Surviving ‘‘Payment by Results’’: A simple method of improving clinical coding in burn specialised services in the United Kingdom Katy L. Wallis a,e, *, Claudia C. Malic b,e , Sonia L. Littlewood c,e , Keith Judkins d,e , Alan R. Phipps e a Plastic Surgery, St George’s Hospital, London, UK b Plastic Surgery, Frenchay Hospital, Bristol, UK c General Surgery, Bradford Royal Infirmary, UK d North of England Burn Care Network, UK e Yorkshire Regional Burns Centre, Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DQ, UK 1. Introduction With the introduction of ‘‘Payment by Results’’ (PbR) in 2003, the United Kingdom’s National Health Service faced dramatic changes in the organisation of its funding. PbR was recognised as a significant financial management challenge for both Primary Care Trusts (PCTs) as purchasers of health care and Hospital Trusts as providers. The main stated aim was to support patients’ choice and to encourage hospitals to respond to patient preference. It was also intended to provide a fair, consistent and transparent rules-based system for remuner- ating Trusts for the services they provide and to encourage productivity. In order to sustain this new concept, national tariffs were introduced for healthcare services. Each inpatient episode is assigned to a Healthcare Resource Group (HRG), which attracts a national fixed charge according burns 35 (2009) 232–236 article info Article history: Accepted 30 June 2008 Keywords: Burns Economics Hospital Health expenditures abstract Introduction: Coding inpatient episodes plays an important role in determining the financial remuneration of a clinical service. Insufficient or incomplete data may have very significant consequences on its viability. We created a document that improves the coding process in our Burns Centre. Materials and methods: At Yorkshire Regional Burns Centre an inpatient summary sheet was designed to prospectively record and present essential information on a daily basis, for use in the coding process. The level of care was also recorded. A 3-month audit was conducted to assess the efficacy of the new forms. Results: Forty-nine patients were admitted to the Burns Centre with a mean age of 27.6 years and TBSA ranging from 0.5% to 65%. The total stay in the Burns Centre was 758 days, of which 22% were at level B3–B5 and 39% at level B2. The use of the new discharge document identified potential income of about GB£ 500,000 at our local daily tariffs for high depen- dency and intensive care. Conclusion: The new form is able to ensure a high quality of coding with a possible direct impact on the financial resources accrued for burn care. # 2008 Elsevier Ltd and ISBI. All rights reserved. * Corresponding author at: 5 Rosewood Avenue, Heaton Mersey, Stockport SK4 2DQ, UK. Tel.: +44 7799140080. E-mail address: katy.wallis@btinternet.com (K.L. Wallis). available at www.sciencedirect.com journal homepage: www.elsevier.com/locate/burns 0305-4179/$36.00 # 2008 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2008.06.008