1. Healthcare Resource Groups

2. What are HRGs? Casemix methodology underpinning system of payment to providers and contract pricing Aggregation of OPCS or ICD codes with similar resource requirements UK standard Phased programme Vision: HRGs designed as the currency of Care Pathways

3. HRG Development Chapters – clinical relevance Working groups  Chapter working parties  Expert reference panels Anaesthesia in chapter A  Neurosciences

4. HRG Versions DRGs Currently ver 3.5  Interim change from 3 via 3.1  Implemented October 2003  No anaesthesia HRGs – Pain management  Ver 3.5 project recommended OPCS change Project in progress ver 4  More widespread financial proposed use  Use greater detail of OPCS replacement - NIC

5. NIC structure Proposed coding structure more comprehensive than OPCS Anaesthesia poorly represented in OPCS Includes in addition to OPCS4  Laterality  Surgical approach/method  ‘Extent’ Problems  Communication  Changes of leadership More recently – change of direction – on hold

6. Recent DoH Policy ‘NHS Plan’, April 2002  Investment, expansion, reform ‘Reforming Financial Flows’, October 2002  ‘Payment by Results’

7. ‘Payment by Results’ Objectives Pay providers fairly & transparently for services delivered Reward efficiency & quality in providing services Contract price negotiation on volume and mix of services Match capacity to demand Improve patient choice? Use HRG ver 4

8. HRG ver 4  Suitable for a plurality of providers  Reflect change in clinical practice  Setting independent ( I/P D/C O/P )  Take advantage of new procedure classification  Improve suitability for use in specialist services  e.g.Paediatrics; also chronic conditions

9. HRG ver 4 Based on Spells rather than FCEs Unbundling of components within the pathways Completion of missing areas  Chemotherapy  Critical Care  Radiology  Pathology  A&E  Radiotherapy  Anaesthesia

10. Care Pathway Care Package (Episode) Healthcare Resource Groups (HRGs) Healthcare Resource Components (HRCs) Intervention Classification Consultation A&E Critical Care Chemotherapy Radiotherapy Palliative Care Mental health Pathology ICDOPCS NIC SCONI AAAAAAAA A Radiology Interventions A

11. Future Development  For service commissioning beyond Admitted Patient Care, April 2008

12. Caveats Problems and Follies PBR dependent on ver4 HRG in turn dependent on NIC project Medical HRGs  ICD international – changes!!  Length of stay Setting independence Clinical relevance Cross chapter resource/cost comparison Cherry picking! Not much historic anaesthetic data

13. Proposed Anaesthetic HRGs Using BUPA Classification and ASA 1 Anaesthesia assessment (I/P or O/P) only 2 MIN or INT surgery and patient ASA I or II 3 MIN or INT surgery and ASA > II 4 MAJ or MAJ + and ASA I or II 5 MAJ or MAJ + and ASA > II 6 COMPLEX