Clinicians from the Clinical Working Group mapped over 140 care Pathways that describe, in detail the care and resources delivered in each element of care they undertake in their clinics. Many hours of clinicians’ time was used to develop and review these pathways that have been reviewed nationally and have the support of the professional bodies BASHH and The Faculty of Sexual and Reproductive Health. Subsequent changes in care Pathways due to a change in clinical practice can be rapidly implemented in the underlying Tariff charges.
Pathways were developed that represented the care delivered either on a contact basis for care activity that is recorded visit by visit or on an episodic basis for care that is recorded only by diagnosis. For example the pathway for Management of reactive treponemal serology, covers the cost of treatment over multiple visits whereas the pathway for T6 Hepatitis Test, only covers the cost of the single visit when the test is conducted. This approach enables the linking of a Tariff payment to both activity codes and diagnosis codes as appropriate.
Managing 140 care pathways and their Primary and Additional Tariff prices, while not difficult for data collection systems, was considered to be too cumbersome for tariff purposes. It was decided to follow PbR guidance and bundle the Pathways into Currencies.
Detailed Pathway cost data is maintained in the Pathway Analytics Cost model and can be updated automatically when resource costs change.
Pathways are therefore bundled by weighted average into Currencies and a Currency factor is applied to accommodate for the number of times un-coded Pathways in that Currency are delivered. The data behind the Pathway weighting and Currency factoring was collected by a detailed patient-level data collection exercise from 12 representative pilot sites across London.
Pathways, Currencies and Tariffs are published and available for scrutiny and comment in the Pathway Analytics website www.pathwayanalytics.com. Comments on care Pathways are collated and reviewed regularly (now annually) by the responsible clinical working group and any changes are agreed an implemented as part of an agreed change management process.