village Dental Practice Open contract numbers included Primary 11111111111
Prototype reference number 1015021 Prototype blend A Additional 0
NHS England local office Cheshire & M ersey Baseline year 2016-17 Additional 0
Table 1 - Summary information
£520,000.00
£520,000.00
£195,000.00 6,563
£325,000.00 6,750
Table 2 - Calculation of baseline CECP (Contractor's Expected Capitated Population) and capitation element of contract value
6,800 Info rmatio n used fo r adjustments
UDA Delivery 2014-15 17,400.0
-50 UDA Delivery 2015-16 17,500.0
UDA Delivery 2016-17 17,600.0
6,750 Commissioned UDA 2018-19 17,500
£325,000.00
Table 3 - Calculation of baseline EMA (Expected Minimum Activity) and activity element of contract value
B and 1s B and 2s B and 3s
B and 1
urgents
C harge
exempt
C o T s
R eg 11
B and 2s
& B and
3s o n
referral
B and 1
urgents
C harge
exempt
C o T s
R eg 11 T o tal UD A s
Baseline UDA delivery 5750 7500 4100 350 30 10 3 15 2 0 17760
Blend UDA delivery 0 5000 3758 0 0 9 3 15 2 0 8787.5
Adjusted Blend UDA delivery 0 -1000 -1128 0 0 0 0 0 0 0 -2128
0 4000 2631 0 0 9 3 15 2 0 6660
Activity percentage for prototype blend 37.50%
Commissioned UDA 2018-19 17,500
6,563
£195,000.00
Table 4 - Current capitated patient numbers compared to CECP for 2018-19
6,750
6,700
99.3%
Table 5 - Calculation of adjusted EMA for 2018-19
Baseline EM A 6,563
Contract start date Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 M ar-19
Pro Rata Delivery Activity 3,281 2,734 2,188 1,641 1,094 547
Pro Rata Delivery Percentage 50.0% 41.7% 33.3% 25.0% 16.7% 8.3%
B aseline EM A (Commissioned UDA x Activity percentage for prototype blend)
C o ntract value asso ciated with activity (A A P VA -A ) (AAPV x Activity percentage for prototype blend)
C EC P fo r 2018-19
Capitated patient under pro to type rules at Jun 2017
Position at June 2017 against CECP for 2017-18
Baseline prototype capitated patient numbers
Adjusting for changes in delivered and commissioned UDA
Baseline expected patient numbers (CECP)
Contract value associated with capitation (AAPV-C)
C apitated patients N o n-C apitated patients
Negotiated Annual Prototype Value (NAPV)
Actual Annual Prototype Value (AAPV)
A ctual A nnual P ro to type Value - B lend A -
A ctivity Element (A A P VA -A )
B aseline EM A (Expected M inimum A ctivity Level)
A ctual A nnual P ro to type Value - B lend A -
C apitatio n Element (A A P VA -C )
B aseline C EC P (C o ntracto r's Expected C apitated P o pulatio n)
Basic practice
information
Capitation
calculation
Activity
adjustment for
2018-19
Current capitation
compared to the
CECP
Practice contract
summary information
Table
1
Table
2
Table
3
Table
4
Table
5
100000
31. Remuneration year-end
adjustments
• Practices will receive 1/12th of their contract
value each month
• At year-end financial adjustments (if applicable)
will be made for:
– Capitation (patient numbers) and
– Activity
• Under prototype arrangements there is no
financial adjustment associated with the delivery
of the Dental Quality and Outcomes framework
(DQOF) in 2018/19 or 2019/2020
32. Year-end process for capitation and
activity (1)
• At year end a practice will be reviewed to
assess whether:
– Patient numbers are above or below the
expected level (capitation)
– Activity is above or below the expected
minimum level
• The value of these year-end delivery positions
are calculated and combined to determine the
actual remuneration level for the year
33. Year-end process for capitation and
activity (2)
• The calculation of the year-end position will be
calculated by NHS England and the programme
• This process will be undertaken after all year-
end data has been received and processed by
NHS BSA
• Practices will be notified of their year-end
position and any associated financial adjustment
or carry forward by NHS England
• Any financial adjustments will be applied and
processed via Compass and reflected in a
practice’s monthly pay schedule
34. The exchange mechanism
The calculation of the value of year-end
delivery positions takes into account where
practices have utilised the flexibility within the
prototype remuneration system to see more
patients where lower activity is delivered due to
the treatment needs of the practice population
35. Calculating activity delivery at
year-end
RULE 1
• If patient numbers are less than or equal to 100% of
expected levels, then any adjustment relating to activity
delivery will be capped at 100%
RULE 2
• If patient numbers are more than 100% of the expected
level, then any adjustment relating to activity will be
capped at the same percentage as the achieved level for
the patient numbers.
36. Year-end adjustments (1)
Where value of delivery is less than 100%
• If the combined value of delivery is above 96% at
year-end there will be no financial recovery and the
value of under-delivery will be carried forward to
the next financial year
• If the combined value of delivery is less than 96%
at year-end the value of under-delivery will be
recovered by NHS England
• Under the prototype arrangements the maximum
financial recovery will be 10% of the contract value
associated with mandatory services
37. Year-end adjustments (2)
Where value of delivery is greater than 100%
• Where the combined value of delivery exceeds
100%, NHS England will recognise over-delivery
up to 102%.
• The value of this over-delivery will be carried
forward to the next financial year unless paid by
NHS England (by local agreement)
38. How the year-end process will work
STEP 1
• Calculate the year-end delivery percentage for the
capitation and activity elements separately
STEP 2
• Apply rules for adjustments (if required) to activity and
capitation delivery
STEP 3
• Calculate the combined value of the year-end
achievement for capitation and activity
STEP 4
• Apply the carry forward for the previous year
STEP 5
• Calculate the final position and carry forward (if
applicable) for the next year
39. Year-end mechanism year example 1
Practice information
Actual Annual Prototype Value (AAPV) £600,000.00
Capitation element (AAPV-C) £505,500.00
Activity element (AAPV-A) £94,500.00
Expected patient list (CECP) 10,000
Expected Minimum Activity (EMA) 3,780
Contract value c/fwd - previous year (£) £0.00
Year-end delivery
Patient numbers 9,900
Prototype UDAs 3,818
40. Year-end mechanism year example 1
Carry
forward of
under-
delivery
Activity was
capped at
100% as
capitation
was less
than 100%.
Step 1 - Year end delivery percentage for capitation and activity
Capitation 9,900 / 10,000 99.00%
Activity 3,818 / 3,780 101.01%
Step 2 - Apply rules for adjustments for activity and capitation delivery (exchange
mechanism)
Capitation 99.00%
Activity 100.00%
Step 3 - Combine the year end achievement for capitation and activity
Capitation 99.00% of £505,500.00 £500,445.00
Activity 100.00% of £94,500.00 £94,500.00
Total £594,945.00
% total £594,945.00 / £600,000.00 99.16%
Step 4 - Apply carry forward from previous year
Carry forward from previous year £0.00
£594,945.00
% total 99.16%
Step 4a - Additional calculation if initial Y/E position is less than 90% (SFE 4.6 - CAAML)
Total £594,945.00
% total 99.16%
Step 5 - Calculate the final position and carry forward (if applicable) for next year
Initial year-end value £600,000.00 – £594,945.00 £5,055.00
Initial year-end percentage £5,055.00 / £600,000.00 0.84%
Step 5a - Apply tolerances to carry forward figures
Final year-end value Under-performance £5,055.00
Final year-end percentage 0.84%
41. Year-end mechanism year example 2
Practice information
Actual Annual Prototype Value
(AAPV) £600,000.00
Capitation element (AAPV-C) £505,500.00
Activity element (AAPV-A) £94,500.00
Expected patient list (CECP) 10,000
Expected Minimum Activity (EMA) 3,780
Contract value c/fwd - previous year
(£) £5,055.00
Prior year under-
performance
Year-end delivery
Patient numbers 10,400
Prototype UDAs 3,400
42. Year-end mechanism worked example 2
Practice has
utilised the
exchange
mechanism
Carry
forward of
under-
delivery
from last
year
Carry
forward of
over-
delivery
Step 1 - Year end delivery percentage for capitation and activity
Capitation 10,400 / 10,000 104.00%
Activity 3,400 / 3,780 89.95%
Step 2 - Apply rules for adjustments for activity and capitation delivery (exchange
mechanism)
Capitation 104.00%
Activity 89.95%
Step 3 - Combine the year end achievement for capitation and activty
Capitation 104% of £505,500.00 £525,720.00
Activity 89.95% of £94,500.00 £85,000.00
Total £610,720.00
% total £610,720.00 / £600,000.00 101.79%
Step 4 - Apply carry forward from previous year
Carry forward from previous year
Prior year under-
performance £5,055.00
£605,665.00
% total £605,665.00 / £600,000.00 100.94%
Step 4a - Additional calculation if initial Y/E position is less than 90% (SFE 4.6 - CAAML)
Total £605,665.00
% total 100.94%
Step 5 - Calculate the final position and carry forward (if applicable) for next year
Initial year-end value £600,000.00 – 605,665.00 -£5,665.00
Initial year-end percentage -0.94%
Step 5a - Apply tolerances to carry forward figures
Final year-end value Over-performance -£5,665.00
Final year-end percentage -0.94%
44. Modelling tool
• Even though there is a process for year end,
practices are able to monitor progress against
capitation and activity measures on a regular
basis using the modelling tool
• The modelling tool can be used for:
– Understanding the practice forecast year-end
position based on current delivery positions
– Allows a practice to estimate the number of
patients/activity needed to meet contract
requirements at year-end
45. Prototype practice year-end calculation modelling tool
Cells requiring manual input
Practice name
Practice information (from capitation remuneration report)
Actual Annual Prototype Value (AAPV)
Capitation element (AAPV-C)
Activity element (AAPV-A)
Expected patient list (CECP)
Transitional allowance
Expected Capitated Population 0 less transitional allow ance
Expected Minimum Activity (EMA)
Contract value c/fwd - previous year (£)
Estimated year-end delivery percentage (practice's own figures)
Prototype UDAs (number); or
Prototype UDAs (percentage)
Estimated patient numbers
Estimated UDAs 0
Step 1 - Year end delivery percentage for capitation and activity
Capitation #DIV/0!
Activity #DIV/0!
Step 2 - Apply rules for adjustments for activity and capitation delivery (exchange mechanism)
Capitation #DIV/0!
Activity #DIV/0!
Step 3 - Combine the year end achievement for capitation and activty
Capitation #DIV/0!
Activity #DIV/0!
Total #DIV/0!
% total #DIV/0!
Step 4 - Apply carry forward from previous year
Carry forward from previous year £0.00
#DIV/0!
% total #DIV/0!
Step 4a - Additional calculation if initial Y/E position is less than 90% (SFE 4.6 - CAAML)
Total #DIV/0!
% total #DIV/0! #DIV/0!
Step 5 - Calculate the final position and carry forward (if applicable) for next year
Initial year-end value #DIV/0!
Initial year-end percentage #DIV/0!
Step 5a - Apply tolerances to carry forward figures
Final year-end value #DIV/0! #DIV/0!
Final year-end percentage #DIV/0!
For every 100 UDAs below your expected
minimum activity level (EMA)
#DIV/0! extra patients are required to
achieve the same financial value
The figures from the top
section of the capitation
remuneration report are
entered here