HRG4: Impact on Arrhythmia Care Donna Elliott-Rotgans Cardiology Service Manager UCLH / The Heart Hospital
PbR: The National Tariff Reforming NHS Financial Flows published October 2002 Introduced the concept of a national agreed set of prices known as ‘Healthcare Resource Groups’ (HRGs) Ensured healthcare providers were paid fairly and transparently for services delivered Refocused discussion from disputes over price to volume and mix of service required
PbR: The National Tariff Supported the introduction of patient choice by ensuring that diverse providers can be funded according to where patients choose to be treated Initially began in 2005 with 15 HRGs Phased introduction over 5 years Instead of commissioning through block agreements, providers will be paid for the activity they undertake
How is reimbursement calculated? Unit of currency is a ‘Finished Consultant Episode’ (FCE) Each FCE is coded with details of patient diagnosis, co-morbidities, procedures carried out and any complications (OPCS Codes) Coding is fed into software package to generate the appropriate HRG
How is reimbursement calculated? HRG adjusted for: Elective vs non-elective activity Market Forces Factor (MFF) Length of stay Additional income for: Items excluded from the national tariff High cost items ‘pass-through’ directly to PCT
PbR in 2009 / 10 HRG 3.5 replaced by HRG4 Product of several years of work by over 300 NHS clinicians Brings reimbursement more in line with current clinical practice It is the first time the groupings have been specifically designed with payment as the main end use
How is HRG4 different? Clinical activity broken down into more discrete stages Prices therefore aligned to complexity of treatment Allows elements of care pathway to be unbundled This allows some services to be priced separately for the first time (e.g. diagnostic tests)
How is HRG4 different? Separate price for Day Case activity Removal of specialist service top-ups Increased categories of outpatient attendances to allow for multi-disciplinary and multi- professional clinics Diagnostic testing and outpatient procedures unbundled BUT only supported by non- mandatory tariff in 2009/10 MFF reduced to move in line with cost-of-living adjustments
HRG4 and Arrhythmia Management HRG3.5
HRG4 and Arrhythmia Management HRG4
Highlights so far…. Outpatient Procedures Exclusions Coding algorithm
Outpatient Procedures
Coding Algorithm
Device Exclusions 3 dimensional navigation system mapping catheters Aortic stents Cardiac resynchronisation therapy (CRT) Implantable defibrillators (ICD) Implantable loop recorders Left ventricular assist devices (LVAD) Minimal invasive mitral valve replacement pack Occluder septal devices Percutaneous valve replacement devices Surgical and percutaneous electrical ablation – probes and catheters
Device Exclusions 3 dimensional navigation system mapping catheters Aortic stents Cardiac resynchronisation therapy (CRT) Implantable defibrillators (ICD) Implantable loop recorders Left ventricular assist devices (LVAD) Minimal invasive mitral valve replacement pack Occluder septal devices Percutaneous valve replacement devices Surgical and percutaneous electrical ablation – probes and catheters
Device Exclusions 3 dimensional navigation system mapping catheters Aortic stents Cardiac resynchronisation therapy (CRT) Consumables for robotic surgery ICD with CRT capability Implantable defibrillators (ICD) Implantable loop recorders Left ventricular assist devices (LVAD) Minimal invasive mitral valve replacement pack Occluder septal devices Percutaneous valve replacement devices Surgical and percutaneous electrical ablation – probes and catheters
The Future Outpatient Procedures: Reduced number of classifications Subject to mandatory tariff Imaging rebundled Device exclusions Removal of Day Case tariff Limited opportunity for growth / service development