Why Develop HRG4? John Madsen, Programme Manager Stephen Cole, Principal Casemix Consultant

What is an HRG?  Standard groupings  Clinically similar patients  Consume comparable levels of healthcare resource  NHS equivalent to Diagnostic Related Groups (DRGs)  Relies on underlying classification systems (OPCS, ICD)  Version 3.5 used as basis for payment in delivering Payment by Results  Intention: to accurately capture clinical activity in the NHS

Version 3.5 HRGs: the Political Environment  Designed prior to introduction of Payment by Results – no relationship to reimbursement  Partial support for wider DH policy initiatives  No annual review cycle

Version 3.5 HRGs: the Design Environment  550 HRGs  Based on Length of Stay  Wide cost variation within the same HRG  Based on OPCS 4.2  Revised early 1990s  Not updated for changes in clinical practice  Simplified complications and comorbidities  Limited age and other splits

Version 3.5 to HRG4  Differences in…  Activity measures [spells]  Scope [settings]  Coverage [services]  Counting [unbundling]  Codes [OPCS 4.3] and  HRG format…

HRG4 Format 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