Healthcare Resource GroupsHealthcare Resource Groups

What are HRGs?What are HRGs?

Casemix methodology underpinning system of payment to providers and contract pricing

Aggregation of OPCS or ICD codes with similar resource requirements

UK standard Phased programme Vision: HRGs designed as the currency of Care

Pathways

HRG DevelopmentHRG Development

Chapters – clinical relevance Working groups

Chapter working parties Expert reference panels

Anaesthesia in chapter A Neurosciences

HRG VersionsHRG Versions DRGs Currently ver 3.5

Interim change from 3 via 3.1 Implemented October 2003 No anaesthesia HRGs – Pain management Ver 3.5 project recommended OPCS change

Project in progress ver 4 More widespread financial proposed use Use greater detail of OPCS replacement - NIC

NIC structureNIC structure Proposed coding structure more comprehensive than OPCS Anaesthesia poorly represented in OPCS Includes in addition to OPCS4

Laterality Surgical approach/method ‘Extent’

Problems Communication Changes of leadership

More recently – change of direction – on hold

‘‘Payment by Results’ ObjectivesPayment by Results’ Objectives Pay providers fairly & transparently for services

delivered Reward efficiency & quality in providing services Contract price negotiation on volume and mix of

services Match capacity to demand Improve patient choice? Use HRG ver 4

HRG ver 4HRG ver 4 Suitable for a plurality of providers Reflect change in clinical practice Setting independent ( I/P D/C O/P ) Take advantage of new procedure classification Improve suitability for use in specialist services

e.g.Paediatrics; also chronic conditions

HRG ver 4HRG ver 4 Based on Spells rather than FCEs Unbundling of components within the pathways Completion of missing areas

Chemotherapy Critical Care Radiology Pathology A&E Radiotherapy Anaesthesia

Care PathwayCare PathwayCare Package

(Episode)

Healthcare Resource Groups (HRGs)

Healthcare Resource Components (HRCs)

Intervention Classification

Consultation A&E

Critical Care

Chemotherapy

Radiotherapy

Palliative CareMental health

Pathology

ICD OPCS NIC

SCONI

A A A A A A AAA

Radiology

Interventions

A

Future DevelopmentFuture Development

For service commissioning beyond Admitted Patient Care, April 2008

Caveats Problems and FolliesCaveats Problems and Follies PBR dependent on ver4 HRG in turn dependent on

NIC project Medical HRGs

ICD international – changes!! Length of stay

Setting independence Clinical relevance Cross chapter resource/cost comparison Cherry picking! Not much historic anaesthetic data

Proposed Anaesthetic HRGsProposed Anaesthetic HRGs Using BUPA Classification and ASA

1    Anaesthesia assessment (I/P or O/P) only

2    MIN or INT surgery and patient ASA I or II 

3    MIN or INT surgery and ASA > II 

4    MAJ or MAJ +  and ASA I or II

5    MAJ or MAJ +  and ASA > II

6    COMPLEX