Features of HRG4 Paula Monteith Principal Casemix Consultant – Finance & Commissioning

Features of HRG4  Differences in…  Format  Scope  Settings  Services  Underlying OPCS Codes  Logic  Specificity  Multiple Procedures  Multiple Trauma  Output  Spells  Counting [unbundling]  Data output

The Focus of HRG4 “ To better describe the care that a patient receives in terms of treatment and resources”

Format of HRG4 Chapter & subchapter LA 03 B Urinary Tract & Male Reproductive System Urinary Tract & Male Reproductive System Number Split In this case ‘B’ means <19 ‘Z’ means no split In this case ‘B’ means <19 ‘Z’ means no split Renal Procedures and Disorders Renal Procedures and Disorders Kidney Transplant from Live Donor

Scope of HRG4 (1)  More Settings  Designed to extend beyond admitted care  Can allocate the same core HRG to procedures regardless of delivery setting  Increased Services  Chemotherapy  Critical Care  Diagnostic Imaging  Emergency & Urgent Care  Interventional Radiology  Rehabilitation  Radiotherapy  Specialist Palliative Care

Scope of HRG4 (2)  Supported by extended underlying OPCS classification (4.3)  Over 2,000 new codes introduced [25% increase]  New codes for new procedures incl. non-surgical interventions

Logic of HRG4 (1)  Specificity  Complications and Comorbidities  3 levels of CC rather than the 2 (‘with CC’ and ‘without CC’), of HRG 3.5  Level 1 – Not a significant diagnosis  Level 2 – Intermediate diagnosis  Level 3 – Major diagnosis  Splits  Paediatrics  Length of Stay  Other

Logic of HRG4 (2)  Accommodates Multiple Procedures  Not global – chapter specific  Takes account of bilaterals  Applies escalator logic  Concept of Multiple Trauma  Requires more than one trauma diagnosis from more than one of 9 body sites for the first FCE in a spell  An MT FCE will generate an MT spell  Multiple Immediate Significant Trauma [MIST]  Grouping  Re-groups FCE data to spell level [see diagram] – removes dominant FCE

Output of HRG4 (1)  Spell-based activity  Spell based HRGs cover the whole stay from admission to discharge [but see unbundling]  Remains relevant for FCEs  Incorporates concept of “Unbundling” and the “Unbundled” HRG – 4 Qs  When?  What?  Why ?  How?

Output of HRG4 (2)  When unbundle?  Where a component within an episode of care could be provided in a different setting, or by a different provider  Where a high cost component is sometimes, but not always, provided within an HRG spell  What unbundle? Renal DialysisRehabilitation Diagnostic ImagingAdult Critical Care Interventional RadiologyPaediatric Critical Care ChemotherapyNeonatal Critical Care RadiotherapyHigh Cost Drugs Specialist Palliative Care

Output of HRG4 (3)  Why unbundle?  Improves performance of HRGs so they can better represent activity and costs  Identifies specialist services to ensure recognition of priority areas  Supports service redesign (e.g. locally commissioned rehabilitation)  Supports Patient Choice – increase flexibility to allow separate elements of the care pathway to be delivered by different providers  How unbundle?  Grouper separately identifies high cost elements to form additional HRGs [but only where recorded]  Unbundled components may be allocated as HRGs in their own right or may be generated as additions to a core HRG

Output of HRG4 (4) - Errors  Grouping identifies all errors  Single error code – UZ01Z ‘Data Invalid for Grouping’  Detailed error report to support improved data quality  UZ01Invalid Primary Diagnosis  UZ02Poorly Coded Primary Diagnosis  UZ03Age Conflicting with Diagnosis  UZ04Diagnosis Conflicting with Anatomical Sites  UZ05Invalid Primary Procedures  UZ06Poorly Coded Primary Procedures  UZ11NCC Failed to Group  UZ12PCC Failed to Group

Output of HRG4 (5) - Summary  Now a single “spell” can generate more than one HRG  Depends upon treatment patient receives…  And whether that treatment is “unbundled”  Ability to generate additional HRGs will also depend upon HRG unit of activity, e.g.  Rehabilitation – one HRG per IP day  Radiotherapy –  One planning HRG  One delivery HRG

Spells, Unbundling & FCEs FCE LA03B Spell HRG grouped from all the procedures and diagnoses in the Spell Spell HRG grouped from all the procedures and diagnoses in the Spell Unbundled HRGs Unbundled HRGs LC02B XD23Z VC42Z RA03Z  Renal Dialysis  High Cost Drug  Renal Dialysis  MRI  Rehab You can get one core and one or more unbundled HRGs per FCE/Spell You can get one core and one or more unbundled HRGs per FCE/Spell FCE HRGs grouped from all the procedures and diagnoses in the FCE FCE HRGs grouped from all the procedures and diagnoses in the FCE Individual FCE HRGs may be different from the Spell HRG Individual FCE HRGs may be different from the Spell HRG