Transcript HRGs - North Trent Critical Care Network

HRGs
What’s Different About
HRG4
Mike Ireland
NHS Rotherham
What’s Different About HRG4
 Background: What are Healthcare
Resource Groups (HRGs)
 The Focus of HRG4
 Adult Critical Care
 Top Six Tips for HRG4
Background: What are Healthcare Resource
Groups
 Standard Groupings of clinically similar Treatments
using comparable levels of healthcare resources.
 Derived from underlying coding classifications
1.
OPCS-4, ICD-10
 Development with coding input and clinical
ownership
Background: What are Healthcare Resource
Groups
What do HRGs Achieve
HRGs assist the DoH to implement Payment by Results
(PbR).
Used to determine fair and equitable reimbursement for
care services rendered.
Supports standardised healthcare commissioning across
services
Background: What are Healthcare Resource
Groups
What do HRGs Achieve
Offer organisations the ability to understand their
activity.
They improve the flow of finances within – and
sometimes beyond – the NHS.
The Focus of HRG4
 HRGs (v3.5) have been in use since October 2003 and
consisted of 650 groupings.
 In 2009/10 HRG3.5 has now been replaced by a major
revision, HRG4
 The number of groupings in HRG4 have increased to
over 1400.
The Focus of HRG4
HRG4 takes into account complex cases.
HRG4 extends the scope of groupings beyond admitted
care the include new clinical settings
The Focus of HRG4
HRG4 design includes the following
 Increased clinical coverage, including Specialist
Palliative Care, Diagnostic Imaging, Chemotherapy,
Radiotherapy, Critical Care and Rehabilitation.
 Improved use of Complications and Comorbidities
(CC)
The Focus of HRG4
HRG4 design includes the following
 Unbundling – to handle high cost drugs and other
high cost elements of care.
 Setting independence.
Adult Critical Care
 Suitable Case-mix Measures.
 Adult Critical Care Minimum Data Set (CCMDS)
 Comparative Information.
 Funding Models
Top Six Tips for HRG4
It’s all about
Data Quality
Top Six Tips for HRG4
1. Make sure that the relevant outpatient procedures are
coded
2.Ensure that the departmental data is collected and
coded.
3. Make sure that clinicians and coders are aware of the
unbundled elements of care.
Top Six Tips for HRG4
4.Ensure that coders are using the appropriate OPCS
code set.
5.Record and code secondary diagnoses.
6.Ensure that patient date of birth/age is recorded.
Summary
 HRG4 will enable NHS organisations to meet specific
DoH policies such as reform of financial flows and
ensure that PbR policy is based on up to date data.
 The improvement in the match of classification and
casemix activity to clinical practice will help managers
to plan, commission, budget and resource care
services.
HRGs
A Final Bit of Advice
Put as much information in
the casenotes to ensure the
coders code accurately and
effectively
HRGs
And Finally
For those of you who have
managed to stay awake.
Thanks, any questions?