Significant revenue boost for cardiac specialty

How Dr Foster’s Practice and Provider Monitor helped University Hospital of South Manchester NHS Foundation Trust

Peter Nuttall, then director of performance and information, said: “Dr Foster’s Practice and Provider Monitor tool has provided the Trust with valuable insights about the care we provide and the income that we generate. This has allowed us to engage with commissioners about appropriate reimbursement, and with our clinicians about factors such as length of stay. The projects supported by the tool, and Dr Foster, will deliver efficiency benefits for the Trust that will allow us to improve the care that we provide to patients.”


University Hospital of South Manchester NHS Foundation Trust (UHSM) was not,  at the point of the following analysis, a client of Dr Foster. A routine call highlighted that the Trust was not performing as expected in some of the specialties when compared to others across England.

The Trust has been reviewing the financial performance of all its divisions and, unsurprisingly, those more specialist activities have received particular attention. The Trust specialises in cardiac surgery activity, for which it is a tertiary centre, and performed a high number of coronary artery bypass grafts (CABG) and heart valve replacements in 2013. By nature, these procedures are identified as fairly complex and the HRGs/tariffs allocated reflect this complexity.

Dr Foster’s Practice and Provider Monitor enables benchmarking of productivity and efficiency measures, giving the user the ability to compare mean-price-per-spell at both procedure and diagnosis HRG level. This is different from other productivity and efficiency tools, which are often restricted to specialty level.


Analysis identified that the cardiac surgery specialty was generating substantially less revenue than its peers based on an average spell tariff. Additionally, the average income per bed day was also lower compared to peers.

The Dr Foster team raised the following questions:

  • Is this something you were aware of?
  • Is there a logical reason for the variation?
  • Is there a longer length of stay further affecting the income per bed/day?

The Trust was aware there was a variance but only at specialty level, not at diagnosis and procedure level. With the tool, the Trust was then able to drill down to procedure level, allowing comparison of proportions of HRGs/tariffs grouped against the procedure. The Trust appeared to have a lower proportion of the more complex HRGs grouped against the procedures than would be expected.

The Trust investigated the data further to understand the information and the variance from both a clinical and data perspective, undertaking coding audits for these procedures and discussing findings with clinicians involved in the activity.


  • Greater engagement with clinicians and coding: Clinicians trust the data as they have been personally involved in ensuring its accuracy.
  • Increased reimbursement for this procedure activity: Following the review of CABG and heart-valve procedures the Trust estimates that it will receive a substantial increase in revenue.
  • Assurance that the data reflects the patient journey: More reliable monitoring of outcomes against expected with greater complexity available in the data.


Practice and Provider Monitor has now given the Trust the ability to look more deeply at other influences on the efficiency of the pathway as comparison with others has highlighted that the length-of-stay is one of the longest of its peer group. This clearly has an impact on income as the amount earned per bed day is lower, and the capacity to put more patients through the system is reduced. From a patient’s point of view, this is also good news: a longer length-of-stay may increase risk.

UHSM is now moving through the specialties, using Practice and Provider Monitor, to highlight areas of variance and focus on where they can improve productivity and efficiency across the Trust.

Further outcomes for the Trust include:

  • looking more deeply at other influences
  • highlighting areas of variance
  • improving efficiency and productivity
  • reducing length of stay and risk to patients