Admitted patient care (APC)
Routine inpatient activity (including emergencies and day surgery), usually when a patient is admitted to a ward and uses a bed for a period of time (not necessarily overnight).
Comorbidities
Conditions that exist in conjunction with another disease. Common examples of comorbidities are diabetes, asthma, hypertension, chronic obstructive airways disease and ischaemic heart disease.
Currency
A unit of healthcare activity such as spell, episode or attendance. Under PbR, currency is the unit of measurement by which the national tariff is paid. Admitted patient care healthcare resource groups (HRGs) are an example of PbR currency.
Finished Consultant Episode (FCE)
An FCE or episode of care is a completed period of care of a patient using an NHS hospital bed, under one consultant within one healthcare provider. If a patient is transferred from one consultant to another, even if this is within the same provider unit, the episode ends and another one begins.
Healthcare Resource Group (HRGs)
The casemix grouping methodology used to support PbR. The groups are organised by the body system and given clinical coherence by clustering diagnosis and procedure code combinations into groups which consume a similar level of resources. In 2009/10 the version used for payment of admitted patient care changed from HRGv3.5 to HRG4.
Hospital spell
The period from the date of admission to the date of discharge. A hospital spell may consist of more than one FCE.
Impairments
Impairments arise when there is a loss in value of an asset compared with its balance sheet value. They typically arise when an asset becomes obsolete or is to be sold, but can also be identified in a regular revaluation of assets. Any loss in value is recorded in the organisation's income and expenditure account
Inpatient
The informal term for activity admitted to a hospital. The technical term is 'admitted patient care'.
Non-admitted patient care (non-APC)
All hospital services not delivered as routine inpatient activity. Some non-APC is still covered by tariff under PbR (A&E, outpatients) but the majority of non-APC is outside the tariff (such as chemotherapy, community, etc).
Outpatient attendance
The outpatient tariff is based on attendance by treatment function in a consultant-responsible clinic, for which the patient has an appointment. The clinic does not have to take place in trust premises and clinics held off-site are included in the scope of PbR.
Outpatient first/follow-up appointment
A first attendance is the first or only attendance in respect of one referral. Follow-up attendances are those that follow first attendances as part of a series in respect of the one referral. The episode (or series) ends when the patient is not given a further appointment by the consultant or the patient has not attended for six months with no forthcoming appointment.
Payment by Results (PbR)
PbR was first introduced in the NHS in 2003/04 to improve the fairness and transparency of hospital payments, and to stimulate provider activity and efficiency. Rather than relying on locally negotiated contracts based on local prices and with a tenuous link to outputs, providers are paid for the number and type of patients treated, in accordance with national rules and a national tariff.
Patient administration system (PAS)
The trust-wide computer system used to record and report routine hospital activity, such as inpatient admissions and outpatient attendances.
PCT allocations
The amount of NHS revenue allocated to individual PCTs to spend on the delivery and commissioning of care.
Programme budgeting
The analysis of expenditure in healthcare programmes. It covers 23 main programmes of care such as cancer, mental health and cardiovascular diseases.
Quantum
A term used often in finance and simply means a quantity or amount. Total cost quantum is the total monetary amount available at a trust to be allocated within reference costs.
Reference costs
Reference costs are a cost collection exercise that produces data which informs the national tariff under PbR. Reference costs are the average unit cost of an HRG or similar unit of healthcare activity, as reported as part of the reference costs annual mandatory collection from all NHS organisations in England. These have been published in the National Schedule of Reference Costs, by admission type and service, since 1998.
Reference cost index (RCI)
One of the outputs of the reference costs collection exercise: a single figure that acts as a measure of the relative efficiency of NHS organisations. It reflects as a percentage how expensive a trust is relative to a theoretical trust with national average costs (100 being the average). The 2009/10 RCI ranges from 157 to 80 for all trusts.
Service Line Reporting (SLR) or monitoring (SLM)
Service line reporting or monitoring was introduced by Monitor for NHS foundation trusts and involves identifying specialist areas and managing them as distinct operational units. This allow trusts to analyse the relationship between activity and expenditure; much like a local store would do when wanting to understand which sections within the store are most profitable.
Tariff
The nationally mandated price(s) for a unit of healthcare activity as published by DH.
Treatment function and treatment function codes
Treatment function is a division of clinical work based on main specialty, but incorporating approved subspecialties and treatment interests used by lead care professionals including consultants. Treatment function codes are the codes assigned to individual treatment functions.