An evaluation of diagnosis-related group severity and complexity refinement.
In 1988, an ambitious and extensive project was undertaken in New Jersey to evaluate severity class adjustment of the all-payer prospective payment system. Another project objective was to evaluate alternative strategies for refining diagnosis-related groups (DRGs). The evaluation presented here includes a comparison of DRG refinement using Computerized Severity Index classes and Yale University complexity classes. Statistical methods and payment simulations are used to assess the impact of DRG refinement and consequent revenue changes. When a high volume subset of DRGs is refined, simulated payment shifts between hospitals on the order of 5 percent of total hospital costs are indicated by this analysis.
McGuire
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3M Health Information Systems, Wallingford, CT 06492.
D015897:Comorbidity; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D003953:Diagnosis-Related Groups / Q000145:classification*; D004469:Economics, Hospital / Q000706:statistics & numerical data*; D005069:Evaluation Studies as Topic; D006742:Hospital Bed Capacity; D006278:Medicare / Q000458:organization & administration*; D008962:Models, Theoretical; D009515:New Jersey; D012051:Reimbursement Mechanisms; D012424:Rural Population; D012720:Severity of Illness Index; D013383:Suburban Population; D014481:United States; D014505:Urban Population