1. HRG4: Impact on Arrhythmia Care Donna Elliott-Rotgans Cardiology Service Manager UCLH / The Heart Hospital

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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)

8. 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

9. HRG4 and Arrhythmia Management  HRG3.5

10. HRG4 and Arrhythmia Management  HRG4

11. Highlights so far….  Outpatient Procedures  Exclusions  Coding algorithm

12. Outpatient Procedures

15. Coding Algorithm

18. 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

19. 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

20. 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

21. 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