Currently there are significant variations betweenPCTs and Practices in their understanding andimplementation of:

PBC

Data Validation

Information Provision

Support

Incentives

Secondary Care Information Systems provided by PCTs

• Ardentia• CHKS• Dr Foster• Midas• CBSA

• All re-present secondary data in a form which aids easier analysis, however, they are complex and time consuming to obtain information.• They make reference to financial accountability but cannot provide data that identifies the coding errors which currently maybe as high as 30%

(Source: National Association of Clinical Coders / Audit Commission)

• Executive Viewer• PB Views • MIS• etc…

Innovative commissioning support systems now being implemented

The Commissioning Business Support AgencyCovers 17 PCTs in the

West Midlands SHA representing5.5 Million patients

AUDIT COMMISSION REVIEW OF NHS FINANCIAL YEAR 2006/7

- There is a growing concern over accuracy of PbR coding

- Disputed balances were not resolved on a timely basis

These issues are arising from interpretation of 650 codes in HRG V3.5 which will increase to

2000 codes with the launch of HRG V4 in early 2009

Example of benefit from using iQ Budget ManagerSharon Snape – Practice Manager

North Staffs Practice

The Audit Commission isresponsible for ensuring thatpublic money is spent economically,efficiently, and effectively toachieve high quality servicesfor the public

Audit Commission Recommendations

Providers of acute NHS services should :-

Improve coding internally

Ensure local information systems are in place to complement SUS Engage in discussions with commissioners about changing patient pathways, demand management, and use of local flexibilities, such as unbundling the tariff

Audit Commission Recommendations

All PCTs should :-

Adopt a robust yet proportionate approach to monitoring and challenging provider activity and costs under contract, prioritising investment in practice level information systems so that practices can engage in the planning and monitoring of hospital activity

Further develop commercial, legal and contracting skills, identify gaps in line with developing World Class

Commissioning competencies

Audit Commission Recommendations

All PCTs should :-

Continued ….

Focus on demand management (care and resource utilisation) initiatives. Ensure that sufficient resources are devoted to these initiatives

Trusts and PCTs have been slow to engage these recommendations believing that it will prove

confrontational and difficult to administer

Healthcare Financial Management Association

Membership comprises all Trust and PCT Financial Directors / Senior Managers

“Clinical engagement is core to the commissioning process in both primary and secondary care, and practice-based commissioning, at the heart of World Class Commissioning, is a key component. For PBC and commissioning in general to deliver their full potential, accurate clinical coding is essential. Where practices identify inaccuracies, PCTs should support and encourage the improvement of data quality by Trusts and, where inaccuracies are proved to be correct, PBC data and budget spends should be corrected by PCTs. This exercise is determined locally, but without support from PCTs for practices engaged in PBC, they will become disillusioned and a major component of World Class Commissioning will fail.”

Department of Health

iQ BUDGET MANAGEROne Product – Two Vital Tasks

Validating Secondary Care Charges which impact on Indicative Budgets

and

Analysing Demand Management Information to support Preparation and Monitoring of

PCB Plans

Overview of key features of Budget Manager

The key to understanding and managing Charge Coding (HRG and Clinic Codes)

Delivers the HRG code and tariff by describing the patient condition in ordinary terms

The key word search will check patient condition against 160,000+ terms in Read Code V3.0 (all clinical systems use V2.0)

Also automatically references OPCS and ICD10 to filter the description

System automatically displays the HRG and anticipated charge based on the National Tariff. Local and Split Tariffs can also be accommodated

Overview of key features of Budget Manager

Continued ….

Enables referrals/discharges to be analysed against HRG, provider, speciality, episode type, practitioner, patient, pathway, referral status and cost etc

Numerous reports can identify areas of concern e.g. GP referring patterns, overcharging care providers, high incidence procedures, high cost procedures, incorrect charges and the reasons behind them etc.

Brief Demonstration of IQ Budget Manager

Version 2.