Findings of the national PbR data Assurance Framework: improving the quality of data underpinning payment by results using benchmarking to target clinical coding audits

Abstract

Since 2003/04 the Department of Health (DH) has been progressively implementing a prospective payment casemix funding system, known as Payment by Results (PbR), so that in 2008/09 over 90 percent of acute inpatient activity is reimbursed through PbR. The accuracy of the data recorded for each episode of care can directly influence the accuracy of reimbursement between commissioners and providers under PbR. In 2006, the Audit Commission was approached to develop a national data assurance framework for PbR. A pilot study found an average HRG error rate of 11.9 percent with considerable variation between trusts. The financial impact of the errors on payments represented between 5 percent and 14 percent of the total sample value. Following from the pilot, in 2007/08 the Commission began a national programme of PbR data assurance at all NHS acute trusts. This paper explains the components which make up the PbR Assurance Framework today; the particular contribution that benchmarking makes to the process; and the results from the first full year of audits.