SUSPbR SUS in 20067 Using the extracts

1
SUS/PbRSUS in 2006/7Using the extracts

• John Nickson, NHS CFH PbR Technical Lead

2
SUS Payment by Results

• SUS functionality in 2006/7
• Using SUS extracts

3
What does SUS do?
PbR in 2006/7
4
Business Functions

• Provide assured processes for
• grouping
• identification of APC currencies (spells)
• application of national tariffs
• Provide a consistent view of data to support
  dialogue between Commissioner and Provider
• Maintain a frozen view of data to support
  financial reconciliation around flex and freeze
  dates

5
Changes in 06/07

• Changes are relatively simple. Two big
  challenges
• Supporting a mixed economy of 05/06 and 06/07
  data over year end period
• Validation given the short timetable and the need
  to get the algorithm in place end March
• In addition, we need to ensure that we can handle
  in year change, should this prove necessary

6
SUS Implementation - Initial Stage
Providers
Value added extracts will also continue
Commissioners
Existing NWCS
Existing push of CDS will continue
SUS
Main SUS Environment
Providers
Common Landing Stage
Service Providers
PbR Environment
Commissioners
Data receipt and quality reports
7
PbR APC Processing in SUS

• Spell
• Grouping(s)
• Exclude
• Calculate Derivations

• Minor change
• Revised grouperRevised SSC
• Revised ExclusionsMain spec exclusion made
  conditional
• Short stay changed

Identify currency

• Revised tariffs

• Apply standard tariffs

Apply Tariff
Report

• On-line reports

• Extract downloads

• Revised to reflect user concerns

8
What SUS will not do

• Calculation of tariff adjustment above emergency
  threshold will be handled locally.

9
Out-patients and AE

• No workaround where tariffs defined in terms of
  TFC
• Application of OPCS codes
• AE Minor injuries units ability to identify
  these using site code and an internal SUS look-up
  table

10
Transition to an on-line service

• SUS PbR was designed as an on-line service
• However, the critical output will always be
  extracts and we must ensure production of these
• Transition timescale is under review
• Initially, managed service will be extended to
  include AE, Outpatient and error reports.
• We will also be providing data on extended open
  spells on a quarterly basis.

11
Changes to APC extract

• A combination of revised specification and defect
  resolution
• Information on interchange used to generate data
  attached to each record
• Generated record ID
• Episode level SSC
• Episode level calculated HRG
• Control file readable
• Expect definitions on web this week or next

12
What does SUS do?
Using the extracts
13
PbR APC Spells

• All CDS APC data is available for inspection
• Starts by creating hospital provider spell and
  then excluding in accordance with DH algorithm
• All episodes in Hospital Provider Spell
  maintained, linked to spell, with reason for
  exclusion if excluded

Static definition
Hospital Provider Spell
0
PbR Spell
Used to define PbR APC Currency - likely to
change
Episodes In PbR
PbR Excluded episodes
Episodes in Hospital Provider Spell
14
PbR - Reporting processes
SUS PbR Processes
Trust Actions
Commissioner actions
Episode grouping Spell Construction
Check errors re-submit corrections
Option to monitor
Derive currencies apply tariffs
Extract downloads
On-line reports
Current view
Check output
Check output?
15
Extract Report Structure

• All Spells returned non-qualifying flagged
• All Episodes exclusions and dominant flagged
• Approach try and create spells where possible,
  flag errors
• Derivations and payment components
• Spell ID supports episode and spell linkage

Hospital Provider Spell data
Elements TOTAL
PbR Spell Derivations
CDS Data
Episode in HP Spell

• Extract provides CDS data for spell and episodes
  derivations and in two files ( control)
• see http//www.connectingforhealth.nhs.uk/deliver
  y/programmes/sus/docs/sus_pbr_file_extract_layout.
  xls