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Report shows year-on-year improvement but still too many medical coding errors

Report shows year-on-year improvement but still too many medical coding errors

A new Audit Commission report says NHS trusts are making fewer errors under the Payment by Results (PbR) system, but some medical records are still poor quality.

The second annual PbR data assurance framework shows that in the cases audited last year, over 12 per cent of the clinical codes for diagnoses and procedures were wrong. However, this is an improvement on 2007/08's figure of 16.5 per cent and the improvement in specialist trusts, such as hospitals for children, neurological, orthopaedic and cancer patients, was particularly notable.

The report says errors continue to affect the accuracy of payments for treatments in the NHS. On average 8 per cent of payments in the cases audited were wrong in 2008/09, down from 9.4 per cent in 2007/08.

The gross amount of over-charging and under-charging totalled £2.6million, which was 3.9 per cent of the coding sample reviewed compared to 4.7 per cent last year. The net financial impact was almost zero and there is no evidence of trusts seeking to 'game' the system and overcharge purchasers for the work that they do.

Andy McKeon, the Audit Commission's Managing Director, Health, said:
'Accurate information is essential for a quality focused and efficient NHS. There is a clear picture of improvement in the way trusts are coding data for payment under PbR but problems remain and there is very significant variation in trust performance, with errors ranging from 1 per cent to 40 per cent.

'Crucially, the payments system is now more sophisticated and more sensitive to data quality accuracy, which means we are likely to see an increase in error rates in 2009/10.

'Improving the quality of the data, and in some cases the quality of medical records too, is important if the NHS is to improve the quality of its care and its efficiency as well as accurately report its performance. Our report shows how improvements can be made.'

In its new report, the Commission raises concern over the poor quality of some medical records - about 80 per cent of PbR audit reports recorded problems relating to the quality of records. Some medical records were judged unsafe to audit.

A report for the Commission by the Royal College of Physicians, published alongside this year's PbR framework, makes a series of recommendations to improve the recording of medical information. Implementing the College's national standards for the structure and content of medical records would provide much needed clarity and consistency in documenting episodes and care and improves the efficiency of clinical coding.

Professor Iain Carpenter, Associate Director, Records Standards at the Royal College of Physicians, said:
'Implementing the Academy of Medical Royal Colleges’ Record Keeping Standards1 can improve medical records and the accurate retrieval of important clinical data. This report also shows that using the standards would make clinical coding more efficient and accurate, reducing financial errors in the reimbursement of hospital activity - particularly in 2009/10 with the introduction of HRG4, which is more sensitive to coding accuracy and data quality.'

Notes for editors

  1. The Payment by Results (PbR) Data Assurance Framework is designed to support data quality improvement in the NHS. It reviews the quality of key data that underpin payment under PbR and provides assurance that data is of sufficient quality for the system to function robustly. The framework was developed by and is managed by the Audit Commission.
  2. The new report presents key findings and a summary analysis of 170 clinical coding audits of admitted patient care data carried out all acute trusts in England during 2008/09. This is the second year of the programme.
  3. The audit in each NHS trust consisted of a clinical coding audit of 300 finished consultant episodes, or 200 at specialist trusts, reflecting their lower volume and complexity of the case mix. (A more detailed breakdown is available in the full report.) The samples are too small to enable the results to be extrapolated across the whole of a trust’s activity.
  4. Summary results from all the audits are published at www.audit-commission.gov.uk/pbr and there is also a 26-page supplementary analysis report.
  5. Record Keeping Standards is a development led by the RCP’s Health Informatics Unit and funded by Connecting for Health.
  6. The Audit Commission is an independent watchdog, driving economy, efficiency and effectiveness in local public services to deliver better outcomes for everyone.
  7. Our work across local government, health, housing, community safety and fire and rescue services means that we have a unique perspective. We promote value for money for taxpayers, auditing the £200 billion spent by 11,000 local public bodies.
  8. As a force for improvement, we work in partnership to assess local public services and make practical recommendations for promoting a better quality of life for local people.

For further information please contact:

Nigel Watts
Media Relations Manager
Email: nigel-watts@audit-commission.gov.uk
Tel: 020 7166 2129
Mobile:07813 315538

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