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Monitor and NHS England have decided to update the marginal rate rule in the following ways:
- to require baseline adjustment where needed to account for significant changes in the pattern of emergency admissions faced by providers in some areas
- to ensure retained funds from the application of the marginal rate rule are invested transparently and effectively in appropriate demand management and improved discharge schemes
The 30% marginal rate rule for emergency admissions - under which providers are paid less for admissions over a certain level - was introduced in 2010 following concerns over growing emergency admissions.
It was intended as a way of sharing the risk of greater admissions and encouraging NHS providers and commissioners to manage demand.
Monitor and NHS England are interested in hearing from healthcare providers and commissioners on the following questions relating to the rule:
- what has happened?
- has it helped?
- could the approach be improved?