Look after the pennies…

In our hospital it became apparent that we were missing out on income because we were not coding properly. I have no objection to chasing money if it is a consequence of better (or more ordered) practice. But things can get out of control.

In 2009 it was finally agreed that procedures done in NHS outpatients could be charged for. It was also decided that it was necessary to devise a new outcome form to take account of the 18 week target for completion of treatment. So a new form was devised on which all the new relevant information could be entered.

Now with targets there are certain subgroups of outcomes. A repeat follow-up patient need not be counted, so they require a box. There are several outcomes that “stopped the clock” – for example direct admission, first appointment default, discharge – and there are others that left the clock running or start a new one.

The new form appeared.

It was printed in colour.

Each of the clock groups was in a different colour which bore no relation to the goodness of the outcome – thus a stopped clock (which we didn’t have to worry about) was in red. The colour was in large blocks.

Now I know a bit about colour printing as I do some at home. It is quite expensive. So I thought “Why the hell are we printing these forms in colour? The colours mean nothing. They are expensive. The outcome sheets are discarded once the information has gone onto the computer, so if we are seeing 200,000 outpatients a year we are throwing away an awful lot of money.”

I have no idea how many outpatients were seen across our three hospitals, because  no statistics were provided, but if every one of my colleagues sees what I see then my figure is probably an underestimate.

So I wrote to a manager asking why the forms had been printed in colour. I was not given a direct answer, only told that it wasn’t that expensive (4p per sheer) and would easily be covered by the extra income that the forms would facilitate.

The cost of a black and white sheet might be at most 0.3p. So we were wasting over £5600 in unnecessary costs, but it doesn’t matter as we would get it back…

Actually, to be fair, someone did see sense, and the forms were changed to black and white – a good two years after I made a fuss.


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