There are a number of high cost devices that are excluded from the Payment by Results (PbR) tariff.
Excluded high cost devices are typically specialist, and their use concentrated in a relatively small number of centres rather than evenly across all providers that carry out activity in the relevant HRGs. These devices would not be fairly reimbursed if funded through the tariff. For all excluded activity, commissioners and providers should agree local prices.
The following guidelines, linked to current or expected future use, are intended as an appropriate indication of the devices that may be considered by the high cost devices steering group for inclusion on the high cost devices exclusion list:
- high cost and represent a disproportionate cost relative to the relevant HRG
- used in a subset of cases within an HRG and/or used in a subset of providers delivering services under a specific HRG
- relatively high cost in terms of volume and cost.
All three of the listed criteria need to be met in order for a device to be considered an exclusion from PbR.
Note that a device, for the purposes of PbR, is:
- used as part of patient care and generally cannot be transferred or re-used*
- not considered capital equipment.
*There are a few exceptions to devices not being transferable, for example insulin pumps can be reconditioned and reused for a different patient.