Any Willing Provider Pb R A podiatry currency
Any Willing Provider Pb. R - A podiatry currency Mike Townson Head of Podiatry and Equipment Services
Definitions • Currency – the context of the ‘product’ that is being costed • Cost – the actual cost of the product • Tariff- the range/menu of currency and costs that are available to be bought/sold
What makes a ‘good’ currency • Incentivise provision of good care outcome based and avoid perverse incentives • Clinically meaningful • Resource homogenous – similar resource needs within a currency group • Workable – build into existing systems
Intervention Tariff 1 Specialist intervention/m ultiple staff resource/ consumables £ 80+ Out- sourced orthoses (tier 3) Foot pressure measurement systems – mat or in shoe Topical Negative Pressure Nail Surgery Video gait assessment (face to face) Aircast assess/issue Slipper / contact/ serial casting What else? Versajet – single cost Time – including travel Practitioner competence/grade Consumables Case complexity Location Staff numbers Other factors? Significant for added cost ?
IT 2 High risk case mix/moderate cost consumables Ulceration – actively managing foot ulcer Acute foot pain Fixed goal based short course of intensive treatment. Coordinated management plan following ulceration/amputation Infected lesion requiring immediate management/ coordination to resolve / improve Video gait analysis – editing and report writing MSK team prescription and local manufacture of bespoke devices (stage 2) utilising technical equipment and robust shells. Charcot initial diagnosis, arranging imaging and referral Time – including travel Practitioner competence/grade Consumables Case complexity Location Staff numbers Other factors? Significant for added cost ?
IT 3 Increased risk Prevention of ulceration in the case mix/minor “At Risk” foot expense Monitoring and maintenance of pathological/potential consumables exciting conditions in the “At Risk” foot Issue and review of chair side insoles (tier 1) – temporary insole and wedging Paediatric review MSK review Reassessment and update of care plan for patients “At Risk” Time – including travel Practitioner competence/grade Consumables Case complexity Location Staff numbers Other factors? Significant for added cost ?
IT 4 Low current risk intervention Short term management plan for low risk (pulses & sensation present) patients with superficial pressure/trauma related conditions. Review of stretches, strengthening and core stability Footwear assessment/alteration Foot care advice Time – including travel Practitioner competence/grade Consumables Case complexity Location Staff numbers Other factors? Significant for added cost ?
IT 5 Foot care podiatrist Nail care of an increased or high risk limb by a podiatrist Time – including travel Practitioner competence/grade Consumables Case complexity Location Staff numbers Other factors? Significant for added cost ?
IT 6 Foot care – assistant Nail care of an increased or high risk limb by a podiatry tech/assistant Time – including travel Practitioner competence/grade Consumables Case complexity Location Staff numbers Other factors? Significant for added cost ?
IT 7 Prevention/Education Public health brief intervention by trained Prevention team. Group education session Time – including travel Practitioner competence/grade Consumables Case complexity Location Staff numbers Other factors? Significant for added cost ?
IT 8 Initial Assessment to service New patient assessment appointment Time – including travel Practitioner competence/grade Consumables Case complexity Location Staff numbers Other factors? Significant for added cost ?
Outcomes • 50% Improvement in wound care using Texas score • 95% patient record to have a personalised care plan • 70% improvement in pain based on VAS score • 70% improvement in mobility and independence using a PROM • 10 days MSK referral to treatment
Regulation • ?
Workshop • What extra activities? • Consider additional factors? • Put into currency groupings – same intervention may appear in two groups if significant & justifiable reason • Consider existing clinical pathways • Identify expected outcomes • Opportunities for fixed episodes of care? • Keep it simple!!!!
- Slides: 14