News / Monitor examines potential for validation checks to support patient costing

Monitor has started to develop some intelligent validation checks to support future patient-level cost collections.

The sector regulator published some high-level statistics from its second voluntary patient cost collection in December, alongside its proposals to introduce a mandatory patient costing method across the whole English NHS.

The new data, released in a Monitor webinar, is based on 68 acute providers’ 2013/14 admitted patient care costs, up on the 66 providers that submitted data last year, with 52 trusts submitting on both occasions.

The breakdown of the £14.6bn costs, incurred across 7.9 million finished consultant episodes, was similar to the 2012/13 data, with wards (23%), overheads (20%) and medical staffing (16%) accounting for nearly 60% of total costs.

With two years of data, Monitor has been able to start examining cost volatility. For example, submitted data for the healthcare resource group WA01W (Manifestations of HIV or AIDS with CC score of 1+) exhibited a 44% increase in average costs on similar levels of activity – with the majority of costs being associated with drugs.

While the regulator used a number of new validations built into the cost submission process, it has also started to explore how more intelligent checks could be used in future.

In particular it is looking to highlight where coding and costs in cost pools appear inconsistent. So, for example, if there was a procedure code for a pacemaker implant, it would expect to see material costs in the implants cost pool group.

In total, Monitor analysed 3.7 million occurrences of procedure codes linked to eight cost pools, including those for implants, theatres, imaging and other diagnostics.

Some 69% of procedures for which you would expect to see costs in the ‘other diagnostics’ cost pool had zero or small costs in that cost pool. Similarly 44% of episodes with a relevant procedure code had zero costs in the implants cost pool.

Some trusts appeared to have good costing processes in place. For example, in one trust only 0.5% of more than 1,800 episodes associated with implant and prosthesis codes had zero costs in the relevant cost pool. And nearly 70% of these costs were within the expected range for that cost pool. At the other end of the scale, two trusts submitted data with zero costs in the implant cost pool for all its implant associated activity.

Monitor stressed the analysis was still in its early days and that the approach needed to be refined with the involvement of providers. But as well as providing data validation opportunities, it could help identify good practice.

‘There are some organisations where the costs associated with procedure codes are being handled really well and some where that appears not to be the case,’ said Matthew Bell, costing manager at Monitor.

‘This isn’t necessarily a definitive indicator of good quality, but it should raise awareness of potential issues.’

The approach could be developed  as part of an automated check, where there is an unarguable link between procedure codes and cost pools. Or it could be provided as a tool for organisations to run their own validation work.