Health Resource Group version 4 (HRG4) has been designed over a number of years specifically for Payment by Results (PbR), with substantial clinical involvement. The Department is planning for HRG4 to be introduced for payment of tariff from April 2009. The changes underpinning the new tariff have already been extensively discussed and tested with a wide range of stakeholder groups.
The new tariff is currently being ‘road tested’ by the NHS, the purpose of which is to support early service and financial planning and invite comments on the clarity and comprehensiveness of guidance. The Department is also using the exercise to identify whether the new tariff has any unintended consequences. Following the road testing exercise, the final tariff is expected to be confirmed in January.
The Department has already determined though, that in order to help trusts adjust to the new tariff, the full range of potential changes will not be introduced in 2009-10. Tariffs for accident and emergency services will remain based on the current tariff structure, and although HRG4 has the capability to generate HRGs for procedures in outpatients clinics, there will not be a mandatory tariff for these procedures next year. The full benefits of the new design will be realised gradually, as the quality of underlying activity and cost data improves.
The Department has undertaken an analysis which shows that because funds are directed more accurately to specialised services under HRG4, the number of services requiring specialised service ‘top-ups’ is reduced from nine to two. The only two services requiring top-ups in 2009-10 are orthopaedics and specialised services for children, and in both cases the level of top-ups is lower than in 2008-09.