PbR Data Assurance
Framework
Key Messages
PbR Data Assurance Team
Health
PbR Data Assurance Framework
•What is it?
•What did we find out?
•What should you do?
•What’s coming next?
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
PbR assurance 2008/09
• Continuation of clinical coding audit programme at
all acute trusts (follow up on recommendations)
• Reviews of outpatient data quality at approximately
a third of trusts
• Piloting of reviews covering the independent sector
• Further development and refinement of the national
benchmarker
• Research into key areas from 2007/08
Lessons learnt
Issues
Changes for this year
•
•
•
•
• Focus on programme
management
• More local flexibility
• Single report
• Stronger QA
• Closure Meeting
• Piloting account manager pilot
• PbR assurance portal
• SHA reporting
Quality of reporting
Timeliness of reporting
Communication
Engagement
Findings and recommendations
HRG errors (2007/08)
60%
50%
40%
30%
20%
12.0%
10%
4.0%
0%
Trust Value
Low er Quartile
Upper Quartile
HRG errors (Qs 1-3 2008/09)
60%
50%
40%
30%
20%
12.0%
10%
4.0%
0%
Trust Value 2008/2009
National Upper Quartile 2007/2008
National Low er Quartile 2007/2008
Individual trust change
30%
Deterioration
Percentage point change
20%
10%
0%
-10%
-20%
Improvement
-30%
Trust Difference 2007/08 - 2008/09
Individual trust comparison
40%
30%
20%
10%
0%
HRG errors 2007/08
10%
HRG errors 2008/09
20%
30%
40%
Gross financial error (2007/08)
50%
40%
30%
20%
10%
5.9%
1.9%
0%
Trust Value
Lower Quartile
Upper Quartile
Net financial error (2007/08)
50%
40%
30%
20%
10%
1.0%
0%
-0.9%
-10%
-20%
-30%
-40%
-50%
Trust Value
Low er Quartile
Upper Quartile
Net financial error (Qs 1-3 2008/09)
20%
15%
10%
5%
1.0%
0%
-0.9%
-5%
-10%
-15%
-20%
Trust Value 2008/2009
National Upper Quartile 2007/2008
National Low er Quartile 2007/2008
Coding errors (Qs 1-3 2008/09)
Percentage of Secondary Procedures Recorded Incorrectly
Percentage of Primary Procedures Recorded Incorrectly
50%
50%
45%
45%
40%
40%
35%
35%
30%
30%
25%
25%
20%
17.0%
27.4%
20%
15%
15%
10%
10%
7.0%
6.0%
5%
5%
0%
0%
Trust Value 2008/2009
National Upper Quartile 2007/2008
National Low er Quartile 2007/2008
Trust value 2008/2009
Percentage of Primary Diagnoses Recorded Incorrectly
National Upper Quartile 2007/2008
National Low er Quartile 2007/2008
Percentage of Secondary Diagnoses Recorded Incorrectly
50%
50%
45%
45%
40%
40%
35%
35%
30%
30%
25.5%
25%
21.0%
20%
25%
20%
15%
15%
10%
8.0%
5%
8.4%
10%
5%
0%
0%
Trust Value 2008/2009
National Upper Quartile 2007/2008
National Low er Quartile 2007/2008
Trust Value 2008/2009
National Upper Quartile 2007/2008
National Low er Quartile 2007/2008
Key themes & local action
Theme
PCT / Trust Recommendation
•
•
•
•
•
• Implement & monitor of
recommendations
• Use local audits and benchmarker
to improve clinical coding
• Improve quality of source
documentation, clinician
engagement and investing and
development of coding dept
• Ensure coding data is sufficiently
robust for wider use and analysis
Quality of documentation
Coding arrangements
Co-morbidity recording
Lack of clinician involvement
Training issues
Source: Audit Commission PbR Data Assurance Framework 2007/08
Key themes & national action
Theme
DH / CfH Recommendation
•
•
•
•
•
• Training & development
programme for coders
• Guidance on co-morbidities
• Classifications and coding system
of specialist activity
• HRGs with higher error rates
Quality of documentation
Coding arrangements
Co-morbidity recording
Lack of clinician involvement
Training issues
Source: Audit Commission PbR Data Assurance Framework 2007/08
Key themes & Commission action
Theme
Audit Commission follow-up
•
•
•
•
•
• Research programme with Royal
College of Physicians
–Quality of documentation
–Clinician involvement
• Develop of training and quality
assurance with CfH
• Specialist trusts
• Support & challenge to DH
Quality of documentation
Coding arrangements
Co-morbidity recording
Lack of clinician involvement
Training issues
Source: Audit Commission PbR Data Assurance Framework 2007/08
PbR assurance – the road ahead
PbR assurance next year (2009/10)
• 2009/10 (yr3) continuation of programme
• Allows broader understanding of data quality and
each trust
• Key changes in PbR
HRG4 -- new tariff -- OPCS 4.5 -- MFF -- SUS
• Piloting A&E audits
• Reference costs
Impact on HRG4
• Sense check analysis
• Compared impact under HRGv3.5 & HRG4
• Error rate slightly higher under HRG4
• Overall financial impact still relatively neutral
• Volatility for individual trusts and specialities
• Local action required to understand impact
Risk based approach
• 2010/11 (yr4) move to risk based approach
• Consulting with NHS in the summer
• Proportionate approach
• Do more at less trusts
• Integrate all audits
• More data items
• Wider scope
PbR National Benchmarker
PbR National Benchmarker tool
• Powerful online tool freely available
to the NHS
• Developed as part of the
assurance framework
• Robust and sophisticated
benchmarking methodology
• 42 separate indicators
covering both inpatient and
outpatient data
• Focus on data quality but
relevance beyond PbR
Data explorer
Scorecard viewer
HRG4 benchmarking
• PbR National Benchmarker updated
with HRG4 benchmarking May 2008
• Developed in conjunction with NHS
Information Centre
• New HRG4-specific indicators,
including:
– Unbundling
– Planned same day
– Short stay elective
• Improved functionality
So what should you do?
•Identify areas for improvement
•Review findings from audits
– Implement action plans
•Understand your data
– Ratify data with SUS
– PbR National Benchmarker
•Understand impact of HRG4 and new tariff
For more information…
www.audit-commission.gov.uk/pbr