Features of HRG4

1
Features of HRG4

• Paula Monteith
• Principal Casemix Consultant
• Finance Commissioning

2
Features of HRG4

• Differences in
• Format
• Scope
• Settings
• Services
• Underlying OPCS Codes
• Logic
• Specificity
• Multiple Procedures
• Multiple Trauma
• Output
• Spells
• Counting unbundling
• Data output

3
The Focus of HRG4

• To better describe the care that a patient
  receives in terms of treatment and resources

4
Format of HRG4
Split
Number
Chapter subchapter
LA 03 B
Urinary Tract Male Reproductive System
In this case B means lt19 Z means no split
Renal Procedures and Disorders
Kidney Transplant from Live Donor
5
Scope of HRG4 (1)

• More Settings
• Designed to extend beyond admitted care
• Can allocate the same core HRG to procedures
  regardless of delivery setting
• Increased Services
• Chemotherapy
• Critical Care
• Diagnostic Imaging
• Emergency Urgent Care
• Interventional Radiology
• Rehabilitation
• Radiotherapy
• Specialist Palliative Care

6
Scope of HRG4 (2)

• Supported by extended underlying OPCS
  classification (4.3)
• Over 2,000 new codes introduced 25 increase
• New codes for new procedures incl. non-surgical
  interventions

7
Logic of HRG4 (1)

• Specificity
• Complications and Comorbidities
• 3 levels of CC rather than the 2 (with CC and
  without CC), of HRG 3.5
• Level 1 Not a significant diagnosis
• Level 2 Intermediate diagnosis
• Level 3 Major diagnosis
• Splits
• Paediatrics
• Length of Stay
• Other

8
Logic of HRG4 (2)

• Accommodates Multiple Procedures
• Not global chapter specific
• Takes account of bilaterals
• Applies escalator logic
• Concept of Multiple Trauma
• Requires more than one trauma diagnosis from more
  than one of 9 body sites for the first FCE in a
  spell
• An MT FCE will generate an MT spell
• Multiple Immediate Significant Trauma MIST
• Grouping
• Re-groups FCE data to spell level see diagram
  removes dominant FCE

9
Output of HRG4 (1)

• Spell-based activity
• Spell based HRGs cover the whole stay from
  admission to discharge but see unbundling
• Remains relevant for FCEs
• Incorporates concept of Unbundling and the
  Unbundled HRG 4 Qs
• When?
• What?
• Why ?
• How?

10
Output of HRG4 (2)

• When unbundle?
• Where a component within an episode of care could
  be provided in a different setting, or by a
  different provider
• Where a high cost component is sometimes, but not
  always, provided within an HRG spell
• What unbundle?

11
Output of HRG4 (3)

• Why unbundle?
• Improves performance of HRGs so they can better
  represent activity and costs
• Identifies specialist services to ensure
  recognition of priority areas
• Supports service redesign (e.g. locally
  commissioned rehabilitation)
• Supports Patient Choice increase flexibility to
  allow separate elements of the care pathway to be
  delivered by different providers
• How unbundle?
• Grouper separately identifies high cost elements
  to form additional HRGs but only where recorded
• Unbundled components may be allocated as HRGs in
  their own right or may be generated as additions
  to a core HRG

12
Output of HRG4 (4) - Errors

• Grouping identifies all errors
• Single error code UZ01Z Data Invalid for
  Grouping
• Detailed error report to support improved data
  quality
• UZ01 Invalid Primary Diagnosis
• UZ02 Poorly Coded Primary Diagnosis
• UZ03 Age Conflicting with Diagnosis
• UZ04 Diagnosis Conflicting with Anatomical Sites
• UZ05 Invalid Primary Procedures
• UZ06 Poorly Coded Primary Procedures
• UZ11 NCC Failed to Group
• UZ12 PCC Failed to Group

13
Output of HRG4 (5) - Summary

• Now a single spell can generate more than one
  HRG
• Depends upon treatment patient receives
• And whether that treatment is unbundled
• Ability to generate additional HRGs will also
  depend upon HRG unit of activity, e.g.
• Rehabilitation one HRG per IP day
• Radiotherapy
• One planning HRG
• One delivery HRG

14
Spells, Unbundling FCEs
You can get one core and one or more unbundled
HRGs per FCE/Spell
Individual FCE HRGs may be different from the
Spell HRG