High quality data

 

Any payment system requires good quality data. Designing a payment system without ensuring that sufficiently accurate data are available will greatly reduce its effectiveness.

Driving data quality

There was a general consensus among participants that PbR contracts ensured trusts and commissioners collected and used better quality data compared with block contracts. Whatever the benefits or disadvantages of the payment system, providers believed that switching to PbR helped improve their data processes. This in turn increased PbR’s effectiveness as a payment system.

Since PbR has come in, we have got an awful lot better – infinitely better – at counting activity and coding it and classifying it. NHS finance director

However, improving data is not currently the primary purpose of the payment system. Good quality data are important for all aspects of NHS service delivery, so the quality and use of data should be driven independently of the payment system. Health care resource groups (HRGs), which currently underpin units paid for through PbR, have been in use since 1992 – prior to the introduction of the existing payment system. Their use extends beyond payment, to benchmarking, resource planning and monitoring. So linking payments to HRGs should only be done if such a process supports the primary objective, not as a means to drive data quality.

Relying solely on the payment system to improve data may lead to gaming, which ultimately reduces data quality. In recent years, this has led to a lack of trust between commissioners and providers. Disputes arising during the data challenges submitted as part of the monthly PbR reconciliation process can be hard to resolve – this can result in a large number of outstanding challenges at the end of the year.

The impact and burden of counting and coding disputes between commissioners and providers are seemingly unreported. Evidence of the extent of the administration costs associated with this issue is limited. A single high-quality data set, available to all, could be one solution to this.

Wider uses of data

Many participants noted that the vast amount of existing data is not being exploited to its full potential, as it is mainly used at a local transactional level, rather than a national strategic level to help shape policy decisions regarding payment. The Getting It Right First Time (GIRFT) programme, which aims to improve quality of care by reducing unwarranted variations and improving efficiency and patient outcomes, is beginning to use some of these data in a more strategic way. Data quality, an improved understanding of providers’ core costs and an accurate record of treatment outcomes were all seen as important for new payment models.

The data ought to be absolutely visible for everyone because it’s a publicly owned service, and by that you will drive up both the quality of the debate and the quality of the decision making [around payment systems]. NHS medical director

However, many participants of this research viewed the prospect of developing data of this quality for the NHS as a long way off.

I could put forward a model but it’s a completely unworkable one [at the moment…] if purchasers were not paying us for what we did but for the data associated with it, the ability to make rational policy decisions would be greatly altered. NHS medical director

For a number of years Monitor, now part of NHS Improvement, has sought to improve data quality through the patient-level information and costing systems (PLICS) programme. The aim is that, by 2020, costing information will more accurately reflect a patient’s treatment and will be produced more consistently across the provider sector. This programme may significantly improve the data underpinning future payment systems.

Conclusion

Payment systems need to be underpinned by accurate data to ensure that providers’ costs are properly covered, and that any incentives or penalties have the correct balance of risk associated with them. However, the purpose of the payment system is not to improve the quality of data, especially where this can conflict with the primary purpose and could lead to inappropriate recording of data. Ultimately, the payment system should be a beneficiary of quality data, not the key driver for it.

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