Opportunities to learn from the UK Best Tariff Practice

The implementation of Best Practice Tariffs (BPT) has resulted in significant improvements in the outcomes of individuals who had sustained a hip fracture in the UK. This approach may help the USA in their work to improve the health care system to meet the needs of older adult health.  

The way that hospitals and physicians are paid defines how care is provided around the world. In the USA the Affordable Care Act has resulted in Medicare introducing an expanded set of alternative-payment models in an effort to improve the care and resultant outcomes of older adults. A study was undertaken analyzing the use of the Best Practice Tariffs (BPT) which is the payment method used in the UK to support evidence-based management of hip fracture patients, to assess the implications to using this type of payment model in the USA. 

The study published in the Annals of Surgery in 2022 analysed data from 2000 to 2016 Medicare (US) and death certificate-linked claims for people over 65 years in England. Analysis looked at US hip fracture trends as well as changes in English hip fracture trends before-and-after BPT implementation. It then compared changes in US-versus- English mortality and estimate total theoretical lives saved.

From the data, a total of 806,036 English and 3,221,109 US hospitalizations were included. In the UK, after BPT implementation, England’s 30-day mortality decreased by 2.6 percentage-points from a baseline of 9.9%. 90- and 365-day mortality decreased by 5.6 and 5.4 percentage-points. 30/90/365-day readmissions also declined with a concurrent shortening of hospital length-of-stay. From 2000 to 2016, USA outcomes were stagnant. As such it was determined that implementing the UK payment model could result in an inversion of the countries’ mortality with >38,000 potential lives saved each year. 

Matt Costa, orthopaedic surgeon from the UK, and lead author stated: “The best practice tariffs are a payment mechanism that can drive improvement when they are used to support quality standards. To be successful, a mechanism to measure and report these standards is a critical first step.”

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