In 2007, the Audit Commission began a quality assurance programme for the data that drives payment by results, the national tariff payment system for acute and specialist hospitals. The system creates a payment per patient, depending on the treatment that the patient is given, that hospitals charge Primary Care Trusts (PCTs).
Each year, data is audited at every acute and specialist hospital in England to check how accurately its clinical coding reports the treatment given to patients. Since 2008 the accuracy of outpatient data at every hospital has also been looked at. Hospitals use the data on inpatients and outpatients to determine how much PCTs should pay them, so it is important that it is accurate. The NHS also uses this information to plan and monitor healthcare provision. Good quality data also supports effective commissioning. As the NHS places more focus on improving efficiency and outcomes, measurement of progress will be dependent on accurate coding data.
The accuracy of coding data has improved since 2007. At the start of the programme, average clinical coding errors at trusts were 16 per cent. This has reduced to 11 per cent. Over the three years, the gap between the best and the worst trust has also narrowed. Despite the improvement nationally, there is still a high proportion of trusts whose coding accuracy is poor, or who do well in certain specialties but not in others.
The audits normally target specialties at individual trusts where we it seems there may be problems with the coding data. A national benchmarking system, used by all trusts and PCTs, can also be used by trusts and PCTs to spot where hospital activity is inefficient by comparing indicators with other hospitals. Since 2007 random sample audits have also been carried out on four specific specialties at all trusts that deliver them, to give a national picture across the NHS in England. The four specialties are: general medicine, trauma and orthopaedics, cardiology, and paediatrics. It is estimated that, of the £21 billion paid over the last three years for treatments in these specialties, £1 billion was incorrectly paid because of wrong data. Nationally, the under- and overpayments balanced out but there is variation locally.
To tackle this NHS Trusts need to make sure that: regular internal audits on clinical coding and the quality of outpatient data are carried out; clinical coders are well trained and follow national standards; clinicians are engaged in improving the accuracy of inpatient and outpatient data; policies and procedures for data quality and capture are up to date; and medical records are of a good quality, accurate and are readily accessible to those inputting data.