title: Surgonomics: the cost dynamics of craniotomy.
abstract: Prospective payment systems using the diagnostic related group (DRG) mechanism are being phased in for Medicare inpatient hospital care. The purpose of this study was to examine a common neurosurgical procedure (001), craniotomy without trauma, and characterize the cost dynamics of this DRG. All patients (n = 50) treated in this DRG at the Long Island Jewish Medical Center during 1983 had their financial charges exclusive of physician fees examined. The findings were: (a) each hospital service category had wide charge variances around the mean; (b) emergency (ER) admissions were 200% more expensive than nonemergency (non-ER) admissions; (c) ER admissions seemed to have no greater severity of illness than non-ER admissions, but had a significantly different referral pattern (i.e., admission from the ER to a nonneurosurgical service with a subsequent neurosurgical referral); (d) this DRG when grouped into clinical "subproducts" (i.e., craniotomy for tumor, hematoma, hydrocephalus, aneurysm, benign cyst, and other) showed marked charge differences; and (e) the most expensive 25% of patients had five times higher charges than the least expensive 25% for both ER and non-ER admissions. This type of financial analysis may give surgeons a methodology with which to address the problems of cost containment in a more serious manner.
mesh_terms: D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000191:economics / Q000601:surgery*; D001932:Brain Neoplasms / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000601:surgery; D003363:Cost Control / Q000639:trends; D003399:Craniotomy / Q000191:economics*; D003560:Cysts / Q000601:surgery; D003953:Diagnosis-Related Groups; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D002532:Intracranial Aneurysm / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009518:New York; D011183:Postoperative Complications / Q000191:economics; D011445:Prospective Payment System / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000191:economics*