title: Physicians' patient load per DRG, the consumption of hospital resources, and the incentives of the DRG prospective payment system.
abstract: From 1985 through 1987, the authors assessed the relationship between two main variables at a large academic medical center: (1) the numbers (high or low) of patients per diagnosis-related group (DRG) treated by individual physicians and (2) hospital resource consumption of the patients. The patients were classified according to their routes of admission (emergency or non-emergency); the physicians with eight or more patients per DRG were labeled "high-patient-load physicians" (hereafter called "high-load physicians"), and those with five or fewer patients were labeled "low-patient-load physicians," ("low-load physicians"). The resource variables studied were length of stay (LOS) and total hospital cost. For the non-emergency admissions, the low-load physicians' patients had an average LOS that was 56.2% greater and an average hospital cost that was 58.3% greater than were the LOS and cost of the patients of the high-load physicians. (Both LOS and cost per patient were adjusted for DRG weight index.) This was due in part to a greater severity of illness for the patients (as measured by total ICD-9-CM codes per patient) of the low-load physicians. For the emergency admissions, the low-load physicians' patients had an average LOS that was 9.5% greater and an average hospital cost that was 10.5% greater than the LOS and cost of the patients of the high-load physicians. As in the non-emergency admissions group, severity of illness for the patients of the low-load physicians was greater. The only category of patients that was economically profitable to the hospital was the non-emergency admissions group treated by the high-load physicians. Even though these findings were the result of many factors (discussed in the text), they suggest a relationship between hospital resource consumption and the physicians' patient load per DRG.
authors.affiliation: Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, NY 11042.
authors.forename: E
authors.initials: E
authors.lastname: Munoz
authors.forename: K
authors.initials: K
authors.lastname: Mulloy
authors.forename: J
authors.initials: J
authors.lastname: Goldstein
authors.forename: J
authors.initials: J
authors.lastname: Josephson
authors.forename: N
authors.initials: N
authors.lastname: Tenenbaum
authors.forename: L
authors.initials: L
authors.lastname: Wise
mesh_terms: D000046:Academic Medical Centers / Q000191:economics*; D000328:Adult; D003953:Diagnosis-Related Groups; D004632:Emergency Medical Services / Q000191:economics*; D006801:Humans; D008875:Middle Aged; D011445:Prospective Payment System / Q000191:economics*