The equity of diagnostic related group "All Payor" hospital payment and gynecology diagnostic related groups.
Previous work by our group had suggested that some Diagnostic Related Groups did not adequately compensate for patients with multiple complications and comorbidities. However, this question had never been studied for gynecology Diagnostic Related Groups. We analyzed resource consumption in the 15 gynecology Diagnostic Related Groups that were not stratified for complications or comorbidities using the new Diagnostic Related Group prospective "All Payor System" in effect at our hospital. Analysis of 2920 gynecology patients for a 3-year period by payor (Medicare, Medicaid, Blue Cross, and commercial insurance) in the gynecology Diagnostic Related Groups that were not stratified for complications or comorbidities demonstrated that patients with more complications and comorbidities per Diagnostic Related Group for each payor generated higher total hospital costs, a longer hospital length of stay, a greater percentage of procedures per patient, financial risk under Diagnostic Related Group payment, more outliers, and a higher mortality compared with patients in these same Diagnostic Related Groups with fewer complications and comorbidities. These findings suggest that new prospective Diagnostic Related Group All Payor Systems may be inequitable for certain groups of gynecology patients. Gynecology Diagnostic Related Groups should be stratified by the numbers and types of complications and comorbidities to more equitably reimburse hospitals under Diagnostic Related Group All Payor Systems.
Munoz
E
E
Department of Obstetrics-Gynecology, Long Island Jewish Medical Center, New Hyde Park, New York.
Seltzer
V
V
Goldstein
J
J
Benacquista
T
T
Mulloy
K
K
Wise
L
L
D000328:Adult; D054598:Blue Cross Blue Shield Insurance Plans; D015897:Comorbidity; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups; D005260:Female; D006176:Gynecology; D006784:Hospitals, Teaching; D006801:Humans; D008484:Medicaid; D009518:New York; D012051:Reimbursement Mechanisms; D014481:United States