HRG V4 Initiation
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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
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…
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