When PBR came in, there were frequent accusations that hospitals had not
just improved their Coding but were actively 'upcoding' to try to gain
financially: it seems the problem may not be confined to the NHS.
http://www.sciencedirect.com/science/article/pii/S0167629615000557
There is a paywall, but going from the abstract
Using data from the German birth statistics 1996-2010 and German hospital
data from 2006 to 2011, we show that (1) since the introduction of DRGs
(diagnosis related groups, introduced in 2003:higher payments for lower
birthweight infants with 8 transition points), hospitals have upcoded at
least 12,000 preterm infants and gained additional reimbursement in excess
of 100 million Euro; (2) upcoding rates are systematically higher at
thresholds with larger reimbursement hikes and in hospitals that
subsequently treat preterm infants, i.e. where the gains accrue; (3)
upcoding is systematically linked with newborn health conditional on birth
weight. Doctors and midwives respond to financial incentives by not upcoding
newborns with low survival probabilities, and by upcoding infants with
higher expected treatment costs.
One of my questions would be about the German system for reimbursing
'doctors and midwives' and the point at which birth weights are entered into
the infant's medical record: do they benefit directly, or are they being
accused of false data entry to support the hospitals?
The possibilities appear to be - seeing that this appears to be based on a
single measurement (birth weight) which would have to be falsified to
produce upcoding, - that either the doctors/midwives responsible for
weighing the new-born & making the delivery notes, or the departments
responsible for entering data into the DRGs in the hospitals, are falsifying
the birth weights for financial gain: which is very disturbing if true - and
must play havoc with the statistics!
Mary Hawking
Booking is open for the PHCSG AGM & Annual Conference 15th/16th October 2015
http://phcsg.org/agm-and-annual-conference-2015/
Will I be seeing you there?
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