Developing and deploying a Patient Level Payment System for Public Patients treated in Private Hospitals. - The UAN Website System

Brian Mccarthy ^a, Paval Kuriakose ^a, Phil Dunne ^a, Richard Ryan ^a, Joe Hunter ^a

Introduction
In Ireland, most admitted healthcare occurs in one of 54 Public Hospitals, with the remainder admitted to one of 19 Private Hospitals. In common with many other countries, the combination of the ageing demographic and the delayed treatments due to the global pandemic have meant that public hospitals regularly operate at over 95% capacity. The Health Service Executive (HSE) and the Department of Health in Ireland have funded several programmes to allow scheduled care patients waiting for treatment to be treated in Private Hospitals. However, the funders would like to see the detailed outcomes of the funding.

The UAN system was developed by the Healthcare Pricing Office in the HSE to record and track admissions to private hospitals, facilitate the submission of claims for these admissions and reimburse the claims. The detailed record of the admissions and claims ensures that every euro can be tracked.

Methods
A UAN is a Unique Authorisation Number and represents a commitment to treat a patient in a private hospital. Private hospitals do not get paid for treatments unless the patient has a UAN.

The UAN website system was developed to ensure data collection standardisation and to facilitate both the reporting of the referrals and the funding of these referrals. The website consists of five distinct parts

• The UAN referral system allows Public hospitals to refer patients to Private Hospitals
• The HSEClaims system, allows Private hospitals to record patient activity details and submit claims
• The claims management system to review and adjudicate the claims
• The payment system to reimburse for the activity
• The reporting system to report on all aspects of the process.

Finally, for the system to function in a fair and cost-effective manner, a set of treatment costs were agreed with the private hospitals using a national procurement process.

Results
The system went fully live in mid-2022 and has been operating for nearly two years. Public Hospitals access the UAN Referral system to refer patients. Private hospitals access the HSEClaims system, allowing them to submit online claims for the referred patients. The HSE central team use the claims management system to assess claims and payments are made via the HSE financial systems. All parties receive reports on the system.

Nearly 3000 patients have been referred, treated, claimed, adjudicated and paid. The success of the system and the capabilities of the process have led to expansions to cover the referrals of Assisted Human Reproduction patients, outpatient waiting list patients and Medical Bed patients (i.e. non-surgery).

Over 500 users have accessed the system from both Public hospitals, Private hospitals and the central team.

Discussion
The development and deployment of this system was a significant initiative in the HSE as there was no in-house ability to process and pay claims prior to this. The system is a resounding success and is operating well, thanks to the development team in the HPO who manage the system and assist the users in their access and use. It is planned that additional cohorts of activity, funded by the HSE and the Department of Health, will be included from time to time as the system progresses.

The immediate plans for the system are to increase the reporting capabilities and to expand the range of activity covered by the system. More long-term plans include improving the accessibility of the system without compromising security and enabling the capture of clinical data using an appropriate clinical classification.

The overall aims of the project, i.e. to allow the referral of patients, to accept claims for the patients, to assess and reimburse the claims and to report on the process, occur each day and everyone is satisfied with the operation of the system (so far).


^a Healthcare Pricing Office, Ireland

Original Version in PDF