Payment by results: are we missing something?

Payment by results (PbR) was introduced to reward hospitals for productivity. In orthopaedic clinics there is a separate tariff for two procedures: removal of sutures (ROS) and attention to dressing (AD). The Trust claims a fee each time these have been performed. The purpose of this paper is to look at how many of these procedures were performed in an outpatient setting but were not claimed for because of poor documentation.

A retrospective study was performed analysing all orthopaedics clinics occurring in one month. After each consultation the clinician completes a coding pro forma and dictates a clinic letter. The pro forma contains a list of the orthopaedic procedures attracting a tariff and used for coding. A comparison was made between what was documented on the pro forma and the clinic letter to see how many times ROS and AD were done.

A total of 72 letters were extracted which contained ROS and AD. Only one of the ROS was documented on the pro forma and subsequently captured by the coders. In one month the Trust failed to claim 9,838 pounds. Annually this equates to a revenue loss totaling 118,056 pounds. Practical implications - Current coding practice is substandard. To maintain financial security Trusts must improve their coding policies as a matter of urgency.

The paper demonstrates clearly that hospital trusts are losing out financially from this suboptimal practice.