PAYMENT BY RESULTS

Published: 03/11/2005 Volume 115 No. 5980 Page 31

Geoff Bick is director of product development at CHKS, sponsor of the acute healthcare organisation of the year category in this year's HSJ Awards.

There are major questions about some of the key building blocks of payment by results - finished consultant episodes and healthcare resource groups - and how different acute hospital practices of recording these can affect income.

The portrayal of hospital activity through HRGs depends on diagnosis and procedure coding.

There are a range of approaches to the clinical coding process.

Hospitals carry out clinical coding in different ways, whether using the patient case note or an intermediate record as the source.

There is also widespread variation in the number of clinical coders. A survey by CHKS of 74 acute trusts last year found that the average number of FCEs per whole-time equivalent clinical coder ranged from 4,000 to 14,000.

As a result, the diagnostic coding depth with which acute hospitals describe their clinical activity covers an enormous range and the extent to which complications and comorbidities are recorded directly impacts on their HRG profile.

CHKS analysed activity for the current financial year across a representative sample of 98 English hospitals. Key findings were:

For teaching hospitals, which could be expected to have a higher case mix, the average umber of diagnoses per coded FCE was 1.73.3, with a mean of 2.5.

For non-teaching hospitals the average number of diagnoses per coded FCE was 1.6-3.9, also with a 2.5 average.

In both categories, foundation trust hospitals were scattered throughout the distribution and had neither consistently high nor low coding depth.

A comparison of 2004-05 and 2002-03 data showed that 11 per cent of hospitals had a reduction in coding depth, 16 per cent remained the same and 72 per cent had a higher average number of diagnoses per coded FCE. Ironically, the greatest fall, of 0.5 diagnoses per coded FCE, was at a foundation trust hospital.

For more information on coding, visit www. goodmanagementhsj. co. uk/coding