Transcript HRG V4 Initiation

Features of HRG4
Paula Monteith
Principal Casemix Consultant
– Finance & Commissioning
Features of HRG4
 Differences in…
 Format
 Scope
 Settings
 Services
 Underlying OPCS Codes
 Logic
 Specificity
 Multiple Procedures
 Multiple Trauma
 Output
 Spells
 Counting [unbundling]
 Data output
The Focus of HRG4
“To better describe the care that a patient
receives in terms of treatment and resources”
Format of HRG4
Number
Chapter & subchapter
Split
LA 03 B
Urinary Tract &
Male Reproductive
System
Renal Procedures
and Disorders
In this case ‘B’
means <19
‘Z’ means no split
Kidney Transplant from Live Donor
Scope of HRG4 (1)
 More Settings
 Designed to extend beyond admitted care
 Can allocate the same core HRG to procedures regardless of
delivery setting
 Increased Services
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Chemotherapy
Critical Care
Diagnostic Imaging
Emergency & Urgent Care
Interventional Radiology
Rehabilitation
Radiotherapy
Specialist Palliative Care
Scope of HRG4 (2)
 Supported by extended underlying OPCS
classification (4.3)
 Over 2,000 new codes introduced [25% increase]
 New codes for new procedures incl. non-surgical interventions
Logic of HRG4 (1)
 Specificity
 Complications and Comorbidities
 3 levels of CC rather than the 2 (‘with CC’ and ‘without
CC’), of HRG 3.5
 Level 1 – Not a significant diagnosis
 Level 2 – Intermediate diagnosis
 Level 3 – Major diagnosis
 Splits
 Paediatrics
 Length of Stay
 Other
Logic of HRG4 (2)
 Accommodates Multiple Procedures
 Not global – chapter specific
 Takes account of bilaterals
 Applies escalator logic
 Concept of Multiple Trauma
 Requires more than one trauma diagnosis from more than one
of 9 body sites for the first FCE in a spell
 An MT FCE will generate an MT spell
 Multiple Immediate Significant Trauma [MIST]
 Grouping
 Re-groups FCE data to spell level [see diagram] – removes
dominant FCE
Output of HRG4 (1)
 Spell-based activity
 Spell based HRGs cover the whole stay from admission to
discharge [but see unbundling]
 Remains relevant for FCEs
 Incorporates concept of “Unbundling” and the
“Unbundled” HRG – 4 Qs
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When?
What?
Why ?
How?
Output of HRG4 (2)
 When unbundle?
 Where a component within an episode of care could be
provided in a different setting, or by a different provider
 Where a high cost component is sometimes, but not
always, provided within an HRG spell
 What unbundle?
Renal Dialysis
Rehabilitation
Diagnostic Imaging
Adult Critical Care
Interventional Radiology
Paediatric Critical Care
Chemotherapy
Neonatal Critical Care
Radiotherapy
High Cost Drugs
Specialist Palliative Care
Output of HRG4 (3)
 Why unbundle?
 Improves performance of HRGs so they can better represent
activity and costs
 Identifies specialist services to ensure recognition of priority
areas
 Supports service redesign (e.g. locally commissioned
rehabilitation)
 Supports Patient Choice – increase flexibility to allow separate
elements of the care pathway to be delivered by different
providers
 How unbundle?
 Grouper separately identifies high cost elements to form
additional HRGs [but only where recorded]
 Unbundled components may be allocated as HRGs in their
own right or may be generated as additions to a core HRG
Output of HRG4 (4) - Errors
 Grouping identifies all errors
 Single error code – UZ01Z ‘Data Invalid for
Grouping’
 Detailed error report to support improved data
quality
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UZ01
UZ02
UZ03
UZ04
UZ05
UZ06
UZ11
UZ12
Invalid Primary Diagnosis
Poorly Coded Primary Diagnosis
Age Conflicting with Diagnosis
Diagnosis Conflicting with Anatomical Sites
Invalid Primary Procedures
Poorly Coded Primary Procedures
NCC Failed to Group
PCC Failed to Group
Output of HRG4 (5) - Summary
 Now a single “spell” can generate more than one
HRG
 Depends upon treatment patient receives…
 And whether that treatment is “unbundled”
 Ability to generate additional HRGs will also
depend upon HRG unit of activity, e.g.
 Rehabilitation – one HRG per IP day
 Radiotherapy –
 One planning HRG
 One delivery HRG
Spells, Unbundling & FCEs
FCE HRGs
grouped from all the
procedures and
diagnoses in the FCE
FCE
FCE
You can get one core and one
or more unbundled HRGs per
FCE/Spell
FCE
LA03B
FCE
FCE
Spell HRG
grouped from all the
procedures and
diagnoses in the Spell
Individual FCE HRGs may be
different from the Spell HRG
Unbundled
HRGs
LC02B
XD23Z
LC02B
RA03Z
VC42Z
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Renal Dialysis
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High Cost Drug
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Renal Dialysis
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MRI
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Rehab