[Skip to content]

Royal Brompton & Harefield NHS Foundation Trust
For healthcare professionals
Search our Site
Mother, nurse and child

Care of children with cystic fibrosis

3.8 Payment by results – the mandatory tariff 

Since April 2013 there has been a mandatory tariff paid via the Specialist Commissioners to the CF centres, based on a year of care tariff that is dependent on the severity of the child’s CF disease. This is determined by the complexity adjusted yearly banding system (see below) produced from data entered on to the CF national registry. It is critical data is entered for every patient without exception, assuming consent obtained, usually by 31 January each year with the previous year’s data.

 

This is to cover CF related care only (eg not A&E visits or admissions for trauma or non-CF illness). It also specifically excludes charges for high cost CF drugs – DNase, nebulised antibiotics (colistin, tobramycin, aztreonam), mannitol and ivacaftor. High cost antifungals ie voriconazole, posaconazole, liposomal amphotericin and caspofungin are also excluded from the tariff.

 

Part of the tariff is paid to our shared care Network Centres. Each centre must comply with the NHSE National Service Specification (appendix 16), the CF Trust Standards of Care (2011), and the Service Level Agreement signed with the Brompton. The paediatric tariff does not take into account the extra costs incurred by shared care arrangements nor costs of local community services.


The following explanation is taken from the 2016/17 National Tariff Payment System:


2016/17 National Tariff Payment System


Cystic fibrosis pathway payment

 

  • The CF pathway currency is a complexity-adjusted yearly banding system with seven bands of increasing complexity of patient need. The tariff relates to a year of care. The pathway does not distinguish between adults and children. 

 

  • The CF pathway currency was designed to support specialist CF multidisciplinary teams to provide care in a seamless, patient-centred manner, removing any incentives to hospitalise patients whose care can be well managed in the community and in their homes. Furthermore, it allows early intervention (following international guidelines) to prevent disease progression, for example, through the use of antipseudomonal inhaled/nebulised antibiotics and mucolytic therapy. 

 

  • Bandings are derived from clinical information including CF complications and drug requirements. The bands range from band 1, for the patients with the mildest care requirements (involving outpatient treatment two to three times a year and oral medication) to band 5, for patients at the end stage of their illness (requiring intravenous antibiotics in excess of 113 days a year with optimum home or hospital support). 

 

  • Patients are allocated to a band by the CF Registry data manager using data from the national database, the UK CF Registry.

  • The pathway payments cover all treatment directly related to cystic fibrosis for a patient during the financial year. This includes:
    • admitted patient care and outpatient attendances (whether delivered in a specialist centre or under shared network care arrangements)
    • Home care support, including home intravenous antibiotics supervised by the CF service, home visits by the multidisciplinary team to monitor a patient’s condition, eg management of totally implantable venous access devices (TIVADs), collection of mid-course aminoglycoside blood levels and general support for patient and carers
    • Intravenous antibiotics provided during in-patient spells, annual review investigations.

  • For any patient admission or outpatient contact in relation to CF, the HRG is included in the year of care payment regardless of whether it is one of the CF specific diagnosis driven HRGs or not. All outpatient CF activity must be recorded against TFC (Treatment Function Code) 264 and TFC 343.

  • Some elements of services, included in the CF pathway payments, may be provided by community services and not the specialist CF centre, such as home care support, including home intravenous antibiotics supervised by the cystic fibrosis service, home visits by the multidisciplinary team to monitor a patient’s condition (e.g. management of totally implantable venous access devices (TIVADs)) and collection of mid-course aminoglycoside blood levels. In such cases there will need to be agreement between the relevant parties (local services and CF specialist Centre) on reimbursement from the prices paid to the specialist CF centre.

  • There are a number of specified services which require local negotiation on price:
    • High cost CF specific inhaled/nebulised drugs: colistimethate sodium, tobramycin, dornase alfa, aztreonam lysine, ivacaftor and mannitol.
    • Insertion of gastrostomy devices (percutaneous endoscopic gastrostomy [PEG]) and insertion of totally implantable venous access devices (TIVADs) are not included in the annual banded prices. These surgical procedures will be reimbursed via the relevant HRG price.
    • Neonates admitted with meconium ileus who are subsequently found to have CF will not be subject to the CF pathway payment until they have been discharged after their initial surgical procedure. This surgical procedure will be reimbursed via the relevant HRG price. Once discharged after their initial surgical procedure subsequent CF treatment will be covered by the CF pathway payment. Annual banding will not include the period they spent as an admitted patient receiving their initial surgical management.

  • Network care is a recognised model for paediatric care. This model must provide care that is of equal quality and access to full specialist centre care.


Banding definitions 

 

In appendix 17, we have enclosed the section on CF from the Payment by Results Guidance for 2013-14, published in Feb 2013 by the Dept. Health. The full guidance is available below:


Payment by Results Guidance for 2013-14 


Banding definitions

Band

1

1A

2

2A

3

4

5

Therapies

 

Maximum number of total days of IV antibiotics

0

14

28

56

84

112

≥113

Nebulised antibiotics (Pseudomonas infection)

 

Yes

 

 

 

 

 

Long-term (>3 months) nebulised antibiotics or DNase

 

 

Yes

 

 

 

 

Long-term (>3 months) nebulised antibiotics and DNase

 

 

 

Yes

 

 

 

Hospitalisations

Maximum numbers of days in hospital

0

7

14

14

57

112

≥113

Supplemental feeding

Nasogastric feeds

 

 

 

Yes

 

 

 

Gastrostomy

 

 

 

 

Yes

 

 

Complications

 

CF Related Diabetes or ABPA w/o other complications

 

 

 

Yes

 

 

 

CF Related Diabetes and ABPA

 

 

 

 

Yes & (FEV1 ≥60%)

Yes &

(FEV1 <60%)

 

Massive Haemoptysis or Pneumothorax

 

 

 

 

Yes & (FEV1 ≥60%)

Yes &

(FEV1 <60%)

 

CF Related Diabetes and Gastrostomy

 

 

 

 

Yes & (FEV1 ≥60%)

Yes &

(FEV1 <60%)

 

Non Tuberculous mycobacterium treated or difficult to treat infections (eg MRSA or Cepacia) requiring other nebulised antibiotics eg Meropenem, Cayston, Vancomycin.

 

 

 

 

Yes

 

 


Band

Tariff (£)

1

5,033

1A

7,447

2

7,447

2A

12,036

3

18,422

4

33,224

5

40,054


2016/2017 NHSE Tariff

Royal Brompton

Sydney Street,
London SW3 6NP
Tel: +44 (0)20 7352 8121

Harefield