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Healthcare Resource Groups. What are HRGs?. Casemix methodology underpinning system of payment to providers and contract pricing Aggregation of OPCS or ICD codes with similar resource requirements UK standard Phased programme Vision: HRGs designed as the currency of Care Pathways.

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what are hrgs
What are HRGs?
  • Casemix methodology underpinning system of payment to providers and contract pricing
  • Aggregation of OPCS or ICD codes with similar resource requirements
  • UK standard
  • Phased programme
  • Vision: HRGs designed as the currency of Care Pathways
hrg development
HRG Development
  • Chapters – clinical relevance
  • Working groups
    • Chapter working parties
    • Expert reference panels
  • Anaesthesia in chapter A
    • Neurosciences
hrg versions
HRG Versions
  • DRGs
  • Currently ver 3.5
    • Interim change from 3 via 3.1
    • Implemented October 2003
    • No anaesthesia HRGs – Pain management
    • Ver 3.5 project recommended OPCS change
  • Project in progress ver 4
    • More widespread financial proposed use
    • Use greater detail of OPCS replacement - NIC
nic structure
NIC structure
  • Proposed coding structure more comprehensive than OPCS
  • Anaesthesia poorly represented in OPCS
  • Includes in addition to OPCS4
    • Laterality
    • Surgical approach/method
    • ‘Extent’
  • Problems
    • Communication
    • Changes of leadership
  • More recently – change of direction – on hold
payment by results objectives
‘Payment by Results’ Objectives
  • Pay providers fairly & transparently for services delivered
  • Reward efficiency & quality in providing services
  • Contract price negotiation on volume and mix of services
  • Match capacity to demand
  • Improve patient choice?
  • Use HRG ver 4
hrg ver 4
HRG ver 4
  • Suitable for a plurality of providers
  • Reflect change in clinical practice
  • Setting independent ( I/P D/C O/P )
  • Take advantage of new procedure classification
  • Improve suitability for use in specialist services
    • e.g.Paediatrics; also chronic conditions
hrg ver 41
HRG ver 4
  • Based on Spells rather than FCEs
  • Unbundling of components within the pathways
  • Completion of missing areas
    • Chemotherapy
    • Critical Care
    • Radiology
    • Pathology
    • A&E
    • Radiotherapy
    • Anaesthesia
care pathway
Care Pathway

Healthcare Resource Groups (HRGs)

Care Package

(Episode)

Healthcare Resource Components (HRCs)

Radiology

Chemotherapy

Palliative Care

Mental health

Consultation

A&E

Pathology

Critical Care

Radiotherapy

Interventions

A

A

A

A

A

A

A

A

A

A

Intervention Classification

ICD

OPCS NIC

SCONI

future development
Future Development
  • For service commissioning beyond Admitted Patient Care, April 2008
caveats problems and follies
Caveats Problems and Follies
  • PBR dependent on ver4 HRG in turn dependent on NIC project
  • Medical HRGs
    • ICD international – changes!!
    • Length of stay
  • Setting independence
  • Clinical relevance
  • Cross chapter resource/cost comparison
  • Cherry picking!
  • Not much historic anaesthetic data
proposed anaesthetic hrgs
Proposed Anaesthetic HRGs
  • Using BUPA Classification and ASA

1    Anaesthesia assessment (I/P or O/P) only

2    MIN or INT surgery and patient ASA I or II 

3    MIN or INT surgery and ASA > II 

4    MAJ or MAJ + and ASA I or II

5    MAJ or MAJ + and ASA > II

6    COMPLEX