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 GrouperThe 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 requirementsBut 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 HRGgrouped from all theprocedures anddiagnoses in the Spell

Spell HRGgrouped from all theprocedures anddiagnoses 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

FCEFCE

FCEFCE

You can get one core and zeroor more unbundled HRGs perFCE/Spell

You can get one core and zeroor more unbundled HRGs perFCE/Spell

FCE HRGsgrouped from all the procedures and diagnoses in the FCE

FCE HRGsgrouped from all the procedures and diagnoses in the FCE

LA07AAcute Renal Failure with Major CC

Kidney TransplantFrom 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

Outpatientattendance

Data ValidationData Validation

UnbundlingFor example: RA03Z MRI

HRG4 OPCSLogic

For example: JC16B Skin therapies level 4THEN 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 enquiries@ic.nhs.uk

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:

www.ic.nhs.uk/casemix/prepare

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 HRGDepends 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