Experience shows that monitoring payments and behaviour will be crucial to ensure that Payment by Results (PbR) operates as intended. Of particular importance is the quality of the data that underpins payments, and the accuracy of those payments, but there are also broader issues.
What is happening?
This is the third year of the PbR Data Assurance Framework. There are four parts this year to the process:
- an independent, targeted external clinical coding programme on a sample of admitted patient care (inpatient) data
- an assessment of the arrangements and testing of a sample of outpatients data
- provision of a national benchmarking tool
- regular national briefings on emerging issues from both the coding audits and benchmarking indicators
The PbR Assurance Portal has also been developed to support you through every aspect of the assurance framework.
Coding Against OPCS 4.5
In line with Connecting for Health’s Audit Methodology, the coding audit will be undertaken using OPCS 4.5. This was a mandated change and should have happened on 1 April 2009. If trusts have not implemented the update we will report this and record the errors as system errors. Late implementation of the update to OPCS 4.5 is not regarded as a sufficient reason to delay the coding audit at a trust.
What are the arrangements for inpatient audits?
As part of a review of the arrangements, a number of changes have been made to the process, including:
- more local discretion in selection of audit areas – to be agreed at set up meeting
- formal follow-up of recommendations from previous years - the Trust is required to bring an update to the set up meeting and the coding auditor will verify actions during the audit
- SHA Auditor assisting with communication and co-ordination with central team
What are the arrangements for outpatient audits?
From October 2008 the Commission is undertaking a separate audit of data quality in outpatients, visiting all trusts covered by PbR over an 18 month period finishing in March 2010.
A list of trusts to be visited during 2009-10 (XLS) (opens in a new window) is available. The exact date of audit is to be agreed between the Trust and the local Audit Commission auditor.
Account Manager Pilot
In 2008/09 we piloted this process in the London SHA area for some clients. Because of the success we have extended the pilot to cover all trusts in the London, the East and England and the East Midlands SHA areas. The account manager will manage the local delivery of the project, including:
- arranging and chairing the set up and closure meetings
- acting as first point of contact for trusts and PCTs
- managing the delivery of the draft and final reports
A list of all audits involved in the Account Manager Pilot (XLS) (opens in a new window) is now available.
National Benchmarker
At the centre of the Commission's assurance framework lies the first comprehensive programme of national benchmarking using data from the Secondary Uses Service (SUS).
Pilot work
During 2009/10 we piloted work on Accident and Emergency. We have published a briefing outlining our findings from these audits, PbR data assurance framework: briefing on our A&E pilot audits. For more information, please contact Bevin Manoy, PbR programme manager on b-manoy@audit-commission.gov.uk .
Accessing audit reports
If you are a PCT who commissions services from a trust and you require a copy of the reports, please contact the host PCT or access the report via the PbR portal.