Transcript HRG V4 Initiation

Why Develop HRG4?
John Madsen, Programme Manager
Stephen Cole, Principal Casemix Consultant
What is an HRG?
 Standard groupings
 Clinically similar patients
 Consume comparable levels of healthcare resource
 NHS equivalent to Diagnostic Related Groups
(DRGs)
 Relies on underlying classification systems
(OPCS, ICD)
 Version 3.5 used as basis for payment in
delivering Payment by Results
 Intention: to accurately capture clinical activity in
the NHS
Version 3.5 HRGs: the Political
Environment
 Designed prior to introduction of Payment by
Results – no relationship to reimbursement
 Partial support for wider DH policy initiatives
 No annual review cycle
Version 3.5 HRGs: the Design
Environment
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550 HRGs
Based on Length of Stay
Wide cost variation within the same HRG
Based on OPCS 4.2
 Revised early 1990s
 Not updated for changes in clinical practice
 Simplified complications and comorbidities
 Limited age and other splits
Version 3.5 to HRG4
 Differences in…
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Activity measures [spells]
Scope [settings]
Coverage [services]
Counting [unbundling]
Codes [OPCS 4.3] and
HRG format…
HRG4 Format
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