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HRG4+ 2014/15 Reference Cost Grouper

HRG4+ 2014/15 Reference Costs Grouper:

Known Issues

An issue has been identified with the HRG4+ 2014/15 Reference Costs Grouper when processing Emergency Medicine Data.  Where an emergency medicine record has an A&E Patient Group code of '70' and the next record(s) processed have a blank A&E Patient Group code then the HRG VB99Z is being generated incorrectly.  Any subsequent records, where the A&E Patient Group code is left blank, will continue to have the incorrect HRG applied until a valid A&E Patient Group code is present in the record.

In order to prevent your Emergency Medicine groupings being incorrect there are two options to consider:

• Ensure that all records being processed have a valid A&E Patient Group code in them so they will group correctly. Therefore blanks are not included.

• Separately group any records where they have an A&E Patient Group code of '70'. Or sort the record set so these appear at the bottom.

In addition, several cosmetic issues have been highlighted. These are listed in the text file below:

pdf icon HRG Label Errors [182kb]


The Reference Costs 2014/15 collection is the third collection to use the new enhanced HRG4+ National Casemix Office design, and sees the extension of the HRG4+ design concept across the remaining applicable subchapters, most notably Trauma and Orthopaedics (Subchapters HA/HB/HC/HR) and WA, Immunology, Infectious Diseases, Poisoning, Shock, Special Examinations, Screening and Other Healthcare Contacts. It also sees the completion of the second phase of changes to Chapter Y, Vascular Procedures and Disorders and Imaging Interventions, as well as  redesign of the procedure-driven HRGs within Subchapters AA Nervous System Procedures and Disorders, AB Pain Management, BZ Eyes and Periorbits and Chapter E, Cardiac Surgery and Primary Cardiac Conditions, amongst others. As a result, there are significant changes to several subchapters, many  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 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 Procedure Logic to better differentiate between routine and  complex (typically specialised)care 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+ 2014/15 Reference Costs Grouper should be used to process data and produce HRG4+ output for the Reference Cost collection for the 2014/15 financial year.

The grouper is being issued with new episode and spell xls icon Trimpoints [194kb] to be used for the 2014/15 Reference Costs 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+ 2014/15 Reference Costs Grouper Reference Manual 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+ 2014/15 Reference Costs Summary of Changes document to become familiar with the changes made since the HRG4+ 2013/14 Reference Costs Grouper.

Further information regarding the Reference Costs collection for 2014/15 can be found in the 2014/15 Reference Costs Guidance published on the Department of Health website and Monitor website.

For queries about HRG4+ or the grouper, please call the HSCIC Contact Centre on 0300 303 5678 or email enquiries@nhsdigital.nhs.uk FAO "The National Casemix Office".  


HRG4+ 2014/15 Reference Costs Grouper Documentation

pdf icon Casemix Companion [760kb] - the starting point and general reference for new and existing users, providing an introduction to Casemix, HRG4 and HRG4+ design concepts and grouping logic.

pdf icon HRG4+ 2014/15 Reference Costs Grouper User Manual [1Mb] - provides full instructions on how to prepare and group data using the HRG4+ Grouper software application.

pdf icon HRG4+ 2014/15 Reference Costs Summary of Changes [367kb] - overview of changes between the current HRG4+ grouper design and its HRG4+ predecessor.

pdf icon HRG4+ 2014/15 Reference Costs Chapter Summaries [2Mb] - updates on changes and an overview of the scope, composition and grouping logic of individual subchapters.

zip icon HRG4+ 2014/15 Reference Costs Code to Group & User Manual [8Mb] - details on all mappings between primary classification codes and HRGs and the logic required to generate HRGs.

xls icon HRG4+ 2014/15 Reference Costs Trimpoints [194kb] - details of Episode and Spell-level Trimpoints to be used for the 2014/15 Reference Costs collection.

pdf icon HRG4+ 2014/15 Reference Costs Trimpoints Methodology [251kb]- details the methodology for calculation of the Trimpoints.

xls icon HRG4+ 2014/15 Reference Costs Specialised Services ID Code Sets [1Mb] - a workbook containing details regarding the flags and trigger codes in the HRG4+ Reference Costs Grouper to aid identification of specific Specialised Service activity.

xls icon HRG4+ 2014/15 Reference Costs Roots [1Mb]- identifies new HRGs, deleted HRGs and changes to existing HRG Labels between designs using colour-coding.

pdf icon HRG4+ 2014/15 Reference Costs Design Concepts Implemented [1Mb]- worked examples of specific grouping logic to highlight new design concepts.

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