EPA-1738 – Auditing Payment by Results- How Accurate are We at Clustering Our Patients

Abstract

Introduction

The NHS introduced Payment by Results (PbR) as a means of classifying mixed cases treated within a hospital. A specific tariff is applied to each healthcare resource group (the unit of currency used). Payment follows the level of activity, according to the tariff. Care Clusters are a currency developed to support PbR for Mental Health Services. There are 21 clusters based upon patient's characteristics. Care Clusters are assigned using a decision tree of algorithm, based on the Person Score from the Mental Health Clustering Tool (MHCT), undertaken by a care professional involved in the patient's care.

Method

A random sample of 30 patients was audited. Patients were allocated care clusters by care professionals at initial assessment. The same patients were re-clustered by Doctor A(Middle Grade) and Doctor B(Consultant Grade). The audit tool was the MHCT.

Results

100% of sample was allocated a care cluster at initial assessment. 70% of cases indicated differences in the care clusters initially allocated. There was a trend towards the Doctor A (middle grade) clustering higher than the care professional. Doctor B (consultant) had a tendency to cluster higher than Doctor B and the care professional.

Conclusion

Clustering relies on subjective views of individuals conducting assessments. The more senior the professional, the higher the care cluster. This raises questions about individual assessment of risk/symptomatology and training provided in using MHCT. This could lead to serious consequences financially.

Recommendations

Retrain all staff in use of MHCT, consider clustering in MDT settings and recluster cases to ensure accuracy.