Transcript Slide 1

HRG4 and Payment By Results
Roadshows 2009
Information Breakout Session Part 1
Scope of presentation
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HRG4 Grouping (not the grouper)
Grouping scope/coverage
HRG4 in SUS
HRG derivation process
New in HRG4 grouping
Comparative statistics
What can the Local Payment Grouper
group?
• Admitted Patient Care
• Non-Admitted Consultations
• Adult Critical Care
• Emergency and Urgent Care (HRG4)
• Accident & Emergency HRG v3.2 algorithm from
HRG v3.5
What are the HRGs that the Local Payment
Grouper can produce?
• Covers all the areas of HRG v3.5
• More Settings
– Extends beyond admitted patient care
– Ability to generate the same HRG with data from
different settings
• Generates HRGs for additional services:
Chemotherapy
Diagnostic Imaging
Emergency & Urgent Care
Rehabilitation
Radiotherapy
Specialist Palliative Care
• The grouper accommodates the mandated underlying OPCS-4
classification (OPCS-4.5 from 1 April 2009)
Roles of the SUS Grouper and the Local
Payment Grouper
The NHS Operating Framework for 2008/09 stated that
“…by April 2009, when the NHS should use SUS as the
standard repository for activity for performance monitoring,
reconciliation and payments"
SUS has its own grouper and will allocate HRG4 to all relevant
data submissions. SUS also implements PbR business rules.
The role of the Local Payment Grouper application is:
- Planning
- Monitoring
- Data validation
- Supporting payment for locally commissioned services
SUS and the Local Payment Grouper share the same grouping algorithms.
HRG4 in CDS6?
• DSCN 17/2008 (HRG4)’ states that: “There is no national
requirement to flow HRG4 through the CDS”.
• DSCN 24/2008 (CDS 6.1), Finished General Episode
CDS section includes:
3 characters!
M = Mandatory - data must be included where available
Guidance: HRGs in CDS 6.1
HRG4 cannot be accommodated by CDS 6.1; HRG and HRG
Version Number should not be populated in data submissions.
SUS will not reject records where these two fields are not
populated.
The SUS CDS Validation Table categorises HRG as:
• F – the format is validated
• R – required as part of NHS business rules to meet NHS
business requirements
But not
• M – mandatory in XML schema (messages will not flow if
absent)
SUS will derive the HRG.
New in HRG4 Grouping: General
• Single application groups episodes and spells (no
separate spell converter)
• Improved user interface
• Record Definition File Wizard
• Enhanced data validation
• Support for newer versions of Windows
• Larger range of output files to support various
user requirements (more in the next
presentation…)
Note that the Local Payment Grouper does not
produce reports.
New in HRG4 Grouping: Derivation Process
FCE HRGs
grouped from all the
procedures and
diagnoses in the FCE
Patient
Admission
Acute Renal Failure
LA07A
with Major CC
Data
Kidney Transplant
Validation
Kidney Transplant from Live
donor 18 years and
under
Spell
FCE
From Live donor 18 LA03B
years and under
LA03B
FCE
Spell HRG
grouped from all the
procedures and
diagnoses in the Spell
Patient
Discharge
You can get one core and zero
or more unbundled HRGs per
FCE/Spell
LC02B XD23Z VC42Z 
Source: Local
Payment
Grouper
Unbundled
HRGs
Renal Dialysis

High Cost Drug

Rehab
New in HRG4 Grouping: Multiple Trauma
• Trauma means non-superficial injury (e.g.
broken limb bone)
• Requirements
– In the first episode of the spell:
• Primary diagnosis of trauma
• Another diagnosis of trauma from a different
trauma site (body is divided into nine areas)
Diag1 (trauma), Diag2 (non-trauma), Diag3 (trauma)
New in HRG4 Grouping: Non-Admitted
Consultations
• HRG allocation is based on OPCS code
• If no OPCS code, then HRG is WF01* Non-Admitted
Attendance
• Multi-professional clinics identified by OPCS code
X62.2 and X62.3 (HRG is WF02*)
• Diagnosis is ignored
• Where APC HRG is based on procedure, then the NonAdmitted HRG will be the same (for the same
procedures) i.e. setting-independent
Non-Admitted Consultations
Outpatient
attendance
Data Validation
For example:
 RA03Z MRI
Unbundling
HRG4 OPCS
Logic
yes
For example:
 JC16B Skin therapies level 4
THEN STOP
no
HRG4 Default Logic
For example:
 WF01A Non-admitted Face to
Face Attendance – Follow-up
Where Has Our Activity Gone?
A comprehensive set of comparative analyses are available from the
Casemix website. For example:
PCT Comparative Statistics:
HRG v3.5 to HRG4
• This needs to be mentioned…
– Sent to all English PCTs ‘Director of
Commissioning’ in January 2009 via courier
– Check with your Director of Commissioning if
you want access to these data
– Password available from [email protected]
HRG4 and Payment By Results
Roadshows 2009
Information Breakout Session Part 2
Scope of presentation: HRG4 Grouping
• Ingredients
• Process
• Products
Downloading the Grouper
• Grouper applications
• Documentation
• FAQ
All available from:
www.ic.nhs.uk/casemix/prepare
Types and Roles of Groupers
• Reference Costs
– Used as part of the PbR reference costs
process carried out annually by DH
• RoadTest
– Used to support the annual DH road-test
exercise. Precursor to…
• Local Payment
– Derives the HRGs that underpin tariff
Grouper Recognition
•The application title bar indicates the version
•The icon helps to remind the user of the grouper type
Title
bar
Icon
Input Data
• Comma-separated text files only
• Each data type has its own mandatory
fields
• Fields must be in the correct format
• The input files are described in the Guide
to File Preparation document available
from the Casemix website
Output of HRG4 - Unbundling
Each episode and spell can now generate more
than one HRG
Depends on:
– Treatment patient receives
– Whether that treatment is unbundled
Ability to generate unbundled HRGs will also
depend on HRG unit of activity, e.g.
– Rehabilitation – one HRG per inpatient day
– Radiotherapy
• one planning HRG
• one delivery HRG
Output Files
• Comma-separated text files
• Different output files for each data type
• No reports
The Output Files – Admitted Patient
Care
• There are eleven output files but all grouped
data can be obtained by using just two of them:
– The FCE output file contains everything apart from
Specialised Service Codes (SSCs)
– SSCs are available from the spell output file
• The other nine files consist of:
– Five containing alternate views of data
– Two containing data quality messages
– Two containing data about the grouping run
Unbundling Sample Output – Admitted
Patient Care
Note: the input rows contain the spell number; this enables spell members to be identified.
The Output Files – Non-Admitted
Consultations
• There are seven output files but all
grouped data is available from just one of
them
• The other six files consist of:
– Two containing alternate views of the data
– Two containing data quality messages
– Two containing data about the grouping run
Relational Output
• This is targeted at technical users
Summary
• Ensure that the correct grouper is being
used (Local Payment, Reference Costs
etc.)
• Ensure that the appropriate data are being
used
• All the output files are described in detail
in the grouper User Manual