Haslemere Health Centre & Grayshott Surgery Commissioning Data Quality Audit Report

Transcription

1 Haslemere Health Centre & Grayshott Surgery Commissioning Data Quality Audit Report October 2010: Results from historic analysis This report covers the findings of a pilot which we were commissioned to undertake on historic data for Haslemere Health Centre and Grayshott Surgery over a 1 month period October This shows the validation results broken down by episode type. It also provides summary information of the overall findings and information around Discharge Delays. Particular attention to paid to the figures on Page 9 and also the percentage error rates. Introduction It s important to note the following, when viewing this report: 1) The full audit includes 2 practices: Haslemere Medical Centre (including Fernhurst Surgery) and Grayshott Surgery. 2) This is a complete dataset for October ) If a (discharge and clinic letters) has not been received by a practice, validation on HRGs cannot take place on these episodes. It should therefore be assumed that, as this audit took place in February 2011, the practices are unlikely to receive these s. 4) Any local agreements, for example Local Tariffs or Block Contracts, have not been taken into account in this data audit. 5) All costs are pre Market Forces Factors. 6) Queries are only shown where the practice has been overcharged. Haslemere Health Centre & Greyshott Surgery Data Quality Audit Report (Oct 2010 Historic analysis) 16-February-2011 Page 1 of 15

2 Definitions Charge Code Queries these are simply where the Clinic / HRG code on the SUS data disagrees with the information from the Secondary Care ation received by the practice (Clinic Letters / Discharge Summaries) The Queries also take into consideration discrepancies associated with Episode Type, Cost and Length of Stay. Rejected Items these are administration based errors identified during the validation process including: No ation received Patient did not attend Patient not registered at the practice Billed date is different to letter date Duplicate bill Document has no admission date/discharge date No NHS number supplied on SUS Other essential information missing Patient did not wait A&E attendance has linked IP letter but no A&E letter Haslemere Health Centre & Greyshott Surgery Data Quality Audit Report (Oct 2010 Historic analysis) 16-February-2011 Page 2 of 15

3 Potential Financial Results A&E 459 records have been processed. Charge Code Queries 15 Charge Code Queries were raised, that show an overcharge of Rejected Items 280 items were rejected as follows: 128 x A&E attendance has linked IP letter but no A&E letter 12, x No ation received 9, x No NHS number supplied on SUS 2, x Other essential information missing x Patient not registered at the practice x Duplicate bill Total Rejected 26, Total Charge Code Queries Total 26, Haslemere Health Centre & Greyshott Surgery Data Quality Audit Report (Oct 2010 Historic analysis) 16-February-2011 Page 3 of 15

4 Planned same day 259 records have been processed. Charge Code Queries 15 Charge Code Queries were raised, that show an overcharge of 20, Rejected Items 81 items were rejected as follows: 65 x No ation received 36, x No NHS number supplied on SUS 7, x Other essential information missing 4, x Document has no admission date/discharge date 0.00 Total Rejected 48, Total Charge Code Queries 20, Total 68, Haslemere Health Centre & Greyshott Surgery Data Quality Audit Report (Oct 2010 Historic analysis) 16-February-2011 Page 4 of 15

5 Elective inpatient 53 records have been processed. Charge Code Queries 9 Charge Code Queries were raised, that show an overcharge of 6, Rejected Items 7 items were rejected as follows: 5 x No ation received 11, x No NHS number supplied on SUS 1, x Other essential information missing 1, Total Rejected 14, Total Charge Code Queries 6, Total 21, Haslemere Health Centre & Greyshott Surgery Data Quality Audit Report (Oct 2010 Historic analysis) 16-February-2011 Page 5 of 15

6 Non-elective inpatient No SLAM data available, as all episodes are paid for under a block contract. Rejected Items No SLAM data available. Total Rejected Total Charge Code Queries Total N/A N/A N/A Haslemere Health Centre & Greyshott Surgery Data Quality Audit Report (Oct 2010 Historic analysis) 16-February-2011 Page 6 of 15

7 Outpatients 1262 records have been processed. Charge Code Queries 29 queries were raised, that show an overcharge of 1, Rejected Items 311 items were rejected as follows: 279 x No ation received 22, x No NHS number supplied on SUS 2, x Duplicate bill x Document has no admission date/discharge date x Patient not registered at the practice Total Rejected 25, Total Charge Code Queries 1, Total 27, Haslemere Health Centre & Greyshott Surgery Data Quality Audit Report (Oct 2010 Historic analysis) 16-February-2011 Page 7 of 15

8 Outpatient Procedures 451 records have been processed. Charge Code Queries 74 queries were raised, that show an overcharge of 6, Rejected Items 146 items were rejected as follows: 127 x No ation received 17, x No NHS number supplied on SUS 1, x Duplicate bill x Document has no admission date/discharge date x Patient not registered at the practice Total Rejected 19, Total Charge Code Queries 6, Total 26, Haslemere Health Centre & Greyshott Surgery Data Quality Audit Report (Oct 2010 Historic analysis) 16-February-2011 Page 8 of 15

9 Totals Total Value of Billed Items processed 405, Total Value of HRG Queries 35, Total Value of Rejections 135, Total Value of HRG Queries and Rejections 170, Total Percentage of HRG Queries (Value) 8.82% Total Percentage of Rejections (Value) 33.36% Total Percentage of Queries and Rejections (Value) 42.18% Haslemere Health Centre & Greyshott Surgery Data Quality Audit Report (Oct 2010 Historic analysis) 16-February-2011 Page 9 of 15

10 Documentation Delays - Results to 16/02/2011 Main Summary Documents Delay Report: Of the 1578 Documents received from: ROYAL SURREY COUNTY HOSPITAL NHS TRUST (RA2) Episode Type Total Processed Total Received 0-3 Days 4-6 Days 7-14 Days Days Days 101 Days + Not Received Accident & emergency attendance Planned same day Elective inpatient Non-elective inpatient New outpatient attendance Follow-up outpatient attendance Outpatient procedures Totals These figures only include s which have been received at the time of the data being exported from the iq Budget Manager system. Haslemere Health Centre & Greyshott Surgery Data Quality Audit Report (Oct 2010 Historic analysis) 16-February-2011 Page 10 of 15

11 Document Delay Chart 800 Number of Documents Processed Received Not Received 0-3 Days 4-6 Days 7-14 Days Days Days 101 Days + 0 Accident & emergency attendance Planned same day Elective in-patient Non-elective inpatient New out-patient attendance Follow-up outpatient attendance Outpatient Procedures Episode Type Haslemere Health Centre & Greyshott Surgery Data Quality Audit Report (Oct 2010 Historic analysis) 16-February-2011 Page 11 of 15

12 Documentation Completeness Results to 16/02/2011 Main Summary Documents Completeness Report: Of the 1578 Documents received from: ROYAL SURREY COUNTY HOSPITAL NHS TRUST (RA2) Episode Type Total Processed Total Received NHS number Patient s name Date of Birth Patient s address Name of clinician seen Was this a typed discharge letter? Patient s postcode Accident & emergency attendance Planned same day Elective inpatient Non-elective inpatient New outpatient attendance Follow-up outpatient attendance Outpatient procedures Totals These figures only include s which have been received at the time of the data being exported from the iq Budget Manager system. Haslemere Health Centre & Greyshott Surgery Data Quality Audit Report (Oct 2010 Historic analysis) 16-February-2011 Page 12 of 15

13 Documentation Completeness Chart Processed 800 Received Number of Documents NHS number Patient s name Date of Birth Patient s address present on Accident & emergency attendance Planned same day Elective in-patient Non-elective inpatient Episode Type New out-patient attendance Follow-up outpatient attendance Outpatient Procedures Name of clinician seen Was this a typed discharge letter Patient s postcode Haslemere Health Centre & Greyshott Surgery Data Quality Audit Report (Oct 2010 Historic analysis) 16-February-2011 Page 13 of 15

14 Summary Notes These notes are made by the Engineer who visited both practices. The notes apply to both practices, unless otherwise specified: Neither practice receives letters for A&E if the patient is subsequently admitted for a non-elective inpatient stay. After speaking with a contact at the PCT, it was confirmed that practices are supposed to receive letters from A&E, but that historically the PCT have not enforced this. If a practice wishes to receive them, then a formal request can be made. Practices do not receive SUS/SLAM data for non-elective inpatient episodes as these are paid under a block contract. Outpatient letters are not formatted in an easy-to-digest manner. If a procedure does take place, therefore increasing the cost, the user is forced to read the entire letter to assess whether a procedure took place or not. Asking the providers to change the format of the letter would make both Read Coding and Validation a faster task. Outpatient appointments and the billing process are not always consistent. For example Clinical Haematology visits where the patient has had bloods taken are often billed as QZ05B Miscellaneous Vascular Procedures without complications. So for every appointment where blood tests are mentioned this code was chosen, as it could be a local agreement. However, sometimes they were billed as a simple Clinical Haematology outpatient attendance. For some reason, this was more inconsistent at Grayshott Surgery. A&E letters are typed on the front page where patient details are given, however these are then completed by hand for the diagnosis and action taken. These are often impossible to read and occasionally, a key word like x-ray could be found, therefore the episode was logged at high cost tariff charge. A fully typed letter would be much more useful for Read Coding and Validation purposes, as the standard of handwriting was often very poor. Haslemere Health Centre & Greyshott Surgery Data Quality Audit Report (Oct 2010 Historic analysis) 16-February-2011 Page 14 of 15

15 Gastroenterology Outpatient Attendances are often billed as General Medicine, but not in a consistent manner. There are lots of random ear procedures and some mouth procedures that have been billed but no ation has been sent. Several of these are for children so it was not known if these are legitimate for things like dental work that is not ed or they are just falsely billed items. They have all been rejected if there was no ation. For both practices we gave +/- 2 days leeway for discharge dates from what the billed item date was, to what date was on the letter. Any more than this was rejected as no ation found. A lot of A&E letters are billed 1 day later than the date on the discharge letter. We linked and accepted these, but this issue would cause confusion from a Validation perspective if not corrected in the future. The majority of letters are not stamped at Haslemere. The majority of letters at Grayshott are stamped but unreadable, so all round better stamping is required. We chose letter received date as same day as clinic/discharge date for episodes where the stamp date was not on the letter or was unreadable. If the local contract has provision for challenges made under the time taken for letters to arrive, this process would need to be improved in both practices. Haslemere Health Centre & Greyshott Surgery Data Quality Audit Report (Oct 2010 Historic analysis) 16-February-2011 Page 15 of 15