title: Gastroenterology, diagnosis-related groups, and age.
abstract: Hospitals are now being reimbursed by a prospective Diagnosis-Related Group (DRG) classification system. There have been no major changes in the Federal Medicare DRG classification system since its inception 5 years ago. In this project, we analyzed all gastrointestinal (GI) medicine admissions by age and resource utilization at a large academic medical center. Total hospital costs for the 3,598 GI patients (January 1, 1985, through December 31, 1987) were $18,460,604. Although DRG reimbursement for all patients for the 3-year period would have generated an aggregate profit of $957,760, four out of five age categories of patients 65 years of age and above would have generated losses; the highest loss was for patients 85 years and over, at $2,235 per patient. Older GI patients (i.e., 65 years and over) had higher hospital costs, longer lengths of stay, more diagnoses and procedures per patient, and a higher mortality rate than younger patients. Both intensive care unit (ICU) and blood utilization rose with age. Thus, older GI patients consumed a disproportionately larger share of hospital resources. Our study suggests that the current DRG reimbursement scheme may be inequitable relative to the older GI medicine patient; financial disincentives from DRGs may affect elderly patients' access to and quality of care in the future.
authors.affiliation: Division of Gastroenterology, Long Island Jewish Medical Center, New Hyde Park, NY 11042.
authors.forename: E
authors.initials: E
authors.lastname: Muñoz
authors.forename: R
authors.initials: R
authors.lastname: Greenberg
authors.forename: G
authors.initials: G
authors.lastname: Faust
authors.forename: J D
authors.initials: JD
authors.lastname: Goldstein
authors.forename: S
authors.initials: S
authors.lastname: Bank
authors.forename: L
authors.initials: L
authors.lastname: Wise
mesh_terms: D000046:Academic Medical Centers / Q000191:economics; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups; D005767:Gastrointestinal Diseases / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D009519:New York City; D014481:United States