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<p>In the development of each national tariff, NHS England and NHS Improvement undertakes
an overall assessment of the impact of proposals. While this provides an overall assessment
of impact, detailed feedback on proposed prices for individual HRGs (units of healthcare)
is sought from clinical Expert Working Groups (EWGs). This is to ensure that the published
tariff supports clinical practice.</p><p>For the 2017/19 tariff (set for two years),
the prices for BZ91 were increased following EWG feedback. However, for the 2019/20
tariff the EWG advised that increasing the prices was no longer appropriate. The EWG
felt that there had been a significant change in clinical practice since the 2017/19
prices were set, with a shift to performing minimally invasive glaucoma surgery (MIGS),
which are significantly cheaper, rather than open/tube glaucoma procedures. Based
on diagnosis and procedure codes entered into patient records, MIGS activity is assigned
to the HRG BZ91. However, the current codes do not allow differentiation between MIGS
and non-MIGS activity. This means that BZ91 covers procedures of different levels
of resource use.</p><p>Reference costs are collected and published annually and the
latest published data is for the financial year 2017-18. The reference cost data and
links to previous years data can be found at the following link:</p><p><a href="https://improvement.nhs.uk/resources/reference-costs/#rc1718"
target="_blank">https://improvement.nhs.uk/resources/reference-costs/#rc1718</a></p>
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