PPUs must keep score

Today it is #2 Administration in our Top 7 countdown. We use seven key factors of success as an Audit Tool when working with Trusts to develop their local private patient service.

Most Trusts now appreciate the importance of data capture and coding for ensuring accurate billing, income and cost information. Professional coders are now essential to the financial viability of the Trust. The same lessons were learned a long time ago in independent hospitals, who invested in the core competences required to record activity and bill accurately in line with the numerous and complex tariffs agreed with insurers, and also to effectively manage basic patient administration.

Private Patient Units (PPUs) also need to develop similar financial and administrative processes and competences.

However, if support from the board is not there to actively develop private income within a Trust, then all too often there is not enough dedicated and trained administrative support for private patients and what little there is may be scattered across divisions and departments.

When private patient activity is sparse in volume, irregular and seen as non-core, this will mean the Trust inevitably experiences frustration in the coding of activity, the raising of invoices and the settling of fee accounts, which knocks on to basic patient administration, such as booking and bed allocation.

Trusts with low private patient volumes will typically:

Not have up to date contracts with key insurers;
Not understand or use CCSD (insurers’) codes
Raise complicated itemised and late bills that can often go into suspense.
This usually results in frustration for all parties: insurers’ shortfall their members payments; aged and bad debt increases for Trusts, and payment of consultant fees slows – all directly or indirectly providing a poorer service to patients.

In this all too familiar situation, NHS Trusts should bring together the administration skills too often dispersed across the organisation into a single team forming a Private Patients Office.

Giving these activities a focus will be a key factor in enabling growth. Those Trusts now growing private patient revenues have done this by supporting a small team (perhaps no more than three or four in an out of London Trust) that quickly pays for itself through reducing debt, improving coding and raising the confidence of consultants to book additional private patients into the Trust.