Healthcare resource groups are standard groupings of clinically similar treatments which use comparable levels of healthcare resource.

Healthcare resource groups are standard groupings of clinically similar treatments which use comparable levels of healthcare resource.

Since 2003, the groups have been used to inform payment by results. They are also used as a framework against which to collect reference costs - national average treatment costs that that help to determine payment tariffs.

Healthcare resource group four is the newly revised and updated version. It will be used to support reference costing for the financial year 2006/07 onwards.

What is HRG4 about?

HRG4 has been developed to:

  • Reflect changes in clinical practice and costs
  • Increase coverage by introducing HRGs to new clinical areas
  • Introduce the concept of 'setting independence', to support the delivery of care in a variety of settings
  • Increase the statistical performance of HRGs by introducing elements such as unbundling of high cost elements of care. HRG4 also provides improved complication and comorbidity splits to reflect the resource implications of more complex cases
  • Incorporate the improved identification and classification of procedures using updated OPCS codes
  • Enable more accurate analysis of healthcare needs within the service.

It will deliver the following:

  • Increase the number of groups from 650 to over 1400 to reflect current clinical practice
  • Introduce new HRG splits for factors such as patient age and clinical complications that make care more costly
  • Introduce groups for some high cost drugs and procedures so these can be recorded separately
  • Extend groups to activity carried out in non-admitted care settings
  • Apply wherever a patient is treated so that care can be provided in new settings.

How was HRG4 developed?

Three hundred clinicians, 38 finance staff and 29 other NHS healthcare workers have taken part in 33 expert working groups and advised on HRG4 design. Seventy eight NHS trusts have helped to collect information about the costs of delivering patient treatments. Eighty NHS volunteers have helped to review casemix products such as software and guidance prior to release.

What does HRG4 mean for my trust?

Counting, and accounting for, activity will be even more important. The data that trusts collect, code and submit will determine how well reference costs represent the real costs of patient treatments.

The following will need to be in place:

  • Procedures to collect data for work carried out in out-patient clinics and clinical departments, for example radiology
  • Departmental data will need to be coded and entered into hospitals' patient administration systems
  • Clinicians and departmental support staff will need to ensure that all relevant procedures and diagnoses are recorded and communicated to coders
  • Clinical coders will need to work with the latest version of OPCS (4.3 and 4.4) codes to accurately record clinical activity to ensure accuracy of grouping
  • Trust information staff should pre-validate data before it is submitted to help check for, and correct, any gaps or errors.

What happens next?

A big part of our work is helping key workers such as finance staff, information workers and clinicians make use of HRG4. A project is running alongside HRG design to produce guidance and the HRG toolkit.

Where can I find out more?

To help Trusts prepare for HRG4, the Information Centre's casemix service and Department of Health reference costs teams will hold a series of one-day HRG4 reference costs roadshows during February and March.

You can find out more and view FAQs at www.ic.nhs.uk/casemix. You can also join our mailing list to stay informed about developments and the latest changes to HRGs and the HRG toolkit. The mailing list saves you having to make regular checks on our website.

You can e-mail questions to enquiries@ic.nhs.uk, or call us on 0845 300 6016.

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