Transcript Slide 1
HRG4 HealthCheck Session Overview • • • • • • • The Science of Casemix The Operating Environment Now and Next HRG4 HealthCheck Things you Need to Know Help! Key Messages The Science • 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 (Simplified) Operating Environment PROVIDER PAYMENT £ TREATMENT NOTES COMMISSIONER PATIENT PAS CDS SUS PbR £ SUS HES CODING COSTING REFERENCE COSTS DH PbR TARIFF NATIONAL SYSTEM Now and Next Services HRG v3.5 HRG4 Narrow New CANCER, RENAL DIALYSIS, REHAB., DI, HCD Settings Concepts Granularity Grouping Restricted Expanded DATASETS: APC, A&E, ACC + DATASETS: PCC, NNCC, OP Limited Innovative SINGLE HRG PER FCE / SPELL UNBUNDLING, M.T., MULTIPLE PXS, DIAG.H, MULTIPLE HRGS PER FCE / SPELL Minimal Improved 2 CCS, AGE SPLITS 3 CCS, PAED. SPLITS, LOS + Best Fit Exact Fit MINIMISES U GROUPS MAXIMISES U GROUPS Format of HRG4 HRG v3.5 (610 HRGs) HRG4 (≈1,400 HRGs) Chapter & subchapter Chapter DZ02C Number D02 Number Respiratory System Thoracic Procedures and Disorders Split Here, ‘C’ represents without CC Complex Thoracic Procedures without CC Respiratory System Plus any unbundled elements. For example: LC02B Haemodialysis/Filtration 18 years and under Complex Thoracic Procedures XD08Z Medical Gases band 1 HRG4 HealthCheck DEVELOPMENT TOWARDS… STAGE 1 STAGE 2 CODING BREAKING THE RULES [INVALID CODES, UZ01Z] CODING COVERAGE ADMITTED PATIENT CARE ADMITTED PATIENT CARE OUTPATIENTS TOP DOWN BOTTOM UP COSTING COMMUNICATING FINANCE / INFORMATION WITHIN ORGANISATION BEING TOO VAGUE [GENERIC HRGS] FINANCE / INFORMATION / CODING WITHIN / BETWEEN ORGANISATIONS HRG4 HEALTH CHECK CONTINUUM BEST PRACTICE VALID & TRUE [SPECIFIC HRGs] ADMITTED PATIENT CARE OUTPATIENTS, UNBUNDLED SERVICES COSTING STANDARDS, PLICS FINANCE / INFORMATION / CODING / CLINICAL BETWEEN ORGANISATIONS Things you need to know • 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 Help! • 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 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 eXtraordinarily good