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Board of Directors – Part I10 th June 2011These have all been hugely challenging, but we have actually achieved the seachange in each to underpin our coding quality. Therefore the areas in the action planare relatively straight forward in comparison to previous year’s requirements. The onlysignificant changes revolve around IT, which are discussed below, under action plan.However, maintaining the constant attention to improvement in all aspects of coding,along with the two day coding completion deadline (the fastest we know of in the NHS)plus having one of the lowest cost departments using Audit Commission benchmarks,is not easy. Therefore Board level recognition of the Coding Department’s staff effortwould be appreciated. This combined with feedback to clinical staff about the positiveimpact of their efforts to improve should create a positive cycle for ongoing accuracy.3. Update on the recommendations and proposed action planThe Coding Department has an accuracy improvement plan that goes far beyond theformal recommendations, as it did last year as well. However this section reflects thesix areas highlighted by the Commission. R6 relating to IT systems, has been carriedover from last year.R1 Angiogram recording. This change has been deferred to April 2012, and isdiscussed further below, as part of the wider context.R2 Skin procedure training has occurred. Action completed.R3 Coding clinic co-morbidity list new widely circulated and embedded. Actioncompleted.R4 Image control recording by clinical staff. Training has been implemented and isbeing monitored, especially in Interventional Radiology. Action completed.R5 Review and share the results with Medical Records User Group. This isunderway, but the Commission recognises this is more good practice rather thanactually being expected to improve accuracy, and is a repeat of last year.R6 Update the system, avoiding READ codes. This is discussed below.As of May 2011 all actions are completed to an agreed outcome, with the exception ofa date for the IT update to allow us to move from READ coding. This is likely to occurin late 2011, following upgrade to the server capacity in the summer. This change willhave numerous benefits including:• Less transcription errors, improving our accuracy scores.• Faster upgrades to OPCS, again improving our coding accuracy.• Less staff time and duplication of entry.• Better ability to audit coding accuracy in house, as part of the coding teams work.Results of the 2010/11 PbR Assurance Clinical Coding Audit Page 2 of 3
Board of Directors – Part I10 th June 20114. Wider context for coding accuracy and improvementThe most contentious part of the Audit Commission recommendations is regardingcardiac angiogram recording, as part of another procedure. Our view, and that ofmany Trusts, is that all activity should be coded, and it is for the grouper to assign thisto the right HRG. Therefore the national and local message was to record allprocedures as part of an episode of care.The recommendation is to stop recording angiograms where an angiography isundertaken. Whilst the financial impact of this within the cohort of patients audited isnet neutral, estimates of the Trust wide impact of this change are between £400k and£750k. The PCT and Trust have not agreed a financial impact figure, but have agreedto defer the implementation of the change for 12 months, starting April 2012. This isbalanced by the Trust agreeing to defer the impact of Emergency Departmentattendance tariffs for the same period. Again estimates have not been agreed, but theTrust is confident we will be able to at least, offset the angiogram impact, andpotentially more than offset it.All other changes arising from the results of the audit will though be enacted in2011/12.5. Future plansAn external company will once again undertake a mid year audit using the samemethodology as the Audit Commission. This will be used to give external assuranceregarding the actions and outcomes discussed here. The audit Commission will thenrepeat this exercise in a similar timescale next year, with exact dates still to beconfirmed.The wider work on improving coding accuracy will also continue.The results of the Audit Commission report will be made available to ourcommissioning PCTs, and publicly. The results will also be used to inform our CQCmonthly quality risk report.6. RecommendationsThe Board are asked to note the report and actions, and the significantimprovements in performance. An update after future re-audits will beshared with the Board.Results of the 2010/11 PbR Assurance Clinical Coding Audit Page 3 of 3
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