Healthcare Resource Groups (HRGs) are the mechanism by which patient activity is classified according to Casemix in England. They are derived from care-activity data, primarily ICD-10 diagnosis codes and the United Kingdom’s OPCS-4 intervention and procedure codes, recorded in local hospital systems. Care events are recorded in standard datasets and processed through the HRG4 grouping algorithm to assign appropriate HRGs for each event.
HRGs are the primary funding mechanism for acute care in the English National Health Service (NHS) under the Department of Health’s Payment by Results (PbR) national policy. In the 2011/12 financial year, this covers admitted patient care, outpatient procedures and emergency medicine, with a total estimated expenditure of £30 billion.
As a precursor to calculating the national tariff for HRG4 “currencies”, where a “currency” is defined in the Department of Health’s PbR Guidance for 2011-12 as “the unit of healthcare for which a payment is made”, the Department collects annual cost data (Reference Costs) from every NHS provider of care. It uses this data as the basis for setting a national tariff and its related price.
The change in Government in the UK in May 2010 has resulted in a transformation in intended healthcare policy, with planned changes including the responsibility for commissioning of NHS and Specialist Services being transferred to Clinical Consortia and the newly established NHS Commissioning Board. At the same time, the State’s role in direct financial management is expected to be reduced as responsibility for national price setting under the current Department of Health Payment by Results (PbR) policy transfers to Monitor, currently an independent regulator.
As highlighted by the proposed Health Bill for 2011, the desire to move to outcome-based payments for healthcare based on patient pathways that are informed by clinical and financial best practice has not waned. In addition, the renewed emphasis on the patient journey, rather than its constituent parts, has led the Casemix team to reconsider the HRG4 classification in light of the new commissioner audience.