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PbR coding errors could delay shift of work to primary care, report warns

By Steve Nowottny

Almost one in ten episodes of acute hospital care is incorrectly coded under Payment by Results, according to a new study.

Researchers from the Audit Commission examined the coding of more than 50,000 episodes – equivalent to roughly £73 million of expenditure under Payment by Results – and found an average Healthcare Resource Group error rate of 9.4%, with a range across trusts from 0.3% to 52%.

The errors contributed to a gross financial error of approximately £3.5 million, approximately 5% of the sample reviewed, although researchers concluded ‘the net financial impact is close to zero, indicating no national trend in under- or over-charging or gaming.'

But the commission warned the poor data quality and inaccuracy of payments would have a knock on effect for NHS reforms, particularly the Darzi review's emphasis on quality and the shift of work to primary care.

‘The accuracy of this information not only affects the finances of the NHS, but also how and where care is delivered,' the report concluded. ‘For example, without accurate and appropriate clinical coding, commissioners would not be able to accurately assess activity that could be redesigned for delivery in primary care.'

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