News / Assurance framework shows decrease in PBR data errors

An improvement in coding, a fall in inaccurate payments and no evidence of gaming were the main headlines of the Audit Commission’s second annual review of payment by results data. But the watchdog warned that some medical records are still poor.

The Audit Commission’s second report as part of its PBR data assurance framework, published at the end of August, was based on the findings from 170 clinical coding audits of admitted patient care carried out in all trusts in England in 2008/09.

In each trust 300 finished consultant episodes were audited across four areas, including either trauma and orthopaedics or general medicine and locally decided areas indicated by a national benchmarking tool.

Trusts were audited in different areas to 2007/08, making the results not directly comparable. But overall, there was an improvement in the coding of activity. The overall mean coding error in 2008/09 was 12.8%, showing an improvement from the previous year of 3.7 percentage points.

Incorrect primary and secondary procedure and diagnosis codes can lead to the assignment of an incorrect healthcare resource group (HRG) and so trigger an incorrect payment. In 2008/09, the average HRG error rate was 8.1%, down from 9.4% in 2007/08. These HRG errors equated to gross payment errors (both under- and over-charging) of £2.6m, 3.9% of the £66m of expenditure covered by the audits.

Again this represented an improvement on 2007/08, when the gross monetary value of errors was 4.9% of the sample. In net terms – looking at the overall impact for each trust taking account of over and underpayments – the impact was virtually zero, just 0.1% of the sample value.

Audit Commission managing director for health Andy McKeon said there was a clear improvement in the way trusts are coding data.

‘But problems remain and there is very significant variation in trust performance, with errors ranging from 1% to 40%,’ he said. ‘Improving the quality of the data and in some case the quality of medical records is important if the NHS is to improve the quality of its care and efficiency as well as accurately report its performance.’

Mr McKeon also warned that the increased sophistication of the payment system is likely to bring higher error rates in 2009/10.

The new version of HRGs (HRG4) is more sensitive to data quality and coding accuracy than version 3.5, used in 2008/09.

The commission said that if the audited sample had been grouped using HRG4, the overall error rate would have risen by 3.2 percentage points to 11.3%, with a resulting 0.8 percentage point increase in the net financial error. Local variation also increased in the HRG4 analysis.