iQ Budget Manager

Managing real secondary care budgets and validating SUS data will be a challenge for GP practices and PBC consortia.

The change of Government will inevitably accelerate the move to real budgets which many PCTs have already declared is an integral part of their plans to move many aspects of secondary care into the primary sector.

This will be an opportunity for many consortia to deliver better patient care, however there could be a high consequential risk of managing these budgets unless appropriate systems are in place to validate all secondary care charges.

The Audit Commission have found the error rates with HRGs and Tariffs is 12.8%; in reality, based on much larger volume analysis, this figure is much higher. By using the iQ Budget Manager across a number of PCTs and PBC clusters it has identified errors in billing from secondary care which could be costing every practice over £220,000 per annum (see case study).

To achieve accurate validation it is essential that all referrals and discharge information is referenced back to the GP clinical system information. As an example reviewing only SUS data would not identify the differences between elective and non-elective charges. In a recent case of an elective leg amputation the national tariff is £8,019; this was charged at the non-elective tariff of £23,221. £15,202 more from a real budget!

Module One of the iQ Budget Manager automatically validates and reconciles SUS data with the GP clinical systems and produces exception reports to challenge errors. It also incorporates an Expert Analyser to provide the ability to interrogate all data for Commissioning Reports and Contract Monitoring.

Module Two provides the tools to create accurate, professional financial plans and monitors all aspects of secondary care income and expenditure. Most of the data is automatically transferred from Budget Manager in to the Finance Manager module.

The information from both these modules can be consolidated into one consortia report if required.

Without financial accuracy and regular monitoring it will be impossible to make decisions affecting care pathways and remain in financial balance

Conclusive proof extracted from a recent analysis of SUS validation for a leading PCT and shows the impact on GP practice budgets 

PCT has 21 practices with a total of 152,000 patients (Av.7238 per practice)

Based on PCT Secondary Care Allocation the average real budget for each of the 21 GP practices would be   £4,803,000 (total PCT allocation £100,863,000)

Total rejections and queries to be challenged £37,434,000

Based on expected recovery rates for each GP practice equates to £231,137 (4.8% of each Practices secondary care budget)

The cost of Budget Manager with Finance Manager is inclusive of training, software updates and ongoing support and is less that 2.5% of the anticipated recovered sums. In addition there will be no software license payment for the first 9 months and thereafter it will be 12 equal monthly payments. This deferred payment plan allows for real budgets to be in place and thereafter cost can be offset against recovered sums.

Module One

Only by automatically referencing both Secondary Care Data (SUS or other variation) and referral and discharge data from GP clinical systems can you deliver improved productivity, financial control and patient care. (Essential for CQUIN and QIPP initiatives).

Given the need to generate efficiency savings and improved patient care pathways, it is an urgent requirement for commissioners and providers to work more closely together.

Quality is at the heart of all commissioning with clear focus on improving productivity. Only accurate, reliable and comprehensive analysis of both data sources will deliver improved commissioning and ensure value for money and budgets come in on target.

iQ Budget Manager is the only tool which can monitor both key data sources automatically. This automation ensures that all data are managed consistently and accurately, and allows a powerful range of reporting to be extracted via the unique ‘Expert Analyser’ to support contract and provider management.

Overview of how iQ Budget Manager (Module One) works

iQ Budget Manager is hosted on a Server either at the PCT or a Lead Practice within the Cluster (both within the N3 network) Practices access the application via a secure internet browser developed by iQ.

iQ’s Clinical Data Interface (which links with all Practice Clinical systems) undertakes an automatic nightly download of significant event information (from referrals / clinic letters and discharge summaries).  It combines this with relevant patient history information and automatically populates it into iQ Budget Manager1.

1It’s important to note, dependant on the quality of data inputted in to the Practice Clinical Systems, and subsequently extracted, some manual data input maybe required.

iQ Budget Manager arrives at relevant Charge Codes and HRG Codes by referencing Read Code V3 and OPCS and ICD-10, applies Length of Stay, Age, Specialist Top-ups, Local Tariffs, and other PbR Rule-sets to arrive at a projected Code/Cost.

Secondary Care data (in whatever form is applicable locally) is posted directly to the Practice’s Login on a monthly basis. iQ Budget Manager imports this data automatically so the validation process can occur.

Stage 1 – iQ Budget Manager compares on the basis of NHS Number / Provider and Admission and Discharge Dates, automatically linking any that match so the user only needs to review any items that don’t automatically match, choosing to Link or Reject them.  

Stage 2 – for all linked items iQ Budget Manager then undertakes HRG Comparison, again automatically linking those items which match, with the user able to view those that don’t match, choosing to Accept or Query the item.

Reports of all ‘Rejected’ items from Stage 1 and ‘Queried’ items from stage 2 are automatically produced and stored for future reference and analysis.

Stage 3 – iQ Budget Manager also identifies those episodes which do not meet the locally specified Contracting Arrangements and therefore require further investigation.   Again, reports are automatically generated which give insight into the reason for rejection such as non-compliance with the pathway and clinical quality of care.

Stage 4 - takes the rejected items from Stage 3 items together with the exception reports of Rejected and Queried items from Stages 1 and 2 and produces a detailed report explaining the reason for challenging.

A clear audit trail is in place for the above detailed process.

Stage 5 - Expert Analyser / Dashboard

One of the unique functions of iQ Budget Manager is the ability to interrogate all the data using a range of pre-determined templates as well as being able to create specific reporting templates easily to answer local issues. These cover Practices, PBC Clusters, Providers and PCT Contract arrangements:

Commissioning Reports include referral patterns by Practitioner, Practice and Cluster, referral / discharge costs by HRG / charge code, actual cost by episode type, and numerous other aspects of primary care activity.

Contract Monitoring Reports will show the performance of a provider on multiple dimensions over time including:

• Referral /discharge cost by provider.
• Waiting times.
• Excess bed days.
• Emergency admissions, repeated admissions, re-admissions and other contiguous spells.
• New outpatient appointments within X no of weeks for same speciality.
• Performance of CQUIN objectives, by each Local Provider.

… and overall monitoring of financial and management aspects which meet the objectives set out to achieve World Class Commissioning.

All the above information can be viewed in various dashboard formats to assist easy assimilation of often complex data.

Module Two

The Finance Manager module facilitates a detailed financial analysis by all seven key episode types:

• New Outpatient Attendance
• Follow-Up Outpatient Attendance
• Elective In-Patient
• Non-Elective In-Patient
• Accident & Emergency Attendance
• Day Case (Planned same day)
• Out-Patient Procedure

The cost for each of these episodes is automatically extracted from the analysis which is undertaken in Module One and imported into the finance module. It will also produce monthly and cumulative actual expenditure vs monthly budget.

By clicking on any monthly total of expenditure or total ‘under query’, it will automatically generate a detailed analysis report for discussion or further investigation. Consolidated PBC consortia reports can also be generated.

Key Benefits

iQ Budget Manager adds value to all organisations involved in the validation process by:

Automating the process – iQ Budget Manager increases the speed, accuracy and reliability of the monthly validation process, releasing staff time to actively manage clinical and contract processes. It enables the necessary reconciliation, validation and reporting to be undertaken and ensures the 6 day flex and freeze deadlines can be met.

Improving Accuracy – iQ Budget Manager drives improvement in data quality and best practice compliance. This leads to more efficient use of resources and improved relations between providers and commissioners.

PBC engagement – iQ Budget Manager provides the reliable and accurate data which encourages participation in care pathway redesign and management of patient costs. This insight supports clinical teams in carrying out more accurate referrals based on patient history and highlights patterns in patient pathways.

Knowledge Management – iQ Budget Manager reporting also enables accurate information for service planning and commissioning purposes. These are particularly beneficial when all organisations within a commissioning consortium collaborate and combine their activities to deliver a more comprehensive understanding of provider activity and performance. 

Data security and patient confidentiality

The data from all Practice / PBC Cluster clinical systems is extracted daily and stored on a server located within the PCT or the lead practice within a defined cluster. Access is protected by the N3 network and prior agreed Data Sharing Agreements between all practices and the PCT.

Each application meets the strict standards set out by IGSoC and CfH for holding and transferring Patient Identifiable Data electronically, including ISO 27001/27002

iQ Budget Manager and iQ HealthMaps also meet the conditions of the 1998 Data Protection Act.

Audit Commission Report 2008/9

Small improvements have been reported but 'the introduction of HRG 4 is likely to bring higher error rates in 2009/10'. Whilst the work undertaken by the Audit Commission is invaluable, it is statistically insignificant as the 49,000 episodes reviewed represent an average of just 320 episodes per PCT; compared to an average practice referral and discharge volume of 500-700 episodes per month.
If you have any queries about the product, or if you would like to arrange a no obligation demonstration to see the product and discuss the associated issues, please do not hesitate to contact us