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Part of SUS+ PbR reference manual

SUS+ pricing differences

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Current chapter – SUS+ pricing differences

Due to processing changes and the correction of historical issues, some known differences exist between SUS+ pricing and pricing in the legacy system.

In some cases the processing changes are affected by SUS+ replacing the legacy SUS concept of spell construction using ‘Slab-logic’ by creating spells using ‘natural keys’ (see 'spell creation' in the HRG grouping chapter).

Hospital provider spell number present but missing NHS number and date of birth

Legacy SUS did not construct spells where NHS number and date of birth were missing from the submitted data.

Where hospital provider spell number is present, SUS+ will form a spell and assign the appropriate price. It is therefore possible for SUS+ processing to result in a higher pricing because of greater coverage.

Legally restricted records

Legacy SUS effectively treated all legally restricted records as single episode spells.

Where multiple episodes exist within a spell, SUS+ links all the related episodes and treats the whole spell as legally restricted. As a result, certain records will attract a price in SUS+ that would not have received a price in legacy SUS.

SUS+ is therefore expected to have a higher total PbR tariff than SUS on average. Across all providers the difference is approximately 0.1%.

Missing discharge date

Where no discharge date has been populated for a single episode day case spell, but the last episode in spell indicator has been set, SUS+ will not price the spells. This is because they are not deemed finished and will therefore be populated in the unfinished spells extract.

Multi-episode day cases

Legacy SUS created single episode spells for all day cases.

Any provider can use multiple day case episodes and SUS+ therefore allows multi-episode day case spells. The same applies to regular day and night episodes.

The impact of this is that legacy SUS is likely to attract a higher average price due to all activity being treated as a single episode spell.

Duplicate hospital provider spell number

Issues may be caused where the same hospital provider spell number has been used for more than one different spell within the same admission date. Legacy SUS relied mainly on NHS number for spell construction and did not use hospital provider spell number.

SUS+ uses hospital provider spell number as a natural key meaning that, where a provider uses the same hospital provider spell number for two or more spells, the constituent episodes will be assigned to the same spell.

SUS+ implements checks for overlapping episodes and/or multiple NHS numbers in spell along with checks to identify multiple patients in a single spell. A spell will not be priced where these checks are failed.

Missing hospital provider spell number

SUS+ uses hospital provider spell number as part of a natural key. Episodes submitted without a hospital provider spell number are therefore treated as single episode spells.

If the episode is part of a multi-episode spell the separated episodes may be incorrectly priced.

Spells containing multiple episodes with last episode in spell indicator set

This only applies to zero length of stay episodes in zero length of stay spells, where the patient classification is not 2 (Day case admission). Legacy SUS assigns all episodes with a last episode in spell indicator of 1 to individual spells. SUS+ will only create a single spell in this instance.

Critical care

Single day overlap threshold

SUS+ has raised the threshold for the number of critical care periods that can ‘overlap’ a single day from 2 to 3. The effect is that slightly fewer spells are treated as having critical care errors in SUS+.

Critical care period overlap

Rather than ignore all critical care processing, legacy SUS only ignored overlapping episodes. SUS+ ignores all critical care and more accurately reflects the processing requirement.

Both of the above issues can impact on prices for spells with critical care problems. Overall spell length of stay is adjusted down by critical care (unless it is ignored). This can lead to an impact on excess bed-day calculations and HRGs. The expected result would be higher average national pricing in SUS+.

This price difference should be noted when considering local adjustments to critical care payments which are not currently priced in legacy SUS or SUS+.

Mixed admission methods

Where episodes in the same spell have different admission methods, the spell admission method used for national pricing in SUS and SUS+ may be different.

Last edited: 7 June 2022 8:53 am