1. HRG4 HealthCheck

2. The Science of Casemix The Operating Environment Now and Next HRG4 HealthCheck Things you Need to Know Help! Key Messages Session Overview

3. 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 Science

4. PROVIDER PATIENT TREATMENT NOTES CODING PAS COSTING REFERENCE COSTS TARIFF DH PbR SUS HES SUS PbR £ NATIONAL SYSTEM COMMISSIONER PAYMENT £ The (Simplified) Operating Environment CDS

5. Now and Next HRG v3.5HRG4 ServicesNarrowNew CANCER, RENAL DIALYSIS, REHAB., DI, HCD SettingsRestricted DATASETS: APC, A&E, ACC Expanded + DATASETS: PCC, NNCC, OP ConceptsLimited SINGLE HRG PER FCE / SPELL Innovative UNBUNDLING, M.T., MULTIPLE PXS, DIAG.H, MULTIPLE HRGS PER FCE / SPELL GranularityMinimal 2 CCS, AGE SPLITS Improved 3 CCS, PAED. SPLITS, LOS + GroupingBest Fit MINIMISES U GROUPS Exact Fit MAXIMISES U GROUPS

6. Format of HRG4 D02 Chapter Number Complex Thoracic Procedures HRG v3.5 (610 HRGs) Respiratory System Respiratory System Split Here, ‘C’ represents without CC Number Chapter & subchapter Respiratory System Respiratory System Thoracic Procedures and Disorders Thoracic Procedures and Disorders Complex Thoracic Procedures without CC DZ02C HRG4 (≈1,400 HRGs) Plus any unbundled elements. For example: LC02B Haemodialysis/Filtration 18 years and under XD08Z Medical Gases band 1

7. HRG4 HealthCheck CODING COVERAGE COSTING COMMUNICATING HRG4 HEALTH CHECK CONTINUUM STAGE 1STAGE 2 BEST PRACTICE BREAKING THE RULES [INVALID CODES, UZ01Z] BEING TOO VAGUE [GENERIC HRGS] VALID & TRUE [SPECIFIC HRGs] ADMITTED PATIENT CARE OUTPATIENTS TOP DOWN BOTTOM UP COSTING STANDARDS, PLICS FINANCE / INFORMATION WITHIN ORGANISATION FINANCE / INFORMATION / CODING WITHIN / BETWEEN ORGANISATIONS FINANCE / INFORMATION / CODING / CLINICAL BETWEEN ORGANISATIONS ADMITTED PATIENT CARE OUTPATIENTS, UNBUNDLED SERVICES DEVELOPMENT TOWARDS…

8. 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 Things you need to know

9. 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 13 th January 2009 HES data therefore may differ from SUS / CDS Help!

10. Key Messages HRG4… - C lassification that is the world leader - A dvanced concepts and scope - S takeholder engagement (design and use) - E ssential for funding - M easure of data quality - I ntelligent logic - X traordinarily good e