HRG4 HealthCheck

• The Science of Casemix

• The Operating Environment

• Now and Next

• HRG4 HealthCheck

• Things you Need to Know

• Help!

• Key Messages

Session Overview

• Casemix

– A system whereby the complexity of care provided to a patient is reflected in an aggregate secondary healthcare classification

• In England

– Healthcare Resource Groups [HRGs], created and owned by the NHS IC in conjunction with over 300 clinicians / NHS staff via Expert Working Groups

– Design defined by international criteria:• Manageable number of groupings from readily available national data; • Intended to be clinically meaningful and use similar amounts of expected

resource

– HRG v3.5 used for funding under Payment by Results in 2008/09

– HRG4 to be used for funding from April 2009

The Science

PROVIDER

PATIENTTREATMENT

NOTES

CODING

PAS

COSTING

REFERENCECOSTS

TARIFF

DH PbR

SUS

HES

SUS PbR £

NATIONAL SYSTEM

COMMISSIONERPAYMENT £

The (Simplified)Operating Environment

CDS

Now and Next

HRG v3.5 HRG4Services Narrow New

CANCER, RENAL DIALYSIS, REHAB., DI, HCD

Settings RestrictedDATASETS: APC, A&E, ACC

Expanded+ DATASETS: PCC, NNCC, OP

Concepts LimitedSINGLE HRG PER FCE / SPELL

InnovativeUNBUNDLING, M.T., MULTIPLE

PXS, DIAG.H, MULTIPLE HRGS PER FCE / SPELL

Granularity Minimal2 CCS, AGE SPLITS

Improved3 CCS, PAED. SPLITS, LOS +

Grouping Best FitMINIMISES U GROUPS

Exact FitMAXIMISES U GROUPS

Format of HRG4

D02

ChapterChapter NumberNumber

Complex Thoracic Procedures

HRG v3.5 (610 HRGs)

RespiratorySystem

RespiratorySystem

SplitSplit

Here, ‘C’ represents without CC

Here, ‘C’ represents without CC

NumberNumberChapter & subchapter

Chapter & subchapter

RespiratorySystem

RespiratorySystem

ThoracicProcedures and Disorders

ThoracicProcedures and Disorders

Complex Thoracic Procedures without CC

DZ02C

HRG4 (≈1,400 HRGs)

Plus any unbundled elements. For example:

LC02B Haemodialysis/Filtration 18 years and under

XD08Z Medical Gases band 1

HRG4 HealthCheck

CODING

CODINGCOVERAGE

COSTING

COMMUNICATING

HRG4 HEALTH CHECK CONTINUUM

STAGE 1 STAGE 2

BESTPRACTICE

BREAKING THE RULES[INVALID CODES, UZ01Z]

BEING TOO VAGUE[GENERIC HRGS]

VALID & TRUE[SPECIFIC HRGs]

ADMITTED PATIENT CARE ADMITTED PATIENT CAREOUTPATIENTS

TOP DOWN BOTTOM UP COSTING STANDARDS, PLICS

FINANCE / INFORMATION WITHIN ORGANISATION

FINANCE / INFORMATION / CODING WITHIN / BETWEEN

ORGANISATIONS

FINANCE / INFORMATION / CODING / CLINICAL BETWEEN

ORGANISATIONS

ADMITTED PATIENT CAREOUTPATIENTS,

UNBUNDLED SERVICES

DEVELOPMENT TOWARDS…

• HRG4 has:-– More HRGs per patient record – but lower price for

core?– Different HRGs for FCEs and spells (between HRG

v3.5 and HRG4 and possibly within HRG4)– Dominant episode as proxy for spell removed - no

direct link to Treatment Function Code at spell level (though episode level reports available);

– Many more U groups – domino principle– Benefits dependent on relevant coding and data

quality

Things you need to know

• www.ic.nhs/casemix/prepare– Introduction to HRG4– HRG4 Concepts– HRG4 Chapter Summaries / Definitions/ Comparative Analysis– HRG4 Code to Group [what goes where and how]– Guide to Unbundling / File Preparation / Data Field validation /

HRG coding validation– Top 10 Tips / FAQs

• Analysis– National comparative statistics– 2006/07 and 2007/08 HES data grouped with each of an HRG

v3.5 and HRG4 local payment grouper, for each PCT-provider relationship

• PCT level summary including Unbundled HRGs• Sent by courier 13th January 2009• HES data therefore may differ from SUS / CDS

Help!

Key Messages

• HRG4…- Classification that is the world leader

- Advanced concepts and scope

- Stakeholder engagement (design and use)

- Essential for funding

- Measure of data quality

- Intelligent logic

- Xtraordinarily good e