HRG4+ 2013/14 Reference Costs Grouper
The Reference Costs 2013/14 collection is the second collection to use the new enhanced HRG4+ National Casemix Office design, and sees the extension of the HRG4+ design concept across several new areas, including those relating to the former CZ Mouth Head Neck and Ears Procedures and Disorders, PA Paediatric Medicine, QZ Vascular Procedures and Disorders and RC Interventional Radiology subchapters. As a result, there are significant changes to these subchapters, all of which have been removed and replaced with new subchapters for this Reference Costs collection. Further details are available in the accompanying documentation for this Grouper release.
The enhancements offered as part of the HRG4+ Casemix classification have been developed in partnership with the clinical community, as represented and endorsed by the Royal Colleges Associations and Professional Bodies. The increased applicability of the Casemix classification to emerging policy requirements has been influenced by findings from the Department of Health's International Review of Classifications, as well as international casemix developments and best practice. The design concepts have also taken into consideration concerns raised by several key national stakeholder forums, including the UKCHA, Project Diamond and the Shelford Group, as well as a variety of publications on HRG and national tariff performance by international consultancy companies such as PWC, KPMG and Ernst & Young.
The recognition of multiples, of both interventions and underlying disease, is an increasingly important international factor in the ability to differentiate between levels of care complexity and the healthcare providers that can effectively deliver such care.
As a response, the key benefits of the changes introduced into the HRG4+ design can be summarised as:
- Procedure and Diagnosis Hierarchy Modifications that allow for greater distinction between procedures (especially) at the lower end of the expected resource use continuum
- Extensions of Multiple Matrix Grid Logic for specific specialised, discrete, service areas to reflect expected resource use of patient care
- Amendments to Complication and Comorbidity (CC) lists to improve consistency and maintain clinical relevance
- The addition of Interactive CC Logic, where clinically feasible, to better reflect the service and resource use in treating multiply comorbid patients
- The creation of HRGs specific to Specialised Activity, such as those for Congenital Cardiac Surgery, and including the expansion of age splits beyond the traditional adult/child boundary, thereby reflecting the significant resource differentiation within the child population
- Quality Improvements including enhancements to support national standards.
HRG4+ facilitates the delivery of requirements outlined in the Health and Social Care Act 2012 by allowing for specialised services provided in tertiary centres and NHS Centres of Excellence to be distinctly identified and appropriately costed and funded. It offers the potential to improve local decision-making, enabling more effective planning and service redesign within all levels of the health economy.
The HRG4+ 2013/14 Reference Costs Grouper should be used to process data and produce HRG4+ output for the Reference Cost collection for the 2013/14 financial year.
The grouper is being issued with new episode and spell Trimpoints to be used for the 2013/14 Reference Costing exercise. Spell level trimpoints only are further differentiated at the HRG level between Elective and Non-Elective admissions, in accordance with Department of Health requirements. This means that there are three trimpoints per HRG, one at episode level, and two at spell level.
It should be used in conjunction with the 
HRG4+ 2013/14 Reference Costs Grouper Reference Manual [1Mb] (Opens in a new window), which explains how data should be sorted and presented for processing by the grouper. This and other resource materials can be downloaded from the documentation downloads section below.
As a precursor to using the grouper, it is strongly advised that users read the HRG4+ 2013/14 Reference Costs Summary of Changes [122kb] (Opens in a new window) document to become familiar with the changes made since the 2012/13 Reference Costs Grouper.
Further information regarding the Reference Costs collection for 2013/14 can be found in the 2013/14 Reference Costs Guidance published on the Department of Health website (external) and Monitor website (external).
For the 2014/15 financial year users should process data for reimbursement calculations using the HRG4 2014/15 Payment Grouper.
For queries about HRG4+ or the grouper, please call the HSCIC Contact Centre on 0300 303 5678 or email enquiries@hscic.gov.uk
HRG4+ 2013/14 Reference Costs Grouper Documentation
Casemix Companion [693kb] (Opens in a new window) The starting point and general reference for new and existing users, providing an introduction to Casemix, HRG4 and HRG4+ design concepts and grouping logic.
HRG4+ 2013/14 Reference Costs Grouper Reference Manual [1Mb] (Opens in a new window) Provides full instructions on how to prepare and group data using the HRG4+ Grouper software application.
HRG4+ 2013/14 Reference Costs Summary of Changes [122kb] (Opens in a new window) Overview of changes between the current HRG4+ grouper design and its HRG4+ predecessor.
HRG4+ 2013/14 Reference Costs Roots [1Mb] (Opens in a new window) Details of new HRGs, deleted HRGs and changes to existing HRG Labels between designs, at the aggregate HRG level.
HRG4+ 2013/14 Reference Costs Chapter Summaries [4Mb] (Opens in a new window) Updates on changes and an overview of the scope, composition and grouping logic of individual subchapters.
HRG4+ 2013/14 Reference Costs Code to Group & User Manual [7Mb] (Opens in a new window) Details on all mappings between primary classification codes and HRGs and the logic required to generate HRGs.
HRG4+ 201314 Reference Costs Specialised Services ID Code Sets [471kb] (Opens in a new window) A workbook containing details regarding the flags and trigger codes in the HRG4+ Reference Costs Grouper to aid identification of specific Specialised Service activity.
HRG4+ 2013/14 Reference Costs Trimpoints [148kb] (Opens in a new window) Details of Episode and Spell-level Trimpoints to be used for the 2013/14 Reference Costs collection
HRG4+ 2013/14 Reference Costs Trimpoints Methodology [192kb] (Opens in a new window) Details the methodology for calculation of the Trimpoints.