Using patient-reported data to identify upcoding by providers under activity-based financing

Thursday 4 February 2016, 2.00PM to 3.15pm

Speaker(s): Matt Sutton, Professor of Health Economics, Manchester University

Abstract: Under activity based financing, providers can increase their revenue by upcoding patients into higher paid Diagnostic-Related Groups. Identification of this behaviour is limited by reliance on provider-reported data. We use data from the national Patient Reported Outcome Measures (PROMs) initiative and exploit an exogenous payment change within the English ‘Payment by Results’ system whereby the financial incentive to record a complication for patients undergoing knee revision replacements was removed. Our analysis of provider-reported data suggests that refining DRG payments based on secondary diagnoses has no unintended effect on hospitals. However, the same analysis of patient-reported data shows that hospitals responded to the removal of the upcoding incentives as expected, by reducing their coding of patients with complications.

Location: ARRC Auditorium A/RC/014

Who to contact

For more information on these seminars, contact:

Maria Jose Aragon
Jessica Ochalek

CHE Seminar Programme

  • Thursday 12 January 2017
    Jon Sussex, Chief Economist, RAND Europe
  • Thursday 9 February 2017
    Richard Murray, Kings Fund