James Larke, Associate Director at Monmouth Partners, discusses what the future might hold for clinical coding under new payment models post Covid-19.
In March, Covid-19 led to a rapid dispersal of non-clinical workers out of hospital buildings, forcing many clinical coders to work remotely for the first time. For some NHS Trusts and independent hospitals this would have been a simple transition. For others, without paperless records, the necessary technology, remote access or data security in place, there might still be some catching-up to do.
But this isn’t the only implication of Coronavirus on clinical coding. The likely continuation of block contracts in the medium term, and new payment models in the longer term, will have an impact on the Payment by Results (PbR) focus of current NHS clinical coding.
What might the future hold for clinical coding?
Waiting lists for elective operations are reported to potentially reach 10 million patients by the end of the year. Meeting the demands of this backlog, while operating under reduced occupancy, is going to require an integrated health system approach, and new NHS funding models to match. The biggest challenges from the virus could still be to come.
While the focus of coding might shift away from PbR reimbursement models, the value of an information led health service will be more important than ever. High quality clinical coding is the root of that rich data.
As we move to an environment of population-based funding, coded information provides the basis on which we understand the health status of a population and how care is being delivered. Without clinical coding we cannot:
- Analyse how we are responding to Covid-19
- Accurately understand the diseases and conditions of patients across a population
- Monitor performance, even if not tied to payment
- Understand how activity varies by provider
- Adjust casemix by complexity – for example to establish standardised mortality rates.
Population-based health systems require much richer information assets. They also require effective integration of disparate data and systems. Coronavirus may well force through better integration of secondary and primary care data sources as well as encouraging services to join up. But all this can’t be done with paper records and local information standards; that’s where EPRs and good clinical coding come into their own.