Identification of a sustainable source of funding for an orthopaedic-geriatric co-care service is essential if the service is to be established and be viable in the long-term. Reimbursement systems for healthcare vary considerably between countries. At the launch of this section of the FFN website, a method of financing services in the UK is considered below, in addition to an analysis of how services can be made viable in the United States.
We strongly encourage you to share your own experiences through the sharing best practice link, to enable colleagues elsewhere to benefit from your knowledge of how to identify sustainable funding for a service.
In 2010, the Department of Health for England introduced a financial incentive for delivery of best practice in hip fracture care. This ‘Best Practice Tariff’ (BPT) was based upon the core professional standards identified in the ‘Blue Book’ consensus guideline on the care of patients with fragility fracture. The BPT for hip fracture offered an increase in payment for hospitals, at the level of the individual patient, which was made possible by the National Hip Fracture Database in the UK. The payment differential for the BPT was £445 for 2010-11, £890 for 2011-12 and £1,335 for 2012-13, which has been maintained for 2013-14. Eligibility for BPT payment was contingent upon adherence to all of the following criteria for 2010-11 and 2011-12:
- Time to surgery within 36 hours from arrival in an emergency department, or time of diagnosis if an inpatient, to the start of anaesthesia.
- Involvement of an (ortho) geriatrician:
- Admitted under the joint care of a consultant geriatrician and a consultant orthopaedic surgeon.
- Admitted using an assessment protocol agreed by geriatric medicine, orthopaedic surgery and anaesthesia.
- Assessed by a geriatrician (as defined by a consultant, non-consultant career grade (NCCG), or specialist trainee ST3+) in the perioperative period (defined as within 72 hours of admission).
- Postoperative geriatrician-directed:
– Multi-professional rehabilitation team.
– Fracture prevention assessments (falls and bone health).
From April 2012, an additional BPT criterion was added which required pre- and post-operative cognitive assessments to be completed.
A financial model has been developed to determine the economic viability of orthopaedic-geriatric co-care services. Based on the characteristics and performance of a typical U.S. hip fracture program, the minimum annual case-load of 72 patients is required. The authors of the model conclude that many existing hospitals which offer hip fracture care may be making an overall loss by providing hip fracture care. Accordingly, consolidation of hip fracture care at dedicated hip fracture centres is proposed, given that typical US cities have adequate case volume to support several such centres.
Economic viability of geriatric hip fracture centers. Orthopedics. 2013 Dec;36(12):e1509-1514. PubMed ID 24579222