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Page 1: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)
Page 2: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

3rd National Conference for Radiology Managers

Unbundling  of    Tariffs  understanding  how  this  will  affect  your  business  

Ian  Francis  

Consultant  Radiologist  BSUH  NHS  Trust  Founder/Director  Medical  Imaging  Partnership  

OrganisaFon  logo  to  be  added  here  if  desired  

Page 3: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

Unbundling  of  Tariffs  -­‐  ObjecFves  

•  Outline  what  the  new  NHS  means  

•  How  PBR  may/may  not    work  

•  Radiology  Business  Development  

•  Thinking  the  unthinkable  

Page 4: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

The New NHS Structure

Page 5: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

MeeFng  the  Financial  and  Quality  Challenges  

▪  Take  out  “unnecessary”    costs  

▪  Reduce  procurement  spend  

▪  Reduce  pathway  inefficiencies  

▪  Increase  operaFng  hours  

▪  “Use  the  user”  

▪  Exploit  technology  

▪  Skill  mix  changes  

▪  Consider  verFcal  or  horizontal  integraFon  across  acute,  community    and  primary  care  services  

▪  Begin  operaFng  networks  across  sites  to  improve  quality  of  care  

▪  Redesign  paFent  pathways  with  clinical  teams  

▪  Reconfigure  services  across  mulFple  sites  to  significantly  reduce  the  physical  asset  base  

▪  Not  all  services  delivered  on  all  sites  

Efficiency  Gains  

Change  operaFng  Models  

VerFcal  and  Horizontal  IntegraFon  

RaFonalisaFon  of  Sites  and  Services  

Page 6: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

New NHS -Creation of Market Economy

Create  the  Market  Create  the  CompeFFon   NHS  April  2013  

FoundaFon  Trusts  Choose  &  Book  Unbundling  Tariffs  

AQP  Clinical  Commissioning    Groups  

Mandate  Choice  Increase  expectaFon  

Page 7: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

Compe&&on  AQP/PBR  

Limited  compe&&on  AQP/PBR  

Compe&&on  for  the  market  OUTSOURCING  

Uncontested  monopoly  

Ter&ary  and  specialist  care  

On-­‐call/IP  complex  hospital  care  

Out-­‐pa&ent  hospital  care  

Out  of  hospital  care  (Simple;  high  vol)  

Radiology  Market  Economy  

Page 8: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

Unbundling  of  Tariffs  -­‐  PBR  

•  Designed  to  promote  health  policy  objecFves  

•  EffecFve  in  elecFve  care  where  there  is  a  desire  to  increase  acFvity  

•  Allows  aspects  of  care  to  be  delivered  by  different  providers  

Page 9: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

PBR  for  OutpaFent  DiagnosFcs  

•  “Sense  Check”  Exercise  •  PotenFal  Financial  risks  

•  Need  to  be  assured:  •  Clinical  Benefit  •  Mindful  of  unexpected  Side  Effects  

Page 10: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

CCGs  

•  “Unbundling  of  diagnosFc  imaging  major  challenge”  

•  Increase  volume  •  Poor  control/duplicaFon  requests  •  Delivery  of  diagnosFcs  in  a  community  se^ng  

Page 11: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

PBR  

•  Not  fit  for  purpose  •  Does  not  promote  conFnuity  of  care  

•  Monitor  and  NHSCB:  •   need  to  promote  local  experimentaFon  within  a  naFonal  framework  of  benchmark  tariffs  

•  Approve  and  analyse  deviaFons  

•  Develop  to  become  part  of  blend  payment  systems    

Page 12: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

What  to  do?  

Page 13: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

Get  Business  Ready  

Page 14: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

“Standard” Radiology Business Development  

•  Need  to  take  ownership  •  Visible  leaders  •  Customer  Engagement    

•  PaFents  •  Clinicians  •  Commissioners  

•  CEOs  •  “True”  Gatekeepers  •  Deliver  enhanced  paFent  pathways  

14  

Page 15: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

“Standard” Radiology Business Development  

•  OpFmal  uFlisaFon  of  exisFng  resources  

•  Scanners •  Staff

•  SegmentaFon  of  radiology  work  streams  

•  ConFnue  to  deliver  secondary  care/specialist  terFary  services  

•  Improved  access  for  primary  care  •  Dedicated  resources  –  “hot  seat”  •  A  community  based  team    

Page 16: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

     Leap  of  Faith  

Page 17: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

     Leap  of  Faith  

   Think  the  Unthinkable    

Page 18: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

Radiology  Community/Partnerships  

•  UnificaFon  of  radiology  services  around  local  groups  

•  Remove imaging services from existing NHS providers – place in regional umbrella organisations

•  Acquire ALL NHS staff groups but with incentivised T&Cs

•  “Fee for service” structure based on unbundled National or Direct Access tariffs

•  Streamline management - services, financial and business development management team

18  

Page 19: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

Radiology  Partnerships  

Page 20: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

IT  Connected  –  Locally  Owned  

•  Improved  access  and  choice  for  primary  and  secondary  care  pts  

•  PACS,  RIS  and  VNAs  •   establish  7-­‐day  working  •  PromoFon  of  super-­‐specialisaFon  and  training  

   In-­‐sourcing  

20  

Page 21: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

Radiology  Community/Partnerships  

•  UnificaFon  of  radiology  services  around  local  groups  

•  Remove  imaging  services  from  exisFng  NHS  providers    –  place  in  regional  umbrella  organisaFons  

•  Acquire  ALL  NHS  staff  groups  but  with  incenFvised    T&Cs  

•  “Fee  for  service”  structure  based  on  unbundled  NaFonal  or  Direct    Access  tariffs  

•  Streamline  management      -­‐  services,  financial  and  business  development  management  team  

21  

Page 22: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

Radiology  Community/Partnerships  

•  UnificaFon  of  radiology  services  around  local  groups  

•  Remove  imaging  services  from  exisFng  NHS  providers    –  place  in  regional  umbrella  organisaFons  

•  Acquire  ALL  NHS  staff  groups  but  with  incenFvised    T&Cs  

•  “Fee  for  service”  structure  based  on  unbundled  NaFonal  or  Direct    Access  tariffs  

•  Streamline  management      -­‐  services,  financial  and  business  development  management  team  

22  

Page 23: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

Radiology  Community/Partnerships  

•  UnificaFon  of  radiology  services  around  local  groups  

•  Remove  imaging  services  from  exisFng  NHS  providers    –  place  in  regional  umbrella  organisaFons  

•  Acquire  ALL  NHS  staff  groups  but  with  incenFvised    T&Cs  

•  Fiscal  Independence  -­‐“Fee  for  service”  structure  based  on  unbundled  NaFonal  or  Direct    Access  tariffs.    

•  Streamline  management      -­‐  services,  financial  and  business  development  management  team  

23  

Page 24: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

Radiology  Community/Partnerships  

•  UnificaFon  of  radiology  services  around  local  groups  

•  Remove  imaging  services  from  exisFng  NHS  providers    –  place  in  regional  umbrella  organisaFons  

•  Acquire  ALL  NHS  staff  groups  but  with  incenFvised    T&Cs  

•  Fiscal  Independence  -­‐  “Fee  for  service”  structure  based  on  unbundled  NaFonal  or  Direct    Access  tariffs    

•  Streamline  management      -­‐  SINGLE  operaFng  service,  financial  and  business  development    team  

24  

Page 25: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

 “Quality”  focused  imaging  business  

•  Customer  buy-­‐  in/markeFng  

•  “Use  the  users”  

•  InformaFon  –  Workflow/financial  management  •  “RIS/PACS  real-­‐Fme  dashboards”  

•  Contract  and  performance  management  •  Adherence  to  and  establishment  of  clear  KPIs  

Page 26: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

3rd National Conference for Radiology Managers

Unbundling  of    Tariffs:  Opportunity  or  Threat?  

OrganisaFon  logo  to  be  added  here  if  desired  

Page 27: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

Grow an Imaging Business

Page 28: Unbundling)of))Tariffs)understanding)how)...3rd National Conference for Radiology Managers Unbundling)of))Tariffs)understanding)how) this)will)affectyour)business ) Ian)Francis)

Thank You

28  www.medicalimaging.org.uk  


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