Costing a pathway
NHS Milton Keynes serves a population of 230,000 people, which is set to increase to 260,000 by 2010. The number of people aged over 50 years is estimated to rise by 37% in the same period of time.
NHS Milton Keynes wanted to know what the cost associated with treating patients with cataracts by a specialist in a hospital was, and whether they could make any savings by producing a local cataract pathway that would clearly define referral criteria and help standardise patient care.
Role of the Map
The Map of Medicine cataract pathway was chosen to cost the service because it was relatively straightforward patient journey and aligned with Healthcare Resource Group (HRG) codes. Also, the pathway provided the latest evidence-based information, guidelines and referral criteria that could be adapted to local use within NHS Milton Keynes to reduce variation in care.
Milestones
- The patient journey on the Map of Medicine pathway consisted of one first outpatient appointment, one inpatient appointment for elective surgery and one or two follow up outpatient appointments, depending on the complexity.
- 20 patient journeys that fit the HRG codes for cataract surgery were examined to calculate the cost of an individual patient journey depending on the hospital patients were treated in.
- The calculated cost according to HRG codes was: £106 for first outpatient appointment, £750 for surgery and £48 for follow up appointment.
- The journey for patients going through Milton Keynes General Hospital appeared to be longer, with a higher frequency of outpatient attendance and therefore a higher cost than other local hospitals patients were referred to.
Challenges
- The variation in referral was derived from the fact that some patients were referred by the GP with no work up prior to referral, so the assessment work was then done in the hospital, resulting in a higher number of outpatient appointments prior to surgery.
- If, as per the patient journey described by the Map of Medicine pathway, patients had their work up done by opticians, rather than being referred by GPs, these costs could have been reduced.
Results
If the patient journey was standardised according to the best practice guidelines outlined in the Map of Medicine cataract pathway, Milton Keynes General Hospital could save approximately £183,000 per annum, based on 713 patients. Allowing for around 30% of the patient cases to be complex, it can be estimated that the savings will be reduced to £128,100.