PbR Payment by Results are fundamentally flawed says coding chief

The current system of Payment by Results (PbR) is 'fundamentally flawed and unacceptable' the head of the Professional Association of Clinical Coders warned last week. Managing director Sue Eve-Jones told an HSJ conference last week that the quality of data in the NHS could compromise any chances of ensuring fairness under PbR. Her presentation was subtitled 'doing the best we can with a fundamentally flawed and unacceptable system'.

Ms Eve-Jones said that healthcare resource groups, the standard treatment groupings used as units of currency within the health service, 'are not designed to support payment systems and we are using them to support PbR'.

She painted a bleak picture of NHS data accuracy, blaming poor training and support for coders, Department of Health tariffs that have 'no bearing on the real service', and pressure to 'upcode' to generate more cash.

'Some coders are asked by clinicians "which code will give me a better HRG?", or you see directors of finance wandering around saying "we need more codes". I am pleased to say that most coders are immune to this.'

And Ms Eve-Jones concluded that the NHS payments system 'scares me witless'. 'It's like going into Tesco, filling up your basket, and getting charged different prices depending on which checkout you go to.'

Health Direct has long warned that Payment by Results was doomed to be an expensive failure since April 01, 2005 Payment by Results- political pressure is undermining new PbR finance reforms

If you allow a whole load of unbundling - where you pay for little bits of the healthcare resource from up here and there - you destroy the principles, don't achieve the benefits, and end up with locally based recovery systems, which is back to where we started with this reform.

Earlier this year the HSJ analysed the crazy conflict that Labour has created between PbR and the PFI schemes: June 10, 2006- NHS trusts feel the impact as PFI and Payment by Results collide "Imagine buying a house for a family with four children. Over the next few years you know you will need a lot of space to accommodate noisy teenagers. But in 10 years’ time your needs are not so clear cut: children may leave, elderly relatives may come to stay or you may be on your own.

Your income is also uncertain and not under your control: your boss has just refused a pay rise to reflect your high accommodation costs and says you can have the same as everyone else."