Auditors urge CCGs to improve PbR data

Clinical commissioning groups should improve the quality of data used for payments to NHS hospitals by making regular audits and reports part of new provider contracts, the Audit Commission has said.

The commission’s annual report on the Payment by Results data assurance programme says four NHS trusts are consistently good at clinical coding, while the rest vary between poor performance and mediocrity.

PbR is the tariff system that governs payments to hospitals by local NHS commissioning organisations.

The report recommends that CCGs use a checklist provided by the commission to improve the quality of this data.

The checklist suggests that CCGs make it part of their contracts with providers to carry out regular audits on data quality and report these to the commissioners.

CCGs should also require assurances from providers that they are implementing recommendations made at audits and make sure that providers with variable or poor performance demonstrate that data quality is improving.

At the moment, there are few consequences for trusts with persistent poor data quality.

When the Audit Commission revisted progress on areas for improvement that it had made in previous reviews, it found that fewer than half of trusts had completed or made satisfactory progress.

The report says that while most primary care trusts have adequate arrangements in place to ensure quality data is being used for contracting purposes, very few PCTs could be regarded as performing well in all the areas reviewed.

“Clinical commissioning groups and clinical support services can learn from the best practice shown by some PCTs in involving and engaging GPs and in benchmarking their acute providers,” it adds.

This includes involving GPs in contracting and data validation to identify potential data quality issues.

The report says that when looking at all trusts as a whole, performance on clinical coding has improved since the PbR assurance framework started, with lower average error rates each year and a smaller gap between the top and bottom of the error range.

However, individual trust performance varies each year and many trusts are not able to consistently achieve good levels of clinical coding accuracy.

Only four trusts have consistently been in the best performing 25 per cent of trusts, with error rates of between 0 – 4%.

“More have performed consistently poorly or have varied between mediocrity and poor performance,” it says.

The report concludes that, nationally, acute trusts undercharged PCTs by about £60m in PbR activity over 2011-12.

The commission this year audited key data that is used – along with clinical coding data – to determine the payment under PbR for a patient’s time in hospital.

It checked the accuracy of admission and discharge dates, which create the length of stay; the sex and age of the patient; and if the patient was admitted to hospital as an elective or an emergency. It found very low error rates of less than 1% in these areas.