Background
Spire Healthcare is a private hospital group with 38 private hospitals throughout the UK. In 2012 it saw 1.1 million patients for outpatient appointments and every year it treats over 930,000 patients. It has been working with CHKS, who are part of Capita Health and Wellbeing over the last six years to improve the accuracy of its coding. Martin Rennison, Director NHS Business, explains how this has improved confidence amongst NHS commissioners and also benefitted Spire’s bottom line.
What challenges were you facing?
Six years ago, we found our business with the NHS was increasing. There was and still is a very strong focus on data quality, particularly in relation to data that was used for financial reporting. We realised that the validity of our data wasn’t as good as it should have been and we found that some commissioners were starting to question our numbers and in some cases this was resulting in non- payment.
What was your first step on the improvement journey?
We recognised that we had to look at the way we were coding hospital activity. At the time we were using administrative staff who had training but weren’t qualified coders. So we brought in CHKS to help us out. Initially, we asked CHKS to code half our activity because we weren’t sure what the best solution was going to be. CHKS’s team was made up of qualified coders and we soon recognised an improvement.
How did you improve?
Using professionally-qualified coders had an instant impact and it was clear that this was improving our data quality. We came to the conclusion that we should contract out all our coding requirements to CHKS and moved all our hospitals across. At the same time we worked with CHKS on a system of quality assurance, which meant we would get monthly reports on the quality of coding followed by regular coding reviews at every hospital.
What benefits have you seen from working with CHKS?
Working with CHKS has improved our coding which in turn means our data quality is much higher. Our coding error rate is less than 4 per cent, which compares favourably with the NHS average of between 7 and 9 per cent. This is very important when it comes to assuring our commissioners that we are invoicing for the right activity. As a result we are being paid more promptly. Six years ago we had a 60 day debt figure of in excess of £28 million and that figure now sits at around £8 million for a business twice the size.
We needed our commissioners to trust that our data and billing is accurate. We now believe it is and achieving this has improved the relationships we have with commissioners and ultimately helped to grow our business with the NHS.
We are now working with our clinicians to improve their understanding of coding to ensure that everything that is done to the patient is clearly written in the medical record. Support from CHKS is now focused on site by site benchmarking and helping to meet our ambition of being recognised nationally as a top performer.
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