HRG4 and Payment By Results Roadshows 2009 Information Breakout Session Part 1

Scope of presentation HRG4 Grouping (not the grouper) Grouping scope/coverage HRG4 in SUS HRG derivation process New in HRG4 grouping Comparative statistics

What can the Local Payment Grouper group? Admitted Patient Care Non-Admitted Consultations Adult Critical Care Emergency and Urgent Care (HRG4) Accident & Emergency HRG v3.2 algorithm from HRG v3.5

What are the HRGs that the Local Payment Grouper can produce? Covers all the areas of HRG v3.5 More Settings –Extends beyond admitted patient care –Ability to generate the same HRG with data from different settings Generates HRGs for additional services: The grouper accommodates the mandated underlying OPCS-4 classification (OPCS-4.5 from 1 April 2009) Chemotherapy Diagnostic Imaging Emergency & Urgent Care Rehabilitation Radiotherapy Specialist Palliative Care

Roles of the SUS Grouper and the Local Payment Grouper The NHS Operating Framework for 2008/09 stated that “…by April 2009, when the NHS should use SUS as the standard repository for activity for performance monitoring, reconciliation and payments" SUS has its own grouper and will allocate HRG4 to all relevant data submissions. SUS also implements PbR business rules. The role of the Local Payment Grouper application is: -Planning -Monitoring -Data validation -Supporting payment for locally commissioned services SUS and the Local Payment Grouper share the same grouping algorithms.

HRG4 in CDS6? DSCN 17/2008 (HRG4)’ states that: “There is no national requirement to flow HRG4 through the CDS”. DSCN 24/2008 (CDS 6.1), Finished General Episode CDS section includes: M = Mandatory - data must be included where available 3 characters!

Guidance: HRGs in CDS 6.1 HRG4 cannot be accommodated by CDS 6.1; HRG and HRG Version Number should not be populated in data submissions. SUS will not reject records where these two fields are not populated. The SUS CDS Validation Table categorises HRG as: F – the format is validated R – required as part of NHS business rules to meet NHS business requirements But not M – mandatory in XML schema (messages will not flow if absent) SUS will derive the HRG.

New in HRG4 Grouping: General Single application groups episodes and spells (no separate spell converter) Improved user interface Record Definition File Wizard Enhanced data validation Support for newer versions of Windows Larger range of output files to support various user requirements (more in the next presentation…) Note that the Local Payment Grouper does not produce reports.

New in HRG4 Grouping: Derivation Process Spell 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 Kidney Transplant from Live donor 18 years and under Unbundled HRGs Unbundled HRGs LC02B XD23Z VC42Z  Renal Dialysis  High Cost Drug  Rehab FCE You can get one core and zero or more unbundled HRGs per FCE/Spell You can get one core and zero 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 LA07A Acute Renal Failure with Major CC Kidney Transplant From Live donor 18 years and under LA03B Data Validation Patient Admission Patient Discharge Source: Local Payment Grouper

New in HRG4 Grouping: Multiple Trauma Trauma means non-superficial injury (e.g. broken limb bone) Requirements –In the first episode of the spell: Primary diagnosis of trauma Another diagnosis of trauma from a different trauma site (body is divided into nine areas) Diag1 (trauma), Diag2 (non-trauma), Diag3 (trauma)

New in HRG4 Grouping: Non-Admitted Consultations HRG allocation is based on OPCS code If no OPCS code, then HRG is WF01* Non-Admitted Attendance Multi-professional clinics identified by OPCS code X62.2 and X62.3 (HRG is WF02*) Diagnosis is ignored Where APC HRG is based on procedure, then the Non- Admitted HRG will be the same (for the same procedures) i.e. setting-independent

Non-Admitted Consultations Outpatient attendance Data Validation Unbundling For example:  RA03Z MRI HRG4 OPCS Logic For example:  JC16B Skin therapies level 4 THEN STOP yes HRG4 Default Logic no For example:  WF01A Non-admitted Face to Face Attendance – Follow-up

Where Has Our Activity Gone? A comprehensive set of comparative analyses are available from the Casemix website. For example:

PCT Comparative Statistics: HRG v3.5 to HRG4 This needs to be mentioned… –Sent to all English PCTs ‘Director of Commissioning’ in January 2009 via courier –Check with your Director of Commissioning if you want access to these data –Password available from

HRG4 and Payment By Results Roadshows 2009 Information Breakout Session Part 2

Scope of presentation: HRG4 Grouping Ingredients Process Products

Downloading the Grouper Grouper applications Documentation FAQ All available from:

Types and Roles of Groupers Reference Costs –Used as part of the PbR reference costs process carried out annually by DH RoadTest –Used to support the annual DH road-test exercise. Precursor to… Local Payment –Derives the HRGs that underpin tariff

Grouper Recognition The application title bar indicates the version The icon helps to remind the user of the grouper type Icon Title bar

Input Data Comma-separated text files only Each data type has its own mandatory fields Fields must be in the correct format The input files are described in the Guide to File Preparation document available from the Casemix website

Output of HRG4 - Unbundling Each episode and spell can now generate more than one HRG Depends on: –Treatment patient receives –Whether that treatment is unbundled Ability to generate unbundled HRGs will also depend on HRG unit of activity, e.g. –Rehabilitation – one HRG per inpatient day –Radiotherapy one planning HRG one delivery HRG

Output Files Comma-separated text files Different output files for each data type No reports

The Output Files – Admitted Patient Care There are eleven output files but all grouped data can be obtained by using just two of them: –The FCE output file contains everything apart from Specialised Service Codes (SSCs) –SSCs are available from the spell output file The other nine files consist of: –Five containing alternate views of data –Two containing data quality messages –Two containing data about the grouping run

Unbundling Sample Output – Admitted Patient Care Note: the input rows contain the spell number; this enables spell members to be identified.

The Output Files – Non-Admitted Consultations There are seven output files but all grouped data is available from just one of them The other six files consist of: –Two containing alternate views of the data –Two containing data quality messages –Two containing data about the grouping run

Relational Output This is targeted at technical users

Summary Ensure that the correct grouper is being used (Local Payment, Reference Costs etc.) Ensure that the appropriate data are being used All the output files are described in detail in the grouper User Manual