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Payment and activity

Critical Care Minimum Data Set

Critical Care Minimum Dataset Full Specification March 2010 - from the Information Standards Board

North West London Critical Care Network - Summary CCMDS interpretation tool

In England, a Critical Care Minimum Data Set (CCMDS) is mandated for patients receiving critical care.This captures the organ support on a daily basis for each patient receiving critical care.

Health Resource Groups
The nationally mandated currency for critical care is Health Resource Groups (HRGs). In critical care these are derived from the organ support needed by patients and captured via the CCMDS. The HRG is allocated from this and is based on total organs supported for each patient's spell in critical care.

These are the Health Resource Groups (HRGs) showing the number of organs supported

HRG Code
Number of organs supported
XC01Z 6+
XC02Z 5
XC03Z 4
XC04Z 3
XC05Z 2
XC06Z 1
XC07Z 0

Commissioning and contracting critical care

Payment by Results (PbR) is currently the payment system which commissioners use to pay Healthcare providers.
With the majority of Specialties, an HRG (Healthcare Resource Group) is assigned to a patients Spell, dependent on the coded interventions / Diagnoses received during that Spell. 
Patients who have an Adult Critical Care stay, still have this Core HRG, but they will also have an Adult Critical Care HRG which is "unbundled" from the rest of the patient episode.
For each critical care stay, the HRG Grouper used by all Trusts will generate 1 HRG per critical care period (not on a per day basis), based on the number of organs supported along with the  Critical Care length of stay.

There is no national price or tariff for critical care so prices per bed day of activity are set locally and are based on the different HRGs.

There are discussions taking place at the moment, nationally, which are suggesting moving critical care service contracting into using a blended payment arrangement. This would include a two part capacity and activity payment - payment for agreed bed capacity plus some activity payment.

For example - setting a fixed element (capacity, workforce and estate costs) into one payment to cover provision of the unit and low or no organ support. higher organ support would be reimbursed based on activity. There are different views on this possible approach. All agree the future arrangement must not end up being more difficult, or onerous to implement and carry out.