An all-payor prospective payment system (PPS) based on diagnosis-related-groups (DRG): financial impact on reimbursement for trauma care and approaches to minimizing loss.
To assess the financial impact of the new all-payor prospective payment system (PPS), data for 430 patients admitted to a Level I Trauma Center were compared to all hospital discharges (n = 35,309). Trauma patients had a LOS of 13.1 days, average Trauma Score of 15, and operating loss for trauma patients totalled $1,310,625. Trauma as compared to all patients showed a greater variance in LOS (6.3 vs. 2.0 days), a higher case mix index (CMI) (1.93 vs. 1.40), and a greater loss per case (-$3,404 vs. -$979), respectively. The trauma group DRG weights correlated with revenue (r = 0.89; p less than 0.0001); however, there was no relation to profit/loss. Review of trauma patients' records revealed inaccurate coding. Corrections led to an increase in reimbursement of $132,000. Five DRGs were added in 1989 for multiple significant trauma (MST). Using the 1989 grouper, 30 patients were reassigned, with an increase in reimbursement of $250,000. Although these strategies reduce operating deficit by 29%, reimbursement for trauma care must be addressed further.
Joy
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Department of Surgery, Cornell University Medical College, New York, NY.
Yurt
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D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups; D004632:Emergency Medical Services / Q000191:economics*; D006801:Humans; D007902:Length of Stay; D008499:Medical Records; D009519:New York City; D011445:Prospective Payment System; D014193:Trauma Centers / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000191:economics* / Q000628:therapy