Abstract
Introduction: Payment by results was introduced into the NHS in an effort to finance Trusts fairly and reward good performance. Tariffs for a single patient episode are derived from diagnosis and procedure codes, comorbidities, patient age, and length of stay. Poor data collection can result in a lower tariff with subsequent under billing of the Primary Care Trust (PCT). In addition, an individual surgeon’s performance in future comparison league tables will rely on the accuracy of this data. Methods of documentation and data collection vary in different units. We evaluated the methods and the resulting tariffs in 2 units in the Northern Deanery.
Methods: Case notes were examined for 20 consecutive orthopaedic patients discharged from unit A, and 20 from unit B. The case mix in the two groups was similar. A correct tariff based on case notes was compared with the actual tariff used to bill the PCT for each patient. The coding department derived actual tariffs from data in electronic discharge summaries created by ward based junior medical staff in unit A. Accurately completed typed case notes were available to coders in unit B.
Results: Only 3 of the 20 tariffs (15%) were correct for unit A patients. This represented a total financial loss to the trust of £14892 (25% of total revenue). In unit B, 19 of 20 (95%) tariffs were correct. An error in the coding for one procedure resulted in a higher tariff being assigned to a patient (total gain of £486, < 1%).
Discussion: Orthopaedic departments create large Trust revenue. Accurate documentation and information transfer for coding is essential for payment by results to function correctly. Trusts which fail to do this will be financially penalised and surgeon league tables may not adequately reflect individual case complexity. We recommend all Trusts use the model established in unit B.
Correspondence should be addressed to Mr John Hodgkinson, BHS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
