scholarly journals Severity variations within DRGs:Measurement of hospital effects by use of data on significant secondary diagnoses

1998 ◽  
Vol 21 (1) ◽  
pp. 37 ◽  
Author(s):  
Don Hindle ◽  
Pieter Degeling ◽  
Ono Van Der Wel
Keyword(s):  
Resource Allocation ◽  
Length Of Stay ◽  
Group Classification ◽  
Public Hospitals ◽  
Diagnosis Related Group ◽  
Use Of Data ◽  
Acute Hospitals ◽  
Related Group

The Diagnosis Related Group classification has provided an excellent basis forenhancing the equity of resource allocation between public acute hospitals. However,it underestimates the higher levels of severity and consequent costliness of referralhospitals.This paper describes a practical way of measuring within-DRG variations in severity,which can be used to increase the precision of casemix-based funding. It involves theregression of length of stay against the numbers of significant diagnoses and procedures,and hence the prediction of additional justified costs. An example is given of itsapplication to data from South Australian public hospitals.

Should Medical Severity-Diagnosis Related Group Classification Be Utilized for Reimbursement? An Analysis of Elixhauser Comorbidities and Cost of Care

2019 ◽  
Vol 34 (7) ◽  
pp. 1312-1316 ◽  
Author(s):  
Sean P. Ryan ◽  
Johannes F. Plate ◽  
Daniel E. Goltz ◽  
David E. Attarian ◽  
Samuel S. Wellman ◽  
...  
Keyword(s):  
Group Classification ◽  
Cost Of Care ◽  
Diagnosis Related Group ◽  
Related Group ◽  
Medical Severity

scholarly journals An Evaluation of Diagnosis-Related Group (DRG) Implementation Focused on Cancer DRGs in Greek Public Hospitals

2019 ◽  
Vol 4 (1) ◽  
pp. 61-69
Author(s):  
Panos Panagiotopoulos ◽  
Nikos Maniadakis ◽  
George Papatheodoridis ◽  
Dimitris Pektasidis
Keyword(s):  
Public Hospitals ◽  
Diagnosis Related Group ◽  
Related Group

scholarly journals The New Diagnosis-Related Group Reimbursement System and Laboratory Test Quality in Korea: Analysis of External Quality Assessment Results

Healthcare ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 127 ◽  
Author(s):  
Sollip Kim ◽  
Yeo-Min Yun ◽  
Hyeongsu Kim ◽  
Tae-Hyun Um ◽  
Jeonghyun Chang ◽  
...  
Keyword(s):  
Laboratory Test ◽  
Quality Assessment ◽  
External Quality Assessment ◽  
Public Hospitals ◽  
Diagnosis Related Group ◽  
Reimbursement System ◽  
Test Quality ◽  
External Quality ◽  
Related Group ◽  
New Diagnosis

Korea introduced a new diagnosis-related group (NDRG), which is a mixed-bundle reimbursement system. We evaluated the effects of NDRGs on laboratory test quality by analyzing data over three years (2016–2018) from the Korean Association of External Quality Assessment Service (KEQAS). A total of 42 NDRG-participating hospitals (CASE), 84 non-participating similar size-hospitals (CON-1), and 42 tertiary hospitals (CON-2) were included. We assumed the proportion of KEQAS results with a larger than 2 standard deviation index (SDI) to be a bad laboratory quality marker (BLQM). CASE BLQMs were lower than CON-1 BLQMs for more than 2 years in alkaline phosphatase (ALP), alanine aminotransferase (ALT), chloride, glucose, sodium, and total protein, and higher in creatinine. CASE BLQMs were higher than CON-2 BLQMs for more than 2 years in ALP, chloride, creatinine, glucose, lactate dehydrogenase (LDH), phosphorus, potassium, sodium, total calcium, total cholesterol, triglyceride, and uric acid. Mean SDIs for general chemistry tests were not significantly different depending on NDRG participation. However, the NDRG is currently a pilot program that compensates the amount of each institution’s reimbursement based on the fee-for-service system, and most participants were public hospitals. Thus, the effects of NDRGs on laboratory test quality should be re-evaluated after the NDRG program has stabilized and more private hospitals are participating.

scholarly journals Impact of case type, length of stay, institution type, and comorbidities on Medicare diagnosis-related group reimbursement for adult spinal deformity surgery

2017 ◽  
Vol 43 (6) ◽  
pp. E11 ◽  
Author(s):  
Pierce D. Nunley ◽  
Gregory M. Mundis ◽  
Richard G. Fessler ◽  
Paul Park ◽  
Joseph M. Zavatsky ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Diagnosis Related Group ◽  
Anterior Fusion ◽  
Private Institutions ◽  
Academic Institutions ◽  
Related Group ◽  
Case Type ◽  
Type 3

OBJECTIVEThe aim of this study was to educate medical professionals about potential financial impacts of improper diagnosis-related group (DRG) coding in adult spinal deformity (ASD) surgery.METHODSMedicare’s Inpatient Prospective Payment System PC Pricer database was used to collect 2015 reimbursement data for ASD procedures from 12 hospitals. Case type, hospital type/location, number of operative levels, proper coding, length of stay, and complications/comorbidities (CCs) were analyzed for effects on reimbursement. DRGs were used to categorize cases into 3 types: 1) anterior or posterior only fusion, 2) anterior fusion with posterior percutaneous fixation with no dorsal fusion, and 3) combined anterior and posterior fixation and fusion.RESULTSPooling institutions, cases were reimbursed the same for single-level and multilevel ASD surgery. Longer stay, from 3 to 8 days, resulted in an additional $1400 per stay. Posterior fusion was an additional $6588, while CCs increased reimbursement by approximately $13,000. Academic institutions received higher reimbursement than private institutions, i.e., approximately $14,000 (Case Types 1 and 2) and approximately $16,000 (Case Type 3). Urban institutions received higher reimbursement than suburban institutions, i.e., approximately $3000 (Case Types 1 and 2) and approximately $3500 (Case Type 3). Longer stay, from 3 to 8 days, increased reimbursement between $208 and $494 for private institutions and between $1397 and $1879 for academic institutions per stay.CONCLUSIONSReimbursement is based on many factors not controlled by surgeons or hospitals, but proper DRG coding can significantly impact the financial health of hospitals and availability of quality patient care.

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