Financial risk, hospital cost, and complications and comorbidities (CCs) in the non-CC-stratified pulmonary medicine diagnostic-related group Medicare hospital payment system.
The purpose of this study was to analyze hospital resource consumption in the 8 noncomplicating condition-stratified pulmonary medicine diagnostic-related groups (DRGs). We analyzed 427 Medicare patients treated during a 2-yr period in these 8 noncomplicating condition-stratified DRGs. Patients with a greater number of complicating conditions (CCs) had higher total hospital costs, a longer hospital length of stay, more procedures per patient, increasing financial risk under DRGs, a larger number of outliers, and a higher mortality than did patients in these same DRGs with a fewer number of CCs. These findings raise the question of the equity of DRG reimbursement at our hospital vis-à-vis the non-CC-stratified pulmonary medicine DRGs. If these findings are generalizable at other teaching hospitals, the current DRG system may provide financial incentives to not treat certain types of pulmonary medicine patients likely to have many CCs, and potentially effect these patient's access and quality of care in the future.
D003953:Diagnosis-Related Groups; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay; D006278:Medicare / Q000191:economics*; D012051:Reimbursement Mechanisms; D012140:Respiratory Tract Diseases / Q000150:complications / Q000191:economics*; D014481:United States