The facts behind Practice Based Commissioning

Approx 1500 PBC clusters in England

Less than two-thirds have an agreed commissioning plan

Less than half have actively commissioned services

Currently there are significant variations betweenPCTs and Practices in their understanding andimplementation of:

PBC

Data Validation

Information Provision

Support

Incentives

“Practice-based commissioning cannot properly get off the ground until commissioners have access to accurate, meaningful real time information”

Dr Michael Dixon Chair NHSAlliance

NHS Alliance opinion

Secondary Care Information Systems provided by PCTs

• Ardentia• CHKS• Dr Foster• Midas• CBSA

• All re-present secondary data in a form which aids easier analysis, however, they are complex and time consuming to obtain information.• They make reference to financial accountability but cannot provide data that identifies the coding errors which currently maybe as high as 30%

(Source: National Association of Clinical Coders / Audit Commission)

• Executive Viewer• PB Views • MIS• etc…

Coding Issues

• There’s a 99% certainty that you are being wrongly charged for some secondary care episodes for your Patients

• Exceeding your indicative budget is therefore inevitable

These issues are arising from interpretation of 650 codes in HRG V3.5 which will increase to

2000 codes with the launch of HRG V4 in early 2009

A West Midlands Practice

The Audit Commission isresponsible for ensuring thatpublic money is spent economically,efficiently, and effectively toachieve high quality servicesfor the public

Audit Commission Recommendations

All PCTs should :-

Adopt a robust yet proportionate approach to monitoring and challenging provider activity and costs under contract, prioritising investment in practice level information systems so that practices can engage in the planning and monitoring of hospital activity

Further develop commercial, legal and contracting skills, identify gaps in line with developing World Class

Commissioning competencies

Focus on demand management (care and resource utilisation) initiatives. Ensure that sufficient resources are devoted to these initiatives

Reinforced by the Department

of Health

Main Points from DH Letter

• ‘For PBC and commissioning in general to deliver their full potential, accurate clinical coding is essential’

• ‘Where practices identify inaccuracies, PCTs should support and encourage the improvement of data quality by Trusts and, where inaccuracies are proved to be correct, PBC data and budget spends should be corrected by PCTs.’

DH Commissioning Assurance Scheme(For SHAs / PCTs)

• PCT Competency 10 Level 2

‘Data is accessible and used to monitor provider performance’

‘Monthly data from providers is no more than one month old’

Trusts and PCTs have been slow to engage these recommendations believing that it will prove

confrontational and difficult to administer

Healthcare Financial Management Association

Membership comprises all Trust and PCT Financial Directors / Senior Managers

Conservative Party Health Policy

‘The Conservatives also propose that the current policy of practice-based commissioning be extended to allow primary care clinicians to hold ‘real’ budgets compared with the ‘notional’ budgets under current policy’

Return of Fundholding?

iQ BUDGET MANAGEROne Product – Two Vital Tasks

Validating Secondary Care Charges which impact on Indicative and ‘Real’ Budgets

and

Analysing Demand Management Information to support Preparation and Monitoring of

PBC Plans

Overview of key features of Budget Manager

The key to understanding and managing Charge Coding (HRG and Clinic Codes)

Delivers the HRG code and tariff by describing the patient condition in ordinary terms

The key word search will check patient condition against 160,000+ terms in Read Code V3.0 (all clinical systems use V2.0)

Also automatically references OPCS and ICD10 to filter the description

System automatically displays the HRG and anticipated chargebased on the National Tariff. Local and Split Tariffs can also be accommodated

Overview of key features of Budget Manager

Continued ….

Enables referrals/discharges to be analysed against HRG, provider, speciality, episode type, practitioner, patient, pathway, referral status and cost etc

Numerous reports can identify areas of concern e.g. GP referring patterns, overcharging care providers, high incidence procedures, high cost procedures, incorrect charges and the reasons behind them etc.

Brief Demonstration of iQ Budget Manager

Version 2.