NHS set to fall £150m short of target on payments from foreign patients

The NHS is set to miss its target of recovering £500m a year for treating patients from overseas, the Whitehall spending watchdog has said.

The National Audit Office (NAO) said hospital trusts in England were getting back more money from overseas visitors who were not entitled to free treatment, but were still facing a shortfall of more than £150m by 2017-18.

The target for reducing the cost of treating overseas patients was announced by the Department of Health in 2014 in a drive to cut trusts’ deficits and counter claims the NHS was being overly generous.

The amount collected has risen from £73m in 2012-13 to £289m in 2015-16. However, the NAO said the increase was mainly due to a new surcharge on temporary migrants from outside the European Economic Area (EEA), which brought in £168m last year.

The department’s forecasts suggest trusts will recover £346m in 2017-18, significantly less than the £500m target. The NAO said the shortfall was in part due to the failure to take account of the cost of administering the programme, while patients were still not paying the full amounts they owed.

“The charging regulations are complex. Trust staff may have to rely on judgment in determining whether a patient is chargeable, sometimes with limited information,” the NAO’s report said.

There was a “particular challenge” in collecting payments from patients – mainly from outside the EEA – who were personally liable for the cost of their treatment, it said. On average, only about half the amount due was being collected.

The head of the NAO, Amyas Morse, said: “Hospital trusts remain some way from complying in full with the requirement to charge and recover the cost of treating overseas visitors.

“In the past two years, the amounts charged and amounts actually recovered have increased. Much of this increase is the result of changes to the charging rules. If current trends continue and the charging rules remain the same, the department will not achieve its ambition of recovering up to £500m of overseas visitor income a year by 2017-18 and faces a potential shortfall in the region of £150m.”

NHS set to fall £150m short of target on payments from foreign patients

Hospitals" premium-rate overtime payments soar

Spending on premium-rate overtime by hospitals across the UK has risen by more than a third in the past two years, a freedom of information request has revealed.

Hospitals can pay consultants a higher-than-normal rate for extra shifts. Some hospitals have paid up to £1,000 for four hours’ work, research by the BBC found, while rates of £600 a shift are common – three or four times consultants’ normal rate of pay.

The average amount paid in high-cost overtime last year was £13,356 per consultant. One doctor at Lancashire teaching hospitals NHS foundation trust made £375,000 on top of their salary from the shifts.

Figures from 114 of the 186 trusts and health boards show the amount hospitals spend on high-cost overtime is increasing. In 2015-16, £168m was spent, up from £125m in 2013-14. Not all hospitals pay overtime at higher rates. Wrightington, Wigan and Leigh NHS foundation trust stopped paying premium rates in 2010.

Andrew Foster, the trust’s chief executive, told the BBC: “I don’t think it is very defensible to pay a huge premium to one group of staff and not to other groups of staff.”

Danny Mortimer, chief executive of NHS Employers, conceded that the figures revealed “challenges in some parts of the country” where trusts are “finding it difficult to recruit doctors to certain specialities”.

But speaking on BBC Radio 4’s Today programme he said: “We don’t believe that in every circumstance these extra payments are generated by shortages. Half of doctors receive these additional payments and half don’t. There are doctors who are working regularly at nights and weekends who aren’t attracting the same rates of additional pay.”

Mortimer said the NHS was working on new standardised arrangements for pay and overtime.

He said: “What we need is a system that can be applied fairly across all doctors, that recognises the extra work they do and pays them an overtime rate when they are working nights and weekends, but does that in a way that is consistent and rewards the doctors that work the most onerous working patterns.

“There are situations where there are shortages. But payments are being made in specialities in departments where there are enough doctors. It’s about the system that we apply and the pressure that people are under to try and provide services.”

The British Medical Association (BMA) said the payments were a sign of doctor shortages. Keith Brent, the BMA consultants’ leader, said: “These payments are made because there simply are not enough doctors and hospitals are under pressure to meet waiting time targets.”

The Department of Health said the NHS would have over 11,000 more doctors by 2020. A spokesman said: “Consultants do a vital job and should be properly rewarded, but this analysis shows why we are working with the BMA to replace a unique evening and weekend ‘opt-out’ in the existing contract.

“This will allow us all to promise patients urgent and emergency care of a consistently high standard across the week, and – as the hospitals themselves say – make better use of operating theatres while reducing big overtime bills.”

Hospitals" premium-rate overtime payments soar

White Home Strategies To Shift Medicare Away From Fee-For-Support 50% Of Payments Tied To Good quality By 2018

The Obama administration will push Medicare payment swiftly away from charge-for-services medicine within four years, outlining a program to have half of all Medicare bucks paid by to doctors and hospitals by means of “alternative” reimbursement models by the finish of 2018.

U.S. Secretary of Well being and Human Solutions Sylvia M. Burwell today said reforming Medicare payment is a priority now that millions far more Americans have overall health coverage beneath the Affordable Care Act and her company as a result will concentrate “energies” on making use of “incentives to inspire increased-value care.” A detailed seem is here.

“A vast majority of Medicare charge-for-service payments currently have a link to good quality or worth,” Burwell stated in a standpoint piece published in the Jan. 26 New England Journal of Medicine. “Our purpose is to have 85% of all Medicare charge-for-service payments tied to top quality or worth by 2016, and 90% by 2018. Probably even far more crucial, our target is to have 30% of Medicare payments tied to high quality or worth by way of alternative payment designs by the end of 2016, and 50% of payments by the finish of 2018.”

Currently, just twenty percent of payments from the Medicare well being insurance system for the elderly are paid through option payment versions like bundled payments, patient-centered health-related houses and accountable care organizations, a swiftly emerging care delivery program that rewards physicians and hospitals for operating collectively to improve top quality and rein in expenses. In these designs, medical doctors and hospitals get on more risk that they can streamline the care, improve quality and remove bureaucratic inefficiencies.

“Three many years in the past, Medicare produced virtually no payments by means of these alternative payment versions,” Burwell stated.

Just last week, UnitedHealth Group UnitedHealth Group (UNH) reiterated its commitment to enhance payments that are tied to value-based mostly arrangements to $ 65 billion by the finish of 2018.  Aetna Aetna (AET), Cigna Cigna (CI), Humana Humana (HUM) and other individuals are expected to supply updates on their worth-based mostly contracting for this yr inside the subsequent two weeks.

Asking yourself how the move away from charge-for-support medicine  will affect your overall health care? The Forbes eBook Within Obamacare: The Resolve For America’s Ailing Well being Care Technique answers that query and much more. Accessible nowat Amazon and Apple.

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White Home Strategies To Shift Medicare Away From Fee-For-Support 50% Of Payments Tied To Good quality By 2018

Far more Sunshine: CMS Desires Businesses To Report Payments To Physicians For Medical Education

In a key reversal of policy, CMS would like market to report payments to physicians for continuing medical training. The move would eliminate from the Doctor Payment Sunshine Act the recent exemption for CME.

At first CMS’s  proposal for implementation of the Sunshine Act necessary business to report payments to doctors for CME applications. But following substantial debate and lobbying from industry, the last rule integrated an exemption. As a consequence, firms are not now essential to report payments to speakers at accredited CME events as lengthy as the firms don’t choose the speakers or right pay them.

CMS now appears to have modified its thoughts. Close to the end of its record of proposed modifications for next year, CMS is proposing to get rid of the exemption:

 …we are proposing to delete the Continuing Education Exclusion in its entirety. Getting rid of the exemption for payments to speakers at specified accredited or certifying continuing health-related schooling events will develop a far more consistent reporting requirement, and will also be a lot more steady for buyers who will eventually have entry to the reported data.

A recent write-up in Contemporary Healthcare examines considerations that the existing exemption “could prompt makers to shift their marketing bucks towards CME and away from direct promotional programs for their products.” The article reports “increasing concern… that industry payments for CME bias these applications.” The consequence, said  Daniel Carlat, director of the Prescription Task at Pew Charitable Trusts, is that these biased programs lead physicians “to unduly prescribe items that industry is pushing.”

The proposed new rule will be published in the Federal Register on July 11. Comments will be accepted till September 2. It is probably that market and healthcare communication companies will exert considerable efforts to avert CMS from implementing this adjust.

Far more Sunshine: CMS Desires Businesses To Report Payments To Physicians For Medical Education

3.2 million think there is "no point" saving for old age as it will be swallowed by care payments

1 current review estimated that more than a million families have had to sell their property in the last five many years alone in order to pay out care payments for loved-ones.

With council budgets below intense strain, much more than 450,000 frail elderly and disabled men and women who would have acquired state assistance for the care even a handful of years ago are now shut out of the technique, academics at the London School of Economics have calculated.

Ministers say the package of reforms ought to lastly allow individuals to stay away from “catastrophic” care costs enough certainty about how considerably they may possibly have to pay to allow them to make strategies.

But polling, carried out for Age United kingdom, suggests that the reforms have so far failed to persuade sufficient reassurance to individuals to program for their potential requirements.

It comes soon after ministers were accused of betraying elderly folks right after it grew to become clear that a promised “universal” scheme meant to avert people having to promote their home to pay for care would not be available to hose with modest cost savings.

The TNS survey identified that nearly three in ten men and women in excess of 50 – the equivalent of five.8 million folks in mainland Britain – are no longer conserving for their future needs specifically because they believe there is basically “no point”.

Of individuals who took that view a lot more than half especially singled out a see that anything they conserve now “will just be taken away later” when they need to have care. That equates to about 3.2 million men and women.

Age Uk warned that a lack of clarity from the Government about how the fine print of changes could be fuelling he uncertainty and failing in its essential aim of providing folks the protection they need to prepare for their outdated age.

Caroline Abrahams, director of Age United kingdom, said: “The Government demands to give individuals a sensible notion of what the can assume to be paying for in the future.

“There is an urgent want for a frank and truthful debate about the funding of care and who will have to shell out for what.”

Ruth Isden, the charity’s head of public solutions, stated: “If we are seeking at a method which was made to motivate individuals to save in direction of the value of later lifestyle and care by making an attempt to give some certainty about the expenses and it seems to be like in reality it is not encouraging individuals men and women to do so, then it is not going as far as it demands to go.”

She added: “Anything that discourages individuals from conserving in putting the right programs and preparations in area for their later existence is not going to be a constructive improvement.

“This is partly historical and partly the truth the people really do not really recognize the new technique but, that is why in our view the Government genuinely does need to step up and make certain that it is clear to individuals what they need to have to do.

“The worst point would be if people both consider that it is all sorted and they really don’t require to be concerned any much more or due to the fact of the way they consider the new technique is going to pan out they really don’t strategy any financial savings then we are not actually making certain the enhancements we need to have to see.”

3.2 million think there is "no point" saving for old age as it will be swallowed by care payments