2011/12 SUS Payment by Results (PbR) Release 9 Webinars - Questions and Answers

Transcription

1 2011/12 SUS Payment by Results (PbR) Release 9 Webinars - Questions and Answers This document contains the Questions and Answers from the five Release 9 webinar sessions run by BT. The answers to the questions have been provided by BT. The five webinar sessions were: o General Overview Part 1 o General Overview Part 2 o Readmissions o Best Practice o Critical Care The slides and recordings of these sessions, along with this document, are available at: Contents: Webinar: General Overview Part Webinar: General Overview Part Webinar: Readmissions... 8 Webinar: Best Practice Webinar: Critical Care Page 1 of 20

2 Webinar: General Overview Part 1 Question: Currently we extract Critical Care for Admitted Patient Care (APC) on a weekly basis; can you confirm if this will functionality will stop in R9? Answer: I assume you are taking the CC data from the SUS Extract Mart (SEM), if this is the case then no changes have been made to SEM data so you can continue. If you are taking Adult Critical Care (ACC) data from the Payment by Results (PbR) extract then these fields are no longer included in the APC data. Question: comment: The acronym RAP (Readmissions Pathway) might get confused with the Local Authority/Mental health definition (referrals, assessments and packages of care). Answer: DH is aware that we are using RAP and were involved in defining the requirements. They had no comment on its use. Question: How do you tell that a RAP is not a tertiary referral? Answer: A RAP is not defined by where the referral came from. Any admission that causes a Commissioning Dataset (CDS) 120, 130 or 140 record to be created will be treated as a potential element in the readmission pathway. The source of referral is not part of the exclusion logic. Question: When in the timetable will the critical care managed service extracts be available? Answer: The new managed service extracts will be produced immediately following the current managed service extracts and it is expected to be within the same timeframe in a normal month. These extracts are not currently within the current Service Level Agreement (SLA) and BT and NHS Connecting for Health (NHS CFH) service teams are working to create some form of SLA. Question: There are two new Specialised Service Codes (SSCs) for 2011/12 - will SUS PbR be applying these? Answer: SUS PbR will apply all SSCs and it will apply the SSC uplift according to the DH policy guidance and tariff spreadsheet. Page 2 of 20

3 The table below shows the SSC codes that cause a top-up to be applied, together with their hierarchy, so if codes 23 and 06 for a child are output from the grouper for a Spell then SUS will apply the top-up for 23 as its rank is highest (first). Age Group Specialised Service Code Rank Specialised Service (based on procedure and diagnosis map) CHI 23 1 Children Specialised CHI 06 2 Spinal surgery ADU 06 2 Spinal surgery OTH 06 2 Spinal surgery ADU 08 3 Neurosciences OTH 08 3 Neurosciences ADU 34 4 Orthopaedic OTH 34 4 Orthopaedic Question: What happens where a patient dies (and so is given a discharge date) but is kept in Critical Care to harvest organs the following day, so discharge from CC is greater than the Spell discharge? Answer: The provider would need to make a decision on which date they record as the Discharge Date for the CDS record. They could choose to use the actual date the patient was released from hospital in this scenario after the organs have been harvested. In this case the two discharge dates would be the same and hence no validation issues. The NHS data dictionary does not stipulate what the definition of a discharge is. If the CC discharge date is greater than the CDS discharge date then a validation error will be shown on the record. Question: From 2011/12 we will only be able to see 2011/12 data? Can we still download 2010/11? Is there a limit of time until when we can download 2010/11? Answer: There is no limit to how far back you can take PbR data from the PbR marts. I would recommend that you use that year s extract definition if you are taking data across multiple financial years as the attributes and views change year on year. So if you want 2006/07 data use 2006/07 extracts, for 2008/09 use 2008/09 extracts. Question: Why are the four new R9 extracts only being delivered as managed service extracts? Page 3 of 20

4 Answer: The CC and RAP extracts need to be at a point in time so the Reconciliation/Post Reconciliation points have been used. It was decided not to make the CC and RAP extracts available via the online service as they require significant processing to create. Question: Will the new critical care extract replace the existing critical care extensions? What will be the impact to the Healthcare Resource Group (HRG) grouper (for critical care)? Answer: The current APC extract contains Adult critical care data; this has been removed in 2011/12 and replaced by the new CC extract. All critical care is computed and grouped in SUS with the adjustments to episode length of stay which will impact the Spell Core HRG. The XC chapter HRG are shown on the new critical care extract for each period/daily record. Question: Will all the new extracts also be available as online extracts? Answer: No, the new extracts won t be available online; they are only available through the Managed Service. The reason for this is that some of the extracts, for example, the Readmissions extract, need to be done at a point in time. To establish what is actually a Readmission you have got to be working with frozen data (because one date could be a readmission and the next date might not be). In addition, it was decided not to make the CC and RAP extracts available via the online service as they require significant processing to create. Question: Where can I get the Department of Health (DH) business rules for readmissions? Answer: The DH guidance is published at the following website: Guidance/DH_ The NHS IC guidance is published at the following website: Question: do we need any additional "roles" to access the additional extracts? Answer: No - the current Role Based Access Control (RBAC) works fine and there are no new roles in R9. Page 4 of 20

5 Question: Further to the readmissions extract question, could you create an extract that is purely readmissions within your organisation, as these would be the majority of readmissions? Answer: It is possible to link admissions within an organisation or even multiple if you are a Primary Care Trust (PCT). You will need to have data that goes back as far as 1 st January 2009 as what you are linking is an Admission date for a closed Spell in 2011/12 where the admission date could be for example June 2009, so you then need to search back 30 days from that June 2009 date. The logic is complex and requires a lot of data to be held and you really need to use static data or readmissions will appear/disappear each time you try and create a report hence the use of the Reconciliation/Post Reconciliation data. Question: Will the critical care fields still be available within SEM as they are now? Answer: The SEM extract has not been changed. However it will not carry the validation indicators etc so what is in SEM today will remain in SEM, but it will not be uplifted for any new derivations that happen in R9. Page 5 of 20

6 Webinar: General Overview Part 2 Question: Should patients with no investigations or treatments have those columns as '00' or should the columns be submitted as null. These seem to conflict on the Data Quality (DQ) Dashboards. Answer: The DQ dashboard checks for a valid investigation code and uses the VODIM (Valid, Other, Default, Invalid or Missing), so if you don t put anything in, it will say that it is missing. 00 I suspect from the local grouper is probably an invalid investigation code; I am not sure what the default is on the CDS. There is no default code therefore I would suggest that you leave it as null. I don t know whether 00 would cause a UZ01Z. The only DQ check I can find for Emergency Medicine (EM) records is on the first ICD10 diagnosis code and is check K9 in the edqrs process. Question: Based on the 2010/11 data, how many episodes/spells will be affected by the new Global Episode Validation rule. Answer: Because all of the test data we use in R9 was based on live data we had well into the 50,000 mark of PbR qualified type eight s out of 500,000 records, so 10% is quite high. The results that we saw from the test data had obviously been compromised by moving dates to create PbR 2011/12 input data. The live service has been interrogated for the month of April and the following results show that 941 Spells had been excluded out of 1,056,003 which is less than 0.1% Question: Query Programme Budgeting Category (PBC) also for non-admitted? Answer: There are no PBC codes output from the grouper for Outpatient. There are PBC codes produced for DAYCASE Spells where the patient has not stayed overnight. Question: Will the PbR mart data items be documented including descriptions and any derivation calculations? Answer: The extract specifications are available on the IC website and contain description fields. What it does not do is give you a detailed logic derivation. But that side of it is being worked on as a separate piece of work with the IC and BT. Page 6 of 20

7 Question: Do the PbR extracts take (Accident and Emergency) A&E Department Type in to consideration to price Minor Injuries Unit (MIU) activity? The local grouper doesn't. Answer: Yes it does. The reference data available from the IC web site, and the Spreadsheet that has the number of 1421 which gives you a full explanation of all the reference data items in PbR, it has got the EM tariff which includes department types and MIUs. The EM mandatory tariff is computed using the HRG code + the Department Type + Patient Type so for example VB01Z Child would result in a tariff of 52. The department types are as follows:- o 01 = Consultant led 24 hour service o 02 = Consultant led mono specialty e.g. Dental o 03 = Minor Injuries Unit o 04 = Walk in Centres The department type 04 is excluded from tariff. Question: Where are you going to get the ICD-10 coding from in the EM CDS as our A&E systems do not use ICD-10 coding? Answer: The CDS record submitted to SUS carries an attribute for ICD-10 diagnosis codes and should be used by providers as it is defined as Mandatory in the NHS data dictionary. If a provider s local system cannot cater for ICD-10 codes then the provider will suffer under the DQ checks if these codes are not submitted. Question: For first question - EM Investigation codes not recorded should be recorded as '24 - None'? Answer: The value 24 in the investigation codes is described as None and the value 99 is also available which is Other. Both are seen as valid entries. Question: A&E Site code should be submitted to SUS or not? Answer: When you say Site Code do you mean using the full ORGANISATION CODE PROVIDER which caters for site codes as there is no separate attribute on the CDS for EM for SITE CODE. If this is what you are referring to then SUS will only use the first three characters of the code for processing unless the code begins with NT in which case it will use 5 characters. Page 7 of 20

8 Webinar: Readmissions Question: Will this (readmissions) work if providers are still submitting "bulk update" rather than "net change"? Answer: Yes, it is totally independent of how a provider sends the data. The service uses the data that is in the reconciliation and post reconciliation marts. Question: Do you also use Spell_ID apart from NHS _Number? Answer: No two admissions would have different Spell ID as each is allocated a unique value when the Spell is first constructed and any subsequent version of the Spell retains that value. So finding two admissions for the same patient can only be performed using a PATIENT identifier and the NHS number is now nearing 99% population on all submissions. Question: What happens if a Trust misses the inclusion points for flex (reconciliation) AND freeze (post-reconciliation) for a particular month? We would never then see readmissions for any initial Spells ending during this period. Also the guidance says that a Spell can only produce single readmissions - how does this sit with the concept of RAP identifiers? Answer: If they miss both months so they have actually had 12 weeks to get the data in and they have missed that point, then you are correct it won t appear in the Readmissions extract. Equally I would suggest that it has breached a lot of the quality rules of submitting data in a timely manner, that is also within the DH guidance, that you are supposed to have submitted within 5 days. From a commissioning perspective it is down to the commissioner as to whether they choose to actually penalise the provider who has missed their deadlines. The second part if a pathway is elective, and then followed by emergency within 30 days, and then admitted again for another elective within 30 days of the previous emergency, and again followed by another emergency admission after the second elective, all four of them will be connected, as they are all within 30 days. However the commissioner will see it as two completely independent readmission cycles so they will be looking at the first elective/emergency pair and the second elective/emergency pair, they are just grouped together under a single RAP identifier. SUS does not make any distinction it is purely providing the data back to the commissioner to help them make an informed decision. Question: How will a provider identify a parent Spell when the child Spell occurs at a different provider? Page 8 of 20

9 Answer: Basically they will not. That is a problem with the provider side. Because of the IG consequences, you should not be looking at different provider data. To actually produce an extract, much like the readmissions for a provider, we would actually have to filter all the data on providers and you still end up with Spells being missed. So it is down to the commissioner to actually manage where you have readmissions from different providers, because it is the commissioner that has the responsibility towards the patient so the commissioner will see both, but the provider the original provider will not. Question: As a provider are you able to see if you are the parent Spell even if you aren't the child Spell? Answer: Since a Provider will not have access to this extract they will not be able to know if they are a Parent of a readmission to a different provider. If the readmission is to the same provider then the APC managed service extract will indicate on the CHILD Spell that this is a readmission and the parent Spell ID is also carried on that record. If a provider is the CHILD (the readmission) from a previous Providers treatment then they will also be able to see the organisation code that provided the previous admission from the APC Spells managed service extract. Question: Is the readmissions extract available to be viewed by providers? Answer: No, it can only be viewed by commissioners. Question: Will the shared services receive this extract and if so will it be a clear extract? Answer: It is a clear extract and shared services that are registered to act on behalf of PCTs will receive the readmissions extract. Question: How will submission timetables across providers and/or extract processing order affect parent child relationships? Answer: Because we have based it upon the frozen data that is the reconciliation and post reconciliation mart it won t do, because that data will never change. The readmissions extract is based on the data held in the Reconciliation and Post Reconciliation marts and is driven by the two Marts created at that point in time. Page 9 of 20

10 For April 2011 the first report is created using the Reconciliation Mart created 20 th May 2011 (Cut off Date). It will use the data in this mart to find all discharges within 30 days of the admission dates for all Spells contained in this Mart. For May 2011 the second report will use the APRIL Post Reconciliation and the May Reconciliation marts as the source of the data. So for all Spells held in these two marts any discharge within 30 days of an admission date will be linked and reported. This model keeps repeating each month so only two months of data are used as potential Child Spells to find parents and grandparents. Once a RAP has all events within it sourced from a Post Reconciliation mart then these events will never ever change and the only possible change would be the addition of a new event that would have an admission date greater than the last discharge date but within 30 days. So you could have a RAP with events in April 2011 and May 2011 and then nothing for six months and then a new event joins as the discharge date would be November 2011 which causes the Spell to be included in the November Reconciliation mart that has an admission date of 20 th May This is the reason why the extract is Years-To-Date (YTD) as you won t know at what date the RAP starts until the discharge happens. Question: It states in the PbR Guidance (para 57(d)) irrespective of whether the initial admission has a national tariff - the slides state that this has to be PbR qualified? Answer: PbR qualified in this context means that a Spell is capable of being created. For example a Spell with no Organisation Code Provider or an episode with no admission date will not be capable of creating a Spell and is deemed not PbR Qualified. Question: Why is the 'RAP Spell Type' and identifier fields blank in some cases? Answer: The RAP Identifier will never be blank. The RAP Spell Type can be blank as the Spell is not classed as either a Parent, Child or Both. Consider the following events in a RAP: Admission Type RAP Spell Admission Date Discharge Date Type Daycase 01/04/ /04/2011 Elective 05/04/ /04/2011 Daycase Parent 09/04/ /04/2011 Non Elective Emergency Child 13/04/ /04/2011 Page 10 of 20

11 This may look strange as the parent is a DAYCASE event but the logic checks the admission type against a reference table to exclude cases e.g. Daycase or Maternity. The current live reference data does not have any values for this check which will cause this combination to be created. The two Spells that belong to the RAP but are not defined as a either child or Parent would have no value for RAP Spell Type. Question: Why was a child aged 4 excluded in the demo? The guidance states only UNDER 4s should be excluded. Answer: Apologies the logic is as the text below and is LESS THAN the value in the reference data which would not exclude a child of 4. Using the CHILD RAP reference data table the AGE ON ADMISSION from the CHILD Spell is compared with the AGE attribute in the reference data and if it is LESS THAN the value it will cause all Re-Admission processing to stop and for ALL Spells in the RAP populate attribute RAP DH TARIFF ADJ with INVALID. Question: Will Providers be able to see the RAP validation indicator e.g. VC1 anywhere on the APC Spell extract? Answer: No, none of the readmissions attributes appear on the APC extracts. Question: What if the CHILD's 5th birthday occurs within a RAP pathway? Answer: Assuming we are using the live reference data then for a child to be excluded they would have to be under 4. An example would be a child born 20/04/2007. So if a RAP starts i.e. The Parent Spell Discharge date is before the birthday Admission Type RAP Spell Admission Date Discharge Date Type Elective Parent 05/04/ /04/2011 Non Elective Emergency Child 13/04/ /04/2011 For the above example the child has a birthday during the admission and becomes age 4 This would be classed as excluded as the AGE ON ADMISSION is used for the age check so the child would be 3. Page 11 of 20

12 Consider the following sequence of events for the same child Admission Type RAP Spell Admission Date Discharge Date Type Elective Parent 05/04/ /04/2011 Non Elective Emergency Child 21/04/ /04/2011 The AGE ON ADMISSION would now be 4 and would therefore now be classed as a RAP that is eligible for a tariff adjustment since it is the CHILD Spell that the age check is performed against and not the Parent Spell. Question: Why can't providers download a subset of the commissioners readmissions extracts containing ONLY their own data? This would not breach IG principles and would allow providers to see the same data as the commissioners. Answer: Because then you would have incomplete pathways, and having an incomplete pathway is not considered appropriate. Question: Does the managed service extract include both readmissions following electives and readmissions following non electives? Answer: The managed service will produce a single readmissions extract which will contain all Spell types; elective, non elective, daycase, regular attenders, everything. However, the subsequent processing in the Readmissions extract to determine whether exclusions apply or if the Spell is eligible for the policy only apply for an emergency readmission. Users should be aware that the readmissions flags in the APC Spells extract only relate to emergency readmissions and not elective readmissions. Question: Why include known exclusions such as regular day attenders? Seems a waste of time and space. Answer: The specification was to include all Spell types so any APC event is considered. Question: The age field which has been discussed - i.e. age under 4. When is the age field calculated? At admission or discharge? Answer: The AGE ON ADMISSION is used for the derivation. Page 12 of 20

13 Question: We are sending our CDS in bulk format and each month we send two months. If we submitted these months in the wrong order i.e. March, then Feb, would this break the linkage in our APC Spell extract? Answer: It would have an impact on the attributes contained in the APC extracts as these would be missing some linkages. It would not affect the new Readmissions extract unless you have missed both the Reconciliation and Post Reconciliation cut off dates. Question: Some of the rules used to construct some of the RAP flags differ from PbR Guidance for example exclusion of non PbR from parent Spells where guidance says those are valid triggers for readmissions Answer: The exclusion is for two types of NOT PBR QUALIFIED 1. When an event is received in SUS but is not capable of creating a Spell e.g. No Provider Code or No Admission Date. 2. Where a Spell has been created but all the episodes have been subsequently deleted via the CDS interchanges. These are classed as Phantom Spells. The reason why a Phantom Spell is retained is so that when the deleted episodes are re-submitted then they are joined to the same Spell ID. Question: If a patient is admitted for a Hernia, goes home, and is re-admitted 3 days later with a broken leg. Then stays in for 3 days, goes home, and is re-admitted for concussion after a car accident. Would all these be re-admissions? Answer: Yes. Question: Paragraph 55 of the PbR guidance states that "For clarity, readmissions following outpatient procedures or A&E attendances are excluded from this rule". Answer: There are no linkages to events outside APC so for example a patient having an Outpatient appointment followed by an Emergency Admission would not create a RAP. Question: Why are daycases excluded? Surely it's worse if there is an emergency admission after a Daycase than an IP (Inpatient)! Answer: Daycase events are not excluded as long they are an APC Daycase and not an Outpatient procedure. Page 13 of 20

14 Question: Will the Providers be able to view the data with the commissioner validation rules applied for their data? Answer: That is between the commissioner and the provider. SUS will not make the data available to a provider. Question: Where the readmission results in a series of transfers, will these subsequent Spells be flagged with the same parent flag? Answer: Discharge Method is included in the delivered logic however there is no reference data to support the use of this attribute. To exclude transfers between providers has not been implemented but should not be a cause for inaccuracies for linkage. Consider the following: Patient admitted to provider ABC and transferred 10 days later to DEF who then creates a new CDS episode with a new admission date that will be equal to the discharge date from ABC. SUS will create two Spells one for ABC and one for DEF and these will be joined together in a RAP and classed as Eligible for adjustment as the admission in DEF should be recorded as an Admission Method of 28 which is classed as an Emergency Admission. In this scenario the commissioner will need to filter Spells where the discharge destination indicates another NHS provider for example 51 (NHS other hospital provider - ward for general PATIENTS or the younger physically disabled). The Readmissions extract does not make the decision for the commissioner it provides the information to enable them to make an informed decision. Question: Paragraph 55 of the guidance states that readmissions following an outpatient procedure or A&E attendance are excluded from this rule. Answer: SUS will not link any EM or Outpatient (OP) data into a Readmissions pathway and doesn t consider whether there have been previous EM or OP attendances when building the pathways. Question: Because primary diagnosis is attributed to an episode how do you decide about a readmissions Spell which has one episode that should get excluded and one which doesn t? Will you check to see if any of the episodes meet the exclusion criteria? Or will you just be looking at the first finished consultant episode? Page 14 of 20

15 Answer: The Spell attributes come from various places, the primary diagnosis and primary procedure codes come from the pseudo dominant episode and that is the episode that has the Spell report flag that has come out of the grouping process. For a Spell to have an HRG it needs to have at least one episode in there so it would take it from the episode that has got the Spell report flag. If you have got a Spell with four episodes, and three are excluded, then what goes to the grouper is just a Spell with one episode, so that is where the primary diagnosis comes from. SUS will not look for where there is a primary diagnosis code on one of those episodes that would exclude it from a readmissions, we only look at the primary diagnosis of the Spell, not each individual episode. Question: Does the new extract take into account Emergency to Emergency Readmissions or just Elective to Emergency Readmissions? Are these flagged differently in the extract? Answer: It takes into account every readmission irrespective of whether it s Emergency, regular attender, Daycase. So you can have Emergency Emergency Emergency. All of those will get classed as a readmission, but will then fail on some of the validation rules and filtering on RAP eligible and RAP DH adjustment will remove those. So what you will get from the readmissions extract is that cycle of events, so if you have patients going in and out of hospital they will be joined up with a RAP identifier in this extract. Question: In an information governance frame of mind, does the commissioner have any obligation to explain to the original provider the reason for the admission at a new provider (thus able to potentially change their processes)? Answer: The commissioner will be required to follow the IG requirements that govern their Local process. This is really a local issue and not something that SUS can address. Question: Why can providers not see the new managed extracts minus Spells at other Trust? Answer: If we provide an extract in this form then it will fall into the Unknown Unknowns i.e. the ones we don't know we don't know which can be more confusing. Question: Are the reference data tables, (showing the rules for which Spells are eligible for adjustment), available for download. Answer: They can be downloaded from the following link: Page 15 of 20

16 Question: Please can you go through the R0 prefix again? Reason for allocation? Answer: The reason we have a Prefix for the RAP Identifier is to enable any changes in intervals or logic to be potentially created using a different Prefix. An example would be that mid-year the period changes to 20 days so if we now start using S for a Pathway ID we know that these have been constructed with new logic. Question: If one Spell fails validation in a sequence of Spells with the same RAP ID, do all of those Spells fail validation? Answer: If the Spell has validation rules applied (is RAP Spell Type of Parent, Child or Both) then yes all Spells would be classed as not eligible. If a Spell does not have a RAP Spell Type then no validation will be applied. Question: What happens where there isn't an NHS number assigned to a record? If this is used to calculate readmissions. Answer: If there is no NHS number then that Spell will not form part of the Readmissions extract as all linkage is performed on NHS number. The population rates of NHS Number are now within the 99.x% and it was not considered to be cost effective to apply fuzzy logic for the missing elements. This is also supported by potential future logic of episodes without NHS Number being excluded from tariff. Question: Will the managed service extract include the critical care cost element which should also be included in the non payment value for a Spell by the PCT, if not do we need to use the MDS files received from providers, or is there another way of obtaining the critical care costs to add on to the amount not to pay due to readmission? Answer: The Readmissions extract has the PbR Spell ID and this can be used to link to the new Critical Care extract to retrieve all Critical Care data. In PbR 2011/12 there are no tariffs applied to Critical Care so these will have to be computed using the new extract and the Local tariffs. Page 16 of 20

17 Webinar: Best Practice Question: Has anyone queried the negative impact of the best practice tariffs as highlighted in an example here. Why would anyone work towards best practice if it penalises them? This seems very odd. Answer: The best practice tariff is reduced in SUS, for example with stroke best practice, to arrive at the Base Tariff. The local commissioner is then expected to verify; for example in stroke the provider is expected to provide information to support that the patient has had Rapid Brain Imaging (+ 224) and Direct Admission to Stroke unit where 90% of stay was (+ 684). These two adjustments cannot be verified with the data submitted to SUS so the uplift is applied locally but is applied to BASE TARIFF. Question: Can we have access to the hierarchy of the SSC codes for local processing? Answer: The reference data used to apply hierarchy is available from the NHS IC website. Question: Are we currently able to submit outpatient CDS with Treatment Function Code (TFC) 329 for Transient Ischaemic Attack (TIA)? Answer: Users of CDS XML v6.1.1schema can submit an OP with TFC 329. The tariff applied would be an attendance value and not a procedural even if a procedural HRG had been produced. Question: I thought that HRGs would only attract the base tariff if they did not meet BP (Best Practice)? If they do meet BP, then they receive an additional payment. SUS appears again to be flagging every column, rather than those that actually meet the criteria. Answer: The indicator is produced by the grouper and is deemed to have met criteria, this will also happen with the Local Payment grouper. SUS does not make any additional derivations. Question: If I have multiple SSC flags say: SSC_01 = 61 SSC_02 = 62, how do I apply the right code? Say the HRG is HB22Z? The question is from the provider side and not the commissioning side. Answer: You would apply BOTH as they have the same hierarchy. Page 17 of 20

18 Question: the 2011/12 PbR guide states that when a Spell has more than one SSC code, then the one that attracts the highest uplift can be applied, does this not contradict your previous answer? If a Spell has SSC values 6 and 8, in line with the guide, 6 can be applied but say in SSC1 the value is 8, is it still the case that the uplift for 6 can be applied? Answer: The single application is based only on codes like 23,08,06,34 which are true Specialist Service Codes and not Best Practice flags. Only one of the four above would be used for SSC uplift, all other codes can attract multiple financial adjustments. Question: I don t think it s correct to say that if a Spell has more than one specialised service flag that both top-ups are applied - the PbR guidance states that only the highest is applied. Answer: For an SSC code you are correct however the same grouper functionality now outputs a Best Practice flag in the same attribute so you have two variations of tariff within the same field. Any SSC code that has a hierarchy of 99 is classed as a Best Practice Flag and will attract tariff for each distinct value allocated to a Spell. Page 18 of 20

19 Webinar: Critical Care Question: What happens where multiple overlapping CC episodes are all sent on the same day? Answer: If there are multiple overlaps and they are exact matches, that is where we would take the last one that has been sent to us. If they are all on the same episode we will take the first one from that episode. So if you have only got a single episode, but you have got three critical care periods with exactly the same start and discharge data values in it, you take critical care period one off that episode. If you have got two episodes with the same critical care data on it you take whichever episode was sent to us last. Question: Am I correct to assume that the critical care extract will be available to providers as well as commissioners? Answer: It s available to everybody. Question: Is there an ID field that can tie the CC extract to the SUS APC extract. Answer: Yes, the Spell identifier is what is used in the APC Spells extract and is also the generated record ID which will take you to the APC episodes extract as well, so they both tie together. So if you want to join the two together use the Spell ID for APC Spells and the episode ID for APC episodes. Question: If we send an episode deletion to SUS will it cascade delete all other elements, e.g. critical care? Answer: If you send an episode deletion what it will do is create a new Spell version. Each Spell version that is created inside PbR goes right back to the beginning and starts right back as if it was a new record. So it will replace the elements that are there, but the new Spell data version will be used. Question: Please could you go through again how the episode length of stay and tariff length of stay is adjusted where the critical care period overlaps more than one episode. Answer: This is having a difference between the tariff length of stay and the adjustment length of stay. Page 19 of 20

20 Question: Please can you explain why the linked Neonatal and Paediatric SUS SEM extracts do not have the daily ACTIVITY dates, this means that we are unable to check the HRG grouping because the grouper requires these dates? Answer: The extract has what has been defined in the extract specification. If they are not there, then that is a consideration issue for a future release. As this is a PbR release and a PbR extract, not a SEM extract, it gives you all the critical care data on a single extract. END OF DOCUMENT Page 20 of 20