Payment by Results: A 2 Centre Comparison Study of Orthopaedic Patients Simon Jameson Tony Nargol Mike Reed Kreibich Memorial Prize Evening, March 2007.

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Presentation transcript:

Payment by Results: A 2 Centre Comparison Study of Orthopaedic Patients Simon Jameson Tony Nargol Mike Reed Kreibich Memorial Prize Evening, March 2007

background importance aim patients & methods results discussion Payment by results. Simon Jameson / Tony Nargol / Mike Reed Kreibich Memorial Prize Evening (March 2007) Outline BackgroundImportanceAim Patients & methods ResultsDiscussion

background importance aim patients & methods results discussion Payment by results. Simon Jameson / Tony Nargol / Mike Reed Kreibich Memorial Prize Evening (March 2007) Trust income Payment by results Tariffs - HRG codes Cost-per-patient Agreed national prices Reimbursement from PCTs >95% orthopaedic dept funding

background importance aim patients & methods results discussion Payment by results. Simon Jameson / Tony Nargol / Mike Reed Kreibich Memorial Prize Evening (March 2007) Factors affecting HRG Primary diagnosis and procedure Other diagnoses / procedures ICD-10 / OPCS-4 Elective or Non-elective Co-morbidityAge LOS (additional costs/day over ‘trim point’)

background importance aim patients & methods results discussion Payment by results. Simon Jameson / Tony Nargol / Mike Reed Kreibich Memorial Prize Evening (March 2007) Data collection & coding Source document: Full medical case notes Discharge summaries only Combination Methods vary between trusts Computer generation of HRG code +/- clinician review prior to billing

background importance aim patients & methods results discussion Payment by results. Simon Jameson / Tony Nargol / Mike Reed Kreibich Memorial Prize Evening (March 2007) Importance Correct payment for service provision Example Trust income ~£240 million £30 million from orthopaedic patients Surgeon performance League tables (drfoster.co.uk) Performance-related pay Statistics (WHO)

background importance aim patients & methods results discussion Payment by results. Simon Jameson / Tony Nargol / Mike Reed Kreibich Memorial Prize Evening (March 2007) Aim To assess: accuracy of data collection Importance of coding method for PbR in 2 NHS Secondary Care Trusts

background importance aim patients & methods results discussion Payment by results. Simon Jameson / Tony Nargol / Mike Reed Kreibich Memorial Prize Evening (March 2007) Patients & Methods 20 consecutive patients at 2 Trusts Review of: Medical case notes Discharge summaries Coding summary sheets Cooperation with Coding Department ACCURATE coding compared with actual Fisher’s exact test used for analysis

background importance aim patients & methods results discussion Payment by results. Simon Jameson / Tony Nargol / Mike Reed Kreibich Memorial Prize Evening (March 2007) Patients & Methods Trust A: Discharge summaries used to code Age 65.3yrs (range 36-96). 6 male: 14 female 14 trauma / 4 elective / 2 day case Trust B: Full case notes Age 52.0yrs (range 4-77). 12 male: 8 female 11 trauma / 4 elective / 5 day case

background importance aim patients & methods results discussion Payment by results. Simon Jameson / Tony Nargol / Mike Reed Kreibich Memorial Prize Evening (March 2007) Results Trust A: Only 9 HRG codes correct (45%) Actual income generated = £58443 ACCURATE income = £73335 Loss to Trust = £14892 (20%)

background importance aim patients & methods results discussion Payment by results. Simon Jameson / Tony Nargol / Mike Reed Kreibich Memorial Prize Evening (March 2007) Case mix & error (Trust A)

background importance aim patients & methods results discussion Payment by results. Simon Jameson / Tony Nargol / Mike Reed Kreibich Memorial Prize Evening (March 2007) Results Trust B: 19 HRG codes correct (95%) Actual income generated = £61125 ACCURATE income = £60639 Over billing error = £486

background importance aim patients & methods results discussion Payment by results. Simon Jameson / Tony Nargol / Mike Reed Kreibich Memorial Prize Evening (March 2007) Case mix & error (Trust B)

background importance aim patients & methods results discussion Payment by results. Simon Jameson / Tony Nargol / Mike Reed Kreibich Memorial Prize Evening (March 2007) Summary of Results Trust A Discharge summaries only 80% reimbursement = 20% loss 45% correct codes Trust B Full medical case notes 100% reimbursement 95% correct codes Code error difference is significant (p<0.05)

background importance aim patients & methods results discussion Payment by results. Simon Jameson / Tony Nargol / Mike Reed Kreibich Memorial Prize Evening (March 2007) Discussion 20% loss = £6million/yr* *Based on annual Orthopaedic department income of £30million

background importance aim patients & methods results discussion Payment by results. Simon Jameson / Tony Nargol / Mike Reed Kreibich Memorial Prize Evening (March 2007) Regional Trust Finances Trust B Surplus / Debt (£mil) Casenotes Combination D/c summaries Methods of coding and financial status of Hospital Trusts in the Northern Region 2005/06 (NHS figures) Trust A NHS Trust

background importance aim patients & methods results discussion Payment by results. Simon Jameson / Tony Nargol / Mike Reed Kreibich Memorial Prize Evening (March 2007) Consultant income £million generated by tariff

background importance aim patients & methods results discussion Payment by results. Simon Jameson / Tony Nargol / Mike Reed Kreibich Memorial Prize Evening (March 2007) Discussion Orthopaedic income is high Limitations – size / case mix Accurate documentation / coding essential Method of coding has implications Case note coding is gold standard Surgeons: league tables and PRP Stimulated pilot study at Trust A

background importance aim patients & methods results discussion Payment by results. Simon Jameson / Tony Nargol / Mike Reed Kreibich Memorial Prize Evening (March 2007) The End Thank you… Acknowledgements: Kim Oliver Head Coder, Northumbria Healthcare NHS Trust Margaret Flynn Senior Coder, North Tees and Hartlepool NHS Trust Nick Steen Statistics Analyst, Newcastle University