Results from 2007/08 Audits

Results from 2007/08 Audits

HRG errors of 9.4%

3.4m/5% financial error

.but no trend of over or under charging

Coder errors have wider data quality implications

Quality of source documentation the most significant cause of error

Training & development not numbers

The consequences of poor performance All reports are shared with the local NHS All summary results are published on the Commissions website Anonymised results appear in bulletins and national reports The trade press report on poor performance This creates a strong current of peer pressure to improve The Commission does not publish league tables In these first years we do not advocate a penalties regime and would not be the body to administer such a scheme PCTs have contractual levers to drive provider improvement The Commission incorporates results into its financial assessment of PCTs The Commission shares results with other regulators principally Healthcare Commission and Monitor

Lessons Learnt What went well What didn t Developments for 2008/09, 2009/10 & Beyond

Successes in 2007/08 We did manage to deliver 171 audits in about 10 months! The majority of audits were not challenged and reports were accepted by the local NHS The national report was well received as a useful contribution to the debate Our clients, stakeholders and sponsor are broadly happy The benchmarking has provided considerable added benefit The Assurance Framework has established its worth and will continue for 2008/09 and 2009/10

Challenges in 2007/08 Bigger logistical challenge than was anticipated a local audit programme being managed nationally joint working and set up outsourced specialist resource making the process leaner Impact on reporting - timeliness, quality, accessibility Adapting the methodology to new areas

National Report

Recommendations : trusts Key action points for NHS Trusts: implement their audit action plans to improve their clinical coding; review and, where necessary, improve their source documentation to promote accurate coding and particularly ensure clinicians are engaged and involved in validating coding; invest in and develop their coding departments through professional training and development; and use the National Benchmarker regularly to review potential coding anomalies and areas for improvement.

Recommendations: PCTs Key action points for primary care trusts (PCTs): monitor trusts implementation of their audit action plans and subsequent improvement in clinical coding; and use the National Benchmarker regularly to review potential coding anomalies and areas for improvement.

Recommendations: DH & NHS CfH Key action points for the Department of Health (DH) and NHS Connecting for Health (NHS CfH): review the coding systems and guidance for specialties, HRG chapters and HRGs which were identified as being prone to higher errors; clarify guidance on the identification and coding of co-morbidities. review the appropriateness of coding classifications for specialist activity to ensure they can accurately describe more complex activity accurately; continue to improve training and development programmes for clinical coders and clinical coding auditors. introduce a wider data quality programme for NHS bodies to drive improvements in the standards of data and increase confidence in its more widespread use.

Further analysis & research Publication of audit results SHA reports Trust and PCT comparisons Research programme on key areas such as clinical records and engagement, coding of specialist activity Data briefings

Programme for 2008/09 Continuation of the inpatient audit programme Re-audit all trusts again Follow up recommendations made this year Extension into audits of outpatient data quality Addition of independent sector providers A&E pilot Continual development and refinement of the audit process and methodology

2009/10 and beyond 2009/10 will see the introduction of a new casemix system - HRG4 - therefore we propose to maintain blanket coverage for another year However, this cannot continue indefinitely. In line with principals for better regulation, we must make the Assurance Framework more proportionate and riskbased in future Evaluation and development of the benchmarking methodology, combined with a track record of audit results will help us to do this