Note the contents of this paper; and Confirm approval of the processes and approach outlined.

Transcription

1 Board of Directors (Public) Item 6.4 Subject: Reference Cost Submission Process 2015/16 Date of meeting: 26 th May 2016 Prepared by: Jim Davies, Deputy Chief Finance Officer Presented by: David Jago, Chief Finance Officer BAF Ref Impact on BAF 6 n/a 1. Executive Summary The purpose of this paper is to: i. Provide an overview of the costing processes in place at the Trust for the completion of reference costs; and ii. To request that the board considers and approves the processes outlined in the paper. With effect from the 2012/13 submission, Monitor highlighted the need for enhanced Board Level engagement in the completion of reference costs. This paper provides the first stage in that process. Further updates will be provided to the Board including a summary of the reference cost position ahead of sign off of final submission by Director of Finance on or before [22nd July 2016]. As part of the approval process, there is a requirement that the Board has sight of, and confirms approval that the trust is compliant with the self-assessment quality checklist (further details of which are included within this paper). Alongside the requirement for enhanced Board level involvement in the process, there is also an increased level of focus on clinical and operational involvement, and this was highlighted in a recent audit undertaken at the Trust. While clinical engagement has always been considered to be a key and essential pillar of the costing process, it is recognised that more formal arrangement is required, and this will be undertaken through Divisional Performance Meeting / Operations Board; as well as specific meetings / discussions as required. The Board is asked to; Note the contents of this paper; and Confirm approval of the processes and approach outlined. 2. Background The reference cost submission is mandatory for all NHS Foundation Trusts and NHS Trusts. The purpose is to provide average unit costs of the services provided by the Trust. These average unit costs are submitted to the Department of Health for the calculation of national average unit costs. These national averages are then used to influence setting the National Tariff. Therefore it is extremely important that the costs submitted are robust and accurate.

2 The average unit costs are based on HRGs i.e. similar groups of treatment which consume similar levels of resource. While the costs are submitted as an aggregated average value, they are built up from extremely detailed patient level information, and so the level of accuracy is high. For the 2015/16, submission the reference costs will be calculated using the same software that is used for Service Line Reporting (SLR) which is called Prodacapo. This means that the cost allocation model is readily available to feed into the reference cost model. The final date for the Reference Cost Submission is the 22 nd July 2016, and the final date for the integrated Reference Cost and Training & Education Cost submissions is the 16 th September Both of which require the approval of the Chief Financial Officer prior to submission. 3. Issues 2015/16 Submission Key Changes The key changes to the reference submission for are summarised as follows: The Trust is required to submit an integrated Reference Cost and Education & Training Cost submission for In the requirement was for the respective returns to be submitted separately. Key changes to the requirements as set out in the guidance for are summarised as follows: o o The first submission which is required is for reference costs only, has a window of submission which opens on the 20 th June 2016 and closes on the 22 nd July During this time the Trust can make as many submissions as it chooses, but the final submission must be made by the 22 nd July 2016, complete with Chief Financial officer approval. The second submission which is required is the integrated submission of both Reference Costs and Education and Training Costs. As with Reference Costs the first date for submission is the 20 th June 2016, with a longer period before submission of the final version which runs until the 16 th September This will require: a. Reference cost at episode level but net of education and training costs; b. Education and Training costs at student year level. Improvements to data quality, validation and assurance. Currently it is the responsibility of the Chief Financial Officer (or a deputy with pre-approved delegated responsibility) to use a specific account on Unify2 to sign-off the reference costs collection. The Department of health (DOH) have introduced an additional step where Trusts must submit a signed pdf document reinforcing the fact that Trust, and its board, have complied with the requirements of Monitor s approved costing guidance. This is attached at Appendix 1. Costing Process The process is set out in Appendix 2. Quality Assurance The Department of Health have provided a Quality Checklist which will provide the Board with assurance that the Trust reference costs are of high quality. This is made up of ten points detailed in Appendix 3.

3 Item 8 on the quality checklist (above) refers to the Materiality and Quality (MAQ) score. This provides an assessment as to the standard of costing assumptions, assessed against national expectations. The scores range from 0.00 (Poor) to 1.00 Good, with an aggregate overall score. The total score the trust costing system in 2014/15 is 78% which is classified as gold standard Only four Trusts in the country achieved gold standard. The analysis of the MAQ Score is shown at Appendix 4, and includes key cost drivers, together with methods for allocation. Benchmarking A high level benchmarking analysis of 2014/15 reference costs is included at Appendix 5. This covers the most common healthcare resource groups and compares against the national average. Further detail is available, and this will form part of the discussions/sense check of outputs with the Divisions. 4. Conclusion. This paper has outlined the proposed approach for the completion of reference costs for 2015/16, incorporating; Key Changes to the Guidance for 2015/16 submissions; The Costing process; Quality Assurance; and High level benchmarking. A draft first submission is scheduled to be made to UNIFY2 on the first day of the open submission (22th June 2015) to test the process. An updated submission will also be made well before the deadline of 22 nd July 2016 and signed off by Chief Financial Officer. The Board will receive regular updates and outputs up until the final submission dates. 5. Recommendations. The Board is asked to; Note the contents of this paper; and Confirm approval of the processes and approach outlined.

4 Appendix 1 - Statement of directors responsibilities for the reference cost return In the production of the annual reference cost return the trust must include a statement of the finance director s responsibilities, in the following form of words: [NHS foundation trusts/nhs trusts] are required pursuant to the [NHS Provider Licence/Accountability Framework] [delete as appropriate] to comply with Monitor s Approved Costing Guidance in the completion of the reference cost return. In preparing the reference cost return the board or relevant sub committee is required to take steps to satisfy themselves that: the reference cost return has been prepared in accordance with Monitor s Approved Costing Guidance, which includes the reference cost guidance the information, data and system underpinning in the reference cost return is reliable and accurate there are proper internal controls over the collection and reporting of the information included in the reference costs, and these controls are subject to review to confirm that they are working effectively in practice costing teams are appropriately resourced to complete the reference costs return, including the self-assessment quality checklist and validations accurately within the timescales set out in the reference costs guidance. the content of the reference cost return is not inconsistent with internal and external sources of information including: Board/delegated committee minutes and papers detailing the process for submission the period April 2016 to [the date of this statement] Board/delegated committee minutes and papers detailing the final submission sign off the period April 2016 to [the date of this statement] The finance director confirms to the best of their knowledge and belief the board has discharged its responsibilities above and the trust has complied with these requirements in preparing the reference cost return. By order of the board NB: sign and date in any colour ink except black...date...finance Director

5 Appendix 2 Costing Process 1. There are some fundamental differences between reference cost requirements and SLR requirements. The most important among them is that costs of non English patients like welsh and Private are excluded for reference cost purposes where as for SLR all patients costs are included for internal management purposes. Another example would be that in SLR, unmatched support services activities and consumables are reported separately. For Reference Costs these costs are absorbed by reported activities. 2. The 2015/16 SLR model will be replicated to create a model purely for reference costs. Various changes are to be made necessary for compliance with reference cost requirements 3. The national reference cost collection process is the development of detailed costing at HRG level which is used for in the development of future tariffs. For a given year the reference cost HRG may be different from payment HRG. Hence, Discharged patients activity data from Patient Administration System (PAS) will be put through Reference Grouper HRG4+, to get the HRG identifier for each episode for the purposes of reference cost. 4. With engagement from clinical leads, the activity used to calculate Reference Costs and the respective outputs will be sense checked and validated. 5. The costs to be included for reference costs will be consistent with the requirements as set out in the reference cost guidance. This will be evidenced through the reconciliation statement which reconciles the reference cost quantum to the Trust s Annual Accounts for 2015/16, clearly showing specific costs excluded from the quantum. 6. The unit costs will be calculated and exported into the reference cost submission workbooks 7. Draft unit costs will be circulated to General Managers, Service Line Managers and clinical leads for sense checking. 8. Evidence based amendments to unit costs will be made where required, and following feedback from the sense check exercise 9. Unit costs will be recalculated and exported onto the final submission workbook 10. Submission workbooks will be uploaded onto UNIFY2 ( a web based submission portal of DOH) 11. In the May Board meeting, the Board will be requested to approve the methodology of reference cost submission for the Trust. 12. In the June Board meeting, a paper will be tabled on the outputs of the exercise and the Board will be requested to approve the outputs of the exercise prior to CFO sign off and Final submission. 13. The Director of Finance will sign off the submission in UNIFY2 on or before 22nd July 2016.

6 Appendix 3 Quality Assurance Checklist Quality item Check Proposed action Evidence 1. Total Costs The 2015/16 reference The reference cost costs quantum will be quantum will be fully reconciled to the calculated in line with annual accounts, using prescribed guidance the reconciliation statement workbook as prescribed through the guidance. and fully reconciled to within +/- 1% of the signed annual accounts. A copy of the reconciliation statement will be provided as part of the approval paper to be drafted for the Board in June. 2. Total Activity The activity information used in the reference cost has been fully reconciled to provisional Hospital Episode Statistics (HES) and documented. 3. Sense Check Low Unit Costs 4. Sense Check High Unit Costs 5. Sense Check all Unit Cost Outliers All unit Costs under 5 to be reviewed and justified. All unit costs over 50,000 will be reviewed and justified. All unit cost outliers (defined as less than one-tenth or more than ten times the previous year s national mean average unit cost) will be reviewed and justified. Activity will be fully reconciled as required. A detailed review will be undertaken and any unit costs below 5 will be reviewed and either a) justification will be documented; or b) the unit cost will be amended. A detailed review will be undertaken and any unit costs above 50,000 will be reviewed and either a) justification will be documented; or b) the unit cost will be amended. The review will be carried out and any such unit cost will be justified seeking input from clinicians and reported to the board A copy of the reconciliation statement will be provided as part of the approval paper to be drafted for the Board in June. A detailed audit trail will be maintained highlighting all unit costs below 5, and actions taken. A detailed audit trail will be maintained highlighting all unit costs above 50,000 and actions taken. A detailed audit trail will be maintained highlighting all such outliers. 6. Benchmarking Data will be benchmarked where possible against The review will be carried out and any such unit cost will be A detailed audit trail will be maintained

7 7. Data Quality - Data 8. Data Quality Systems 9. Data Quality issues identified and resolved national data for individual unit costs and for activity volume (the previous year s information is available in the Audit Commission s National Bench marker) Providing assurance of the quality of data. Assurance is obtained over the reliability of costing and information systems Data quality: Where issues have been identified in the work performed on the data and systems, these issues have been resolved to mitigate the risk of inaccuracy in the reference costs submission. justified seeking input from clinicians and reported to the board. Also the high volume top ten HRGs for each directorate will be shared with internal General Managers for sense checking. External and Independent audits undertaken provide independent assurance. The Clinical Coding Manager undertakes a monthly check on coding of high cost devices such as pacemakers and high cost drugs. The Trust had an external audit of the costing process last year, and relating to the submission. A number of recommendations were made and a paper outlining key actions and responses to the audit was submitted to the IPC in March. An issues log has been opened and shall be maintained and monitored by Deputy Director of Finance highlighting all such outliers. Audit details maintained and details of monthly checks available for review. The MAQ score (Materiality and Quality) for the Trust costing system for 2014/15 is 78% which is gold standard Only five Trusts in the country achieved gold standard. Summary of the log and will be provided as part of the proposed report to the Board in June 10. Data Quality Non Mandatory Validations All other non - mandatory validations as specified in the guidance and workbooks have been investigated and necessary corrections All non-mandatory validations will be investigated and necessary corrections made. Where issues identified are considered to be A summary of key issues identified, together with rationale will be included in paper to Board in June.

8 made. justifiable, a clear rationale will be provided.

9 Appendix 4: Cost Drivers and Materiality and Quality Scores Cost Pool Blood and blood products Clinical Negligence Scheme for Trusts(CNST) Critical Care Drugs Radiology (Diagnostic) Medical Staffing Critical Care Education and Training - Direct costs Medical Staff Operating Theatres excluding Recovery Other e.g. Clinical lead time, admin Outpatients Clinic Costs (Including Procedures) Specialist Procedure Suites Cost type Non pay Method of Materiality & Allocation Quality Score Patient /Spell 1.00 Non Pay - all other specialities NHSLA Allocation Provided 1.00 Consumables Patient /Spell 1.00 (Hours) / Organs Non Pay Supported 1.00 (Hours) / Organs Nursing Salaries Supported 1.00 (Hours) / Organs Other pay costs Supported 1.00 Drugs - inpatient Patient /Spell 1.00 High cost drugs Patient /Spell 1.00 Ward drugs 1.00 Time Taken for Individual Tests (Split by Test type e.g. Pay & Non Pay costs MRI, CT, Xray) 1.00 Medical Staff Costs Medical Staff Costs Medical secretaries Costs Medical Staff Costs & Associated Non Pay Medical Salaries & associated non pay Medical Salaries & associated non pay Medical Staff Costs & Associated Non Pay (Hours) / Organs Supported 0.75 Education & Training Time (Discreet Exercise) 1.00 Based on Consultant Activity / Job Plans 0.75 Theatre Time - Patients 1.00 Based on Consultant Activity / Job Plans 0.75 Outpatient attendances (Weighted for First & Follow UP) 0.50 Procedure Time 1.00

10 Ward rounds Operating Theatres excluding Recovery Other Clinical Services Other diagnostic testing Outpatients Clinic Costs (Including Procedures) Pathology / Diagnostic Pharmacy non production Pharmacy production Prosthetics / Devices / High cost consumables Specialist Procedure Suites excluding Recovery Specialist Procedure Suites excluding Recovery Medical Staff Costs & Associated Non Pay Non Pay Nursing Salaries & other clinicians (ODPs/ODAs) Medical Staff Pay Costs Non Pay Costs Non Pay Costs Pay Costs Items (Hours) 0.75 Patient /Spell 1.00 Theatre Time - Patients 0.80 Split by Activity Type & Attendance 0.75 Time Taken for Individual Tests (Split by Test type e.g. MRI, CT, Xray) 1.00 Time Taken for Individual Tests (Split by Test type e.g. MRI, CT, Xray) 0.50 Split by Consultant Clinic, and Weighted for First and Follow Up 0.50 Split by Consultant Clinic, and Weighted for First and Follow Up 0.75 Patient /Spell 1.00 Allocated based on Actual Activity e.g. LCL 1.00 Proportion of Pharmacist Time Spent 0.75 Based on Value of Issues 0.50 Patient /Spell 1.00 Nursing Salaries & other clinicians (ODPs/ODAs) Procedure time 0.75 Other pay costs & non pay costs Patient /Spell 1.00 Nursing Salaries & other clinicians (ODPs/ODAs) Procedure time 0.75 Other pay costs & 1.00

11 non pay costs Patient /Spell Split by service Area, Specialist Nursing - Acute Sector and then by LoS / Attendance 0.50 Therapies Contact Time 0.75 Wards Admission and discharge facilities (e.g. wards / Costs allocated across all patients admitted to the lounges) facility Wards Consumables (Hours) 0.50 Capital Charges - Equipment that can be allocated to clinical departments Nursing Salaries Other pay costs & non pay costs (Hours) 0.40 (Hours) 0.50 Allocate based on Assets / Equipment 0.50 Catering 0.25 Clinical coding Split Based on Activity and Weighted for Complexity 0.75 Split Based on Activity and Weighted for Complexity 0.75 Clinical safety, quality, audit Directorate Management Costs Directorate WTE 0.50 Equipment maintenance & medical physics department Allocated to Specific Services 0.75 Linen 0.25 Medical records Outpatient library Attendances 0.50 Portering 0.25 Theatre / Procedure Sterile services Time 0.50 Training - Departmental Total Trust Expenditure 0.25 Total Trust Expenditure 1.00 Board Expenses Building Maintenance Floor Area 0.75 Capital Charges - Equipment that cannot be allocated to a specific clinical Clinical Cost Centres 0.25

12 department) Cleaning Floor Area 0.50 Computer Licences Non Pay Clinical Cost Centres 0.25 Energy/Utilities (unless metered) Electricity Weighted Floor Area, Gas Weighted Volume Total Trust 0.75 Finance Expenditure General Trust Administration Total Trust Expenditure 1.00 HR Whole Time Equivalents 0.50 Information Management Activity 0.75 Information Total Trust Technology Expenditure 0.25 Interest Payments Total Trust Expenditure 0.50 Medical Staff Management Medical Staff WTE 0.50 Organisational Total trust Development expenditure 0.25 Payroll Headcount 0.75 Based on Number of 0.75 Procurement Orders Site security Weighted Floor Area 0.25 Training - Organisation Wide Total Trust Expenditure 0.25

13 Appendix 5: High Level Benchmarking Report on 2014/15 Reference Costs: Elective Service Line / Healthcare Resource Group (HRG) Activity / Reference Cost Cost Variation National Number Average ( ) LHCH ( ) Unit ( ) % Aggregate ( ) CABG and Valve Procedures ED23A Standard, Coronary Artery Bypass Graft with Single Heart Valve Replacement or Repair, with CC Score ,358 19,815 2,457 14% 105,651 ED23B Standard, Coronary Artery Bypass Graft with Single Heart Valve Replacement or Repair, with CC Score ,013 13, % 28,454 ED23C Standard, Coronary Artery Bypass Graft with Single Heart Valve Replacement or Repair, with CC Score ,391 12,878 1,487 13% 35,688 ED24B Complex, Single Heart Valve Replacement or Repair, with CC Score ,465 14, % 6,634 ED25A Standard, Single Heart Valve Replacement or Repair, with CC Score ,832 16,180 1,348 9% 44,484 ED25B Standard, Single Heart Valve Replacement or Repair, with CC Score ,069 14,368 2,299 19% 156,332 ED25C Standard, Single Heart Valve Replacement or Repair, with CC Score ,427 12,663 2,236 21% 82,732 ED27B Major Coronary Artery Bypass Graft with CC Score ,094 10, % - 15,048 ED28A Standard Coronary Artery Bypass Graft with CC Score ,706 12, % - 25,281 ED28B Standard Coronary Artery Bypass Graft with CC Score ,106 10, % 19,404 ED28C Standard Coronary Artery Bypass Graft with CC Score ,873 9, % 73,154 ICDs and Bi-ventricular Pacemakers EY01B Implantation of Cardioverter Defibrillator with Cardiac Resynchronisation Therapy, with CC Score ,365 17,522 3,157 22% 211,519 EY02A Implantation of Cardioverter Defibrillator with CC Score ,419 12,272-2,147-15% - 47,234 EY02B Implantation of Cardioverter Defibrillator with CC Score ,777 14,140 1,363 11% 309,401 EY04A Implantation of Biventricular Pacemaker with CC Score ,305 5, % - 33,320 EY04B Implantation of Biventricular Pacemaker with CC Score ,119 5, % 17,664 Pacemakers EY06D Implantation of Dual Chamber Pacemaker with CC Score ,107 3, % 12,710 EY06E Implantation of Dual Chamber Pacemaker with CC Score ,633 4,245 1,612 61% 75,764 EY08C Implantation of Single Chamber Pacemaker with CC Score ,391 3, % 4,524 EY08D Implantation of Single Chamber Pacemaker with CC Score ,696 3, % 34,632 EY08E Implantation of Single Chamber Pacemaker with CC Score ,175 2, % 67,512 Pacemakers Removal and Testing EY12A Implantation of Electrocardiography Loop Recorder with CC Score ,842 2, % 32,292 EY12B Implantation of Electrocardiography Loop Recorder with CC Score ,727 3,424 1,697 98% 78,062 EY13Z Removal of Electrocardiography Loop Recorder 26 1,047 1, % 5,876 EPS and Ablation EY30A Complex Percutaneous Transluminal Ablation of Heart with CC Score ,174 6, % 61,722 EY30B Complex Percutaneous Transluminal Ablation of Heart with CC Score ,137 6,599 1,462 28% 285,090 EY31A Standard Percutaneous Transluminal Ablation of Heart with CC Score ,681 3, % - 88,924 EY31B Standard Percutaneous Transluminal Ablation of Heart with CC Score ,440 3, % - 30,090 EY32A Percutaneous Diagnostic Electrophysiology Studies with CC Score ,238 2, % 21,875 EY32B Percutaneous Diagnostic Electrophysiology Studies with CC Score ,484 3, % 25,585 PCI EY40C Complex Percutaneous Transluminal Coronary Angioplasty with CC Score ,459 4, % 56,544 EY40D Complex Percutaneous Transluminal Coronary Angioplasty with CC Score ,734 3, % 125,646 EY41C Standard Percutaneous Transluminal Coronary Angioplasty with CC Score ,690 2, % 26,593 EY41D Standard Percutaneous Transluminal Coronary Angioplasty with CC Score ,210 2, % 112,014 Cardiac Physiology EY50Z Complex Echocardiogram % 6,396 EY51Z Electrocardiogram Monitoring or Stress Testing % 3,740 Congenital Cardiac Complex EC10B Very Complex Procedures for Congenital Heart Disease with CC Score ,636 20,961 3,325 19% 79,800 Congenital Cardiac Major EC13A Major Procedures for Congenital Heart Disease with CC Score ,789 14,669 2,880 24% 57,600 EC13B Major Procedures for Congenital Heart Disease with CC Score ,649 11,899 2,250 23% 60,750 Congenital Cardiac Intermediate & Minor EC14B Intermediate Procedures for Congenital Heart Disease with CC Score ,122 5, % - 12,075 EC14C Intermediate Procedures for Congenital Heart Disease with CC Score ,603 8,129 2,526 45% 146,508 Cardiac Disorders EB07C Arrhythmia or Conduction Disorders, with CC Score , % - 6,873 EB07D Arrhythmia or Conduction Disorders, with CC Score % - 2,432 EB07E Arrhythmia or Conduction Disorders, with CC Score % 5,796

14 Appendix 5: High Level Benchmarking Report on 2014/15 Reference Costs: Non Elective Activity / Reference Cost National Average Number ( ) LHCH ( ) Unit ( ) % Cost Variation Aggregate ( ) Service Line / Healthcare Resource Group (HRG) CABG and Valve Procedures ED23A Standard, Coronary Artery Bypass Graft with Single Heart Valve Replacement or Repair, with CC Score ,142 19,539 3,397 21% 95,116 ED23B Standard, Coronary Artery Bypass Graft with Single Heart Valve Replacement or Repair, with CC Score ,504 15,316 1,812 13% 27,180 ED25A Standard, Single Heart Valve Replacement or Repair, with CC Score ,570 18,379 4,809 35% 72,135 ED27A Major Coronary Artery Bypass Graft with CC Score ,787 9,335-3,452-27% - 62,136 ED27B Major Coronary Artery Bypass Graft with CC Score ,664 8,777-1,887-18% - 67,932 ED28A Standard Coronary Artery Bypass Graft with CC Score ,658 1,228-10,430-89% - 886,550 ED28B Standard Coronary Artery Bypass Graft with CC Score ,529 8, % - 80,040 ED28C Standard Coronary Artery Bypass Graft with CC Score ,230 7,864-1,366-15% - 39,614 ICDs and Bi-ventricular Pacemakers EY01B Implantation of Cardioverter Defibrillator with Cardiac Resynchronisation Therapy, with CC Score ,308 16, % 29,874 EY02A Implantation of Cardioverter Defibrillator with CC Score ,452 16, % - 25,781 EY02B Implantation of Cardioverter Defibrillator with CC Score ,104 13, % - 57,205 EY04A Implantation of Biventricular Pacemaker with CC Score ,692 6,184-2,508-29% - 30,096 Pacemakers EY06C Implantation of Dual Chamber Pacemaker with CC Score ,449 4, % - 9,030 EY06D Implantation of Dual Chamber Pacemaker with CC Score ,847 4,881 1,034 27% 26,884 EY06E Implantation of Dual Chamber Pacemaker with CC Score ,129 4, % 18,316 EY08D Implantation of Single Chamber Pacemaker with CC Score ,533 4, % 17,199 EPS and Ablation EY31A Standard Percutaneous Transluminal Ablation of Heart with CC Score ,028 4, % - 7,308 PCI EY40A Complex Percutaneous Transluminal Coronary Angioplasty with CC Score ,237 8,953 1,716 24% 36,036 EY40B Complex Percutaneous Transluminal Coronary Angioplasty with CC Score ,320 6,524 1,204 23% 46,956 EY40C Complex Percutaneous Transluminal Coronary Angioplasty with CC Score ,783 4, % 27,360 EY40D Complex Percutaneous Transluminal Coronary Angioplasty with CC Score ,120 3, % 10,878 EY41A Standard Percutaneous Transluminal Coronary Angioplasty with CC Score ,827 8,303 1,476 22% 95,940 EY41B Standard Percutaneous Transluminal Coronary Angioplasty with CC Score ,379 4, % 126,408 EY41C Standard Percutaneous Transluminal Coronary Angioplasty with CC Score ,243 3, % 373,248 EY41D Standard Percutaneous Transluminal Coronary Angioplasty with CC Score ,757 3, % 94,371 TAVI & Other - Table EY23A Standard Other Percutaneous Transluminal Repair of Acquired Defect of Heart with CC Score ,274 9,463 3,189 51% 63,780 EY23B Standard Other Percutaneous Transluminal Repair of Acquired Defect of Heart with CC Score ,213 8,239 4,026 96% 44,286 Cardiac Disorders EB03B Heart Failure or Shock, with CC Score ,727 8,453 5, % 125,972 EB06B Cardiac Valve Disorders with CC Score ,856 6,349 3, % 38,423 EB07B Arrhythmia or Conduction Disorders, with CC Score ,822 3,082 1,260 69% 27,720 EB07C Arrhythmia or Conduction Disorders, with CC Score ,219 2,539 1, % 29,040 EB07D Arrhythmia or Conduction Disorders, with CC Score ,981 1, % 21,340 EB07E Arrhythmia or Conduction Disorders, with CC Score ,037 1, % 26,514 EB10B Actual or Suspected Myocardial Infarction, with CC Score ,062 5,340 3, % 85,228 EB10D Actual or Suspected Myocardial Infarction, with CC Score ,130 1, % 7,049 EB12B Unspecified Chest Pain with CC Score , % 15,876 EB14B Other Acquired Cardiac Conditions with CC Score ,531 3,947 1,416 56% 110,448 EB14C Other Acquired Cardiac Conditions with CC Score ,718 3,947 2, % 173,862 EB14D Other Acquired Cardiac Conditions with CC Score ,224 1, % 14,007 EB14E Other Acquired Cardiac Conditions with CC Score % 2,413