Creating a Postal Kit or eService currency and including it in your Triff Configuration is quite straightforward.  Follow these steps and we can support you in setting one up:

Think about where you want the onus to lie with regard to non-returned samples, damaged samples, equivocal test results etc.  Best practice suggests you charge for each sample that returns an unequivocal result, placing the onus on the provider to ensure the packaging and instructions are adequate to encourage the return of a valid sample.  However, it is also common to split out a seperate charge for the kit dispatch as well as often a full screen kit is dispatched but only swabs are returned for example.  Here is some guidance on how you should approach scoping new currencies for a postal kit service:

• Do not conflate the kit dispatch with the processing of samples.  Sample processing only should be recorded with a Test (ie T2 etc).  If recording kit dispatch, it should be recorded with a suitable alternative local code.
• Treatment is recorded in the normal way and would attract the normal charges which are triggered on a diagnosis code.  If you are delivering treatment by post you will probably want to record an additional local code to identify this and trigger an suitable alternative currency for treatment by post.
• Partner notification costs for negative results are commonly accounted for in the sample processing tariff and positive results in the intervention tariff.  In order to do this an assumption of the positive rate must be applied to the negative PN costs ie include PN costs * (1 - assumed positivity rate) to the sample processing costs.

You then need to think about the practical data journey - who collects the data required, where and how does it get collated?  You will no doubt have though about this from an operational point of view, but consider also how you collate reports required for tariff purposes.  Does the locally hosted provider manage the Postal Kit service or eService, do they subcontract it and collate the activity data associated with it?  If they do, carry on, if not, then the eService provider or Postal Kit dispatcher will need to supply collated data to us.  The data must include an anonymised patient identifier, dispatch date and the associated Local Code we issue that describes the particular activity (ie type of kit being dispatched and scope of activity - see below).

Here are the main considerations to think about the data journey for this activity:

• The data must not be duplicated and included in other submissions
• If the service is subcontracted by the local provider, it is likely the local provider will collate the data, if the service is commissioned directly by the commissioner the service provider will most likely submit the data to us.
• The data must end up with us on a monthly basis
• The data must include an anonymised patient identifier, preferably following a standard GUMCAD or SRHAD format

Consideration should be given to the scope of the activity covered by the new currency:

• Suitable proportion for triaging service (ie website, telephone etc) as the on ramp to ordering a test kit
• Kit materials
• Kit preparation / assembly
• Kit dispatch or in-clinic over-the-counter
• In-clinic self-sample assistance
• Sample return including return postage
• Successful sample return un damaged
• Sample processed
• Sample processed with unequivocal result
• Sample processed with results management
• Postal treatment kit dispatched

The Primary and Additional Tariff Rates set for this type of currency are likely to be the same.  This is because the activity is delivered 'in isolation', there is no marginal cost impact if an eService or postal kit is used and then the patient is treated - both activities can be costed in isolation there is no cost advantage in delivering the bundled activity over delivering them individually.

One example of an eService currency might be, Commissioners decide to commission a kit dispatch with unequivocal sample results returned and base the charge on the cost of the kit, dispatch costs and sample return and include a predetermined factor for un-returned kits.  This approach would place the onus on the service provider to offer kits with adequate incentives (kit design, quality, packaging and instructions etc) to ensure samples are returned in a useable manner and then handled and processed in a way that enabled a high proportion of unequivocal results to be delivered.  The processed sample would be recorded with along with a local code to identify the sample was from a postal kit.  The tariff charge would include an agreed allowance for non-returned kits and unreliable samples being returned.

Another example might offer a number of currencies for various different post kits being dispatched (you could even allow them to be bundled with the use of primary and additional tariff rates to allow for on the fly packaging of different test kits to meet different patient needs).  In this case there is no allowance for unused kits - commissioners are charged for all kits dispatched.  Samples returned would then be processed in the normal manner.  The currency charged for the sample processing would be similar to the normal in clinic test without the associated face to face staff time and consumables.  The activity would be recorded with a normal test code and a supplementary local code.

Also bear in mind, that if a charge is raised for postal treatment kits based on a diagnosis code and a local code for the treatment kit dispatch, then the local code must also be used to eliminate the diagnosis code from triggering a 'normal' in-clinic intervention charge.

In order to implement your own local currencies for Postal Kits or eServices, please contact us at enquiries@pathwayanalytics.com to discuss your plans. 

As always, requests for changes to existing Tariff Configurations must be made by the Lead Commissioner managing the Tariff Configuration.