PbR Data Assurance Framework

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PbR Data Assurance Framework

• Independent Sector Event

26 June 2009
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Outline

• Who are the Audit Commission and what is our role
  in PbR/Data Quality?
• Findings from 2008/09 audits (including IS
  pilots)
• Implications of poor data quality
• Using the assurance framework to improve data
  quality

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Who are the Audit Commission?
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(No Transcript)
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The assurance framework

• A rolling programme of external audits covering
  inpatients and outpatients
• Providing assurance of the accuracy (or not) of
  coding and therefore payments made to providers
• Driving improvements in data quality and clinical
  coding arrangements
• National analysis to identify significant trends
  and share good practice
• Development of online benchmarking function to
  support PCTs trusts

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What have we found? Emerging results from 2008/09
audits
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What have we found? Emerging results from 2008/09
audits
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What have we found? Emerging results from 2008/09
audits
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What have we found? Emerging results from 2008/09
audits
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Issues from IS pilots

• increase priority of clinical coding
• training and development of coding staff
• clinician engagement and validation
• education and understanding of PbR e.g. only
  one payment per spell
• timely vs accurate coding using all available
  information
• policies and procedures
• HRG grouping

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Conclusions for IS

• HRG errors upper quartile
• Financial impact under PbR undercharging
• Coding errors high
• Need to understand system and improve basic
  coding to move forward and limit risk when
  exposed to NHS market

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Implications of poor data quality

• Payment accuracy under PbR (HRG4)
• But far more than that
• Quality focused NHS
• World Class Commissioning
• Efficiency
• Regulation
• Patient care (Mid Staffs, Haringey)

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The assurance framework improving data quality

• Audits coding, outpatient, AE
• Benchmarking
• Wider DQ work

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Error example 1
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Improving clinical records and clinical coding
together

• Joint pilot work with the RCP to ascertain the
  impact of implementing their generic record
  standards on coding
• Ongoing work but emerging findings are
• Assisting with efficiency of coding and reduce
  risk of inaccurate clinical coding
• Reduce pressure on clinical coding departments as
  standards promote consistent structure and
  content
• From limited sample, some evidence to suggest
  correct application of standards may improve
  coding and less resulting HRG errors

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Good practice

• Clinical engagement
• Weekly meeting with clinicians focusing on
  specialities with the biggest problems first.
• simple systems that help clinicians record
  accurately for example using a joint register
  form to record the type of reconstruction joint
  surgery. Speeds up coding and ensures it is
  accurate.
• Consultants validate coding spreadsheets and
  return comments to the coding team. Complex cases
  followed up through discussion and reference to
  case notes. Helps clinicians to understand how
  there recording impacts on coding accuracy and
  helps coders better understand clinicians.

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Benchmarker supports audit and local understanding

• Benchmarker used by PCTs and trusts to
• Understand own performance
• Highlight areas to focus improvement
• Identify where things are working well
• Understand when things are done differently

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HRG4 benchmarking

• PbR National Benchmarker updated with HRG4
  benchmarking June 2009
• Analysis not available anywhere else
• Developed in conjunction with NHS Information
  Centre
• New HRG4-specific indicators, including
• Unbundling
• Planned same day
• Short stay elective

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Supporting Improvement benchmarking case studies

• What?
• Monthly analysis of a particular speciality
  treatment area.
• Getting a lot of unspecified diagnosis codes in
  gastroenterology
• Caused by the way that information was being
  recorded on the electronic patient records
• Took that back to the clinicians, the nurses and
  the management in the department.
• Verdict
• It gets people to sit up and take notice. The
  graphs and reports get service managers,
  healthcare staff, coders, finance professionals
  etc around the table and focuses attention. The
  detail adds weight to discussions we have with
  clinicians.

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Summary

• General improvement in NHS coding in comparison
  IS needs to improve
• Pilots showed undercharging using PbR business
  rules and prices
• HRG4 much more sensitive to coding
• Need to get it right many more reasons!
• Assurance framework audits, research and
  benchmarking can lead to improvement (as
  demonstrated by IS pilots)

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For more information

• www.audit-commission.gov.uk/pbr