Financial risk and hospital cost in stratified, peripheral vascular surgical DRGs without complications and comorbidities.
The purpose of this study was to analyze hospital resource consumption in any of the nine non-complicating conditions covered under stratified, peripheral vascular surgical Diagnosis-Related Groups (DRGs) using the new DRG prospective All Payer System in effect in New York. There is significant health policy debate at the level of the United States Congress regarding the improvement of the equity of DRG hospital payment. Although there have been a number of recommendations by federal advisory bodies to further stratify DRGs by complications and comorbidities, no major revision of DRGs along these lines has been implemented. The all payer system uses the DRG format to pay for all patients. We analyzed 788 peripheral vascular surgical patients by payer (Medicare, Medicaid, Blue Cross and commercial insurance) in these stratified, peripheral vascular surgical DRGs with no complications or comorbidities for a three year period. Our study demonstrated that patients within each DRG with more complications and comorbidities generated higher total hospital costs, a longer hospital length of stay, a greater percentage of procedures per patient, financial risk under DRG payment, more outliers, and a higher mortality, compared to patients in these same DRGs with fewer complications and comorbidities. These findings suggest that new, prospective DRG all payer systems may be inequitable to certain groups of patients or types of hospitals in these stratified peripheral vascular surgical DRGs with no complication or comorbidities. This analysis suggests that these peripheral vascular surgical DRGs should be stratified by the numbers and types of complications and comorbidities to more equitably reimburse hospitals under DRGs.(ABSTRACT TRUNCATED AT 250 WORDS)
Munoz
E
E
Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, New York.
Cohen
J R
JR
Goldstein
J
J
Benacquista
T
T
Mulloy
K
K
Wise
L
L
D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D003953:Diagnosis-Related Groups / Q000191:economics*; D006295:Health Resources / Q000706:statistics & numerical data; D006746:Hospital Bed Capacity, 500 and over; D006784:Hospitals, Teaching / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007350:Insurance, Hospitalization / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D009519:New York City; D011445:Prospective Payment System; D013997:Time Factors; D014481:United States; D014656:Vascular Surgical Procedures / Q000145:classification / Q000191:economics*