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Payment by results: are we missing something?
Mohammad Shahid1, Alistair Tindall
1Department of Orthopaedics, Queen Elizabeth Hospital, Woolwich, London, UK. shahidm99@doctors.org.uk
International Journal of Health Care Quality Assurance
|June 26, 2013
Summary
Hospital trusts are losing significant revenue due to poor documentation of procedures like removal of sutures (ROS) and attention to dressing (AD). Improving coding practices is crucial for financial security.
Area of Science:
- Healthcare finance
- Medical coding
- Orthopaedic surgery
Background:
- Payment by Results (PbR) incentivizes hospital productivity.
- Specific tariffs exist for orthopaedic procedures like removal of sutures (ROS) and attention to dressing (AD).
- Accurate documentation is essential for claiming these tariffs.
Purpose of the Study:
- To quantify the financial losses incurred by hospitals due to underclaimed ROS and AD procedures.
- To identify the impact of poor documentation on revenue in outpatient orthopaedic clinics.
Main Methods:
- A retrospective analysis of orthopaedic clinic consultations over one month.
- Comparison of procedure documentation between coding pro formas and dictated clinic letters.
- Identification of discrepancies in claiming for ROS and AD.
Main Results:
- Only one removal of sutures (ROS) was correctly documented on the pro forma for coding.
- Hospitals failed to claim £9,838 in one month for these procedures.
- Annual revenue loss due to underclaiming is estimated at £118,056.
Conclusions:
- Current medical coding practices in orthopaedic clinics are substandard.
- Suboptimal documentation leads to significant financial losses for hospital trusts.
- Urgent improvement of coding policies is necessary to ensure financial stability.
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