Hospital costs, resource characteristics, and the dynamics of death for hospitalized patients in cardiology Diagnosis-Related Groups.
A number of complex health policy questions face the nation regarding the Diagnosis-Related Group (DRG) prospective hospital payment system. An ongoing debate ensues at the federal level of the utility of improving the DRG system, given the "budget neutrality" provision of the DRG law. We analyzed hospital resource consumption for 5809 cardiology inpatients by outcome (i.e., survival vs death). Hospital resource use was greater and financial risk under DRG pricing schemes was substantial for the 312 deaths compared with the 5497 survivors. Only cases in which the patient died within 1 week of admission to the hospital were profitable under DRGs. A long hospital length of stay for patients who eventually died was very unprofitable (those who died after more than a 60-day hospital length of stay generated a $24,688 loss per patient). Patients who died after emergency admission tended to have a similar hospital length of stay and to be similar financial risk under DRGs, compared with nonemergency patients who died. Those patients who had been referred from other clinical services and who died caused greater resource use and financial risk under DRGs, compared with patients who were not referred and who died. These data suggest significant inequities in the current DRG prospective payment system for patients in cardiology DRGs who die. Variables predictive of greater hospital resource use for cardiology patients who die include longer hospital lengths of stay and referral from another clinical service. Health policy leaders should attempt to improve the equity of cardiology DRGs regarding outcome in the future.
Muñoz
E
E
Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, NY 11042.
Chalfin
D
D
Birnbaum
E
E
Mulloy
K
K
Cohen
J
J
Wise
L
L
D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups / Q000191:economics*; D006295:Health Resources / Q000191:economics*; D006331:Heart Diseases / Q000191:economics* / Q000401:mortality; D006784:Hospitals, Teaching / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008875:Middle Aged; D009519:New York City