Diagnosis-related group refinement with diagnosis- and procedure-specific comorbidities and complications.
Diagnosis-related groups have been revised through more refined uses of secondary diagnoses. Under the refined diagnosis-related groups, patients are distinguished with respect to classes of secondary diagnoses that are disease- and procedure-specific. Each class represents a different level of utilization for a given principal diagnosis or surgical procedure. The refined system was evaluated with national data from the Medicare program. Estimates of hospital costs and utilization based on refined diagnosis-related groups were more precise than those based on unrefined diagnosis-related groups. This approach to diagnosis-related group refinement does not represent a radical departure from the current diagnosis-related group framework and does not require new data collection efforts. Moreover, a payment system based on the refined model is less affected by the ordering of the diagnoses than under the existing diagnosis-related group system. How the refined diagnosis-related group framework can accommodate future refinements at all levels of the classification scheme is also discussed.
Freeman
J L
JL
Department of Internal Medicine, University of Texas Medical Branch, Galveston 77555-0460, USA.
Fetter
R B
RB
Park
H
H
Schneider
K C
KC
Lichtenstein
J L
JL
Hughes
J S
JS
Bauman
W A
WA
Duncan
C C
CC
Freeman
D H
DH
Palmer
G R
GR
D000328:Adult; D015897:Comorbidity; D003953:Diagnosis-Related Groups / Q000145:classification* / Q000191:economics / Q000639:trends; D005260:Female; D006753:Hospital Records; D006760:Hospitalization; D006801:Humans; D008297:Male; D006278:Medicare; D015233:Models, Statistical; D011445:Prospective Payment System; D012720:Severity of Illness Index; D012737:Sex Factors; D014481:United States