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HRG4: Impact on Arrhythmia Care

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

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HRG4: Impact on Arrhythmia Care

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  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

  13. Outpatient Procedures

  14. Outpatient Procedures

  15. Coding Algorithm

  16. Coding Algorithm

  17. 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 • Occluderseptal 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 • Occluderseptal 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 • Occluderseptal 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

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