Classifying Patients with Burns for Hospital Reimbursement: Diagnosis-Related Groups and Modifications for Severity

Sharkey, Phoebe D.; Horn, Susan D.; Brigham, Peter A.; Horn, Roger A.; Potts, Linda; Wayne, John; Dimick, Alan R.

doi:10.1097/00004630-199107000-00007

Cited by 12 publications

(3 citation statements)

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“…Diagnosis-related group coding serves not only as an important tool for burn center reimbursement 16,17 but also as a reliable tool for predicting severity of burns and length of stay. 18 As expected, increases in burn diagnosis-related group severity were associated with increased length of stay and mortality ( Table 2). Usage of diagnosis-related group based data sets is valuable in providing comprehensive, largevolume, multicenter analyses for inpatient diagnoses (such as burns) that have resource-intensive needs.…”

Section: Discussionsupporting

confidence: 66%

Hospital Volume Outcome and Discharge Disposition of Burn Patients

Pacella

Butz

Comstock

et al. 2006

Plastic and Reconstructive Surgery

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Section: Discussionsupporting

confidence: 66%

Hospital Volume Outcome and Discharge Disposition of Burn Patients

Pacella

Butz

Comstock

et al. 2006

Plastic and Reconstructive Surgery

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“…This hypothesis has some support in the scientific literature. For example, Sharkey et al (1991) studied the costs of admitted patients with burns in a sample of United States hospitals. They found that DRGs explained 24␣ per cent of the variation in total costs.…”

mentioning

confidence: 99%

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

Hindle

Degeling²,

Wel³

1998

Aust. Health Review

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The Diagnosis Related Group classification has provided an excellent basis for enhancing the equity of resource allocation between public acute hospitals. However, it underestimates the higher levels of severity and consequent costliness of referral hospitals. 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 the regression of length of stay against the numbers of significant diagnoses and procedures, and bence the prediction of additional justified costs. An example is given of its application to data from South Australian public hospitals.

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“…Finally, Munoz et al 12 have reported that the current DRG payment system is inequitable for patients treated in the ICU. Although the DRG system attempts to predict resource consumption using a number of variables, many studies [13][14][15] have shown that the DRG system is poor at stratifying injury severity and resource utilization and that illness-based severity models are better predictors of hospital length of stay and hospital charges. In light of these studies and our own findings, there appears to be a need to refine the Medicare DRGs to incorporate a measure of severity for the diagnosis of extensive thermal injury requiring skin grafts and the need for prolonged mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

DRG 504: The Effect of 96 Hours of Mechanical Ventilation on Resource Utilization

Kagan¹,

Gamelli²,

Saffle³

2007

Journal of Burn Care & Research

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DRG (diagnosis related group) 504 is utilized for patients with extensive burn injuries with skin grafts along with the recent inclusion of patients with nonextensive full-thickness burns with skin grafts who require >or=4 days of mechanical ventilation. Since patients with extensive burns and/or inhalation injuries often required ventilator support, we elected to compare demographics, length of stay variables, and hospital charges for patients assigned to DRG 504 based upon the length of ventilator support. The American Burn Association's National Burn Repository was queried for all inpatients admitted from January 2000 through December 2001 and who were assigned to DRG 504. Demographic, resource utilization, and financial data were analyzed based upon the need for >or=96 hrs of mechanical ventilation. One hundred seven patients were identified of which 94 (87.9%) required >or=96 hrs of mechanical ventilation. While patients with inhalation injuries required significantly more days of ventilator support, length of stay and hospital charges were nearly identical. Patients who required >or=96 hrs of ventilator support, had a 10-fold greater number of ventilator and intensive care unit days (P < 0.0001) and twice the length of hospitalization (P < 0.005) and hospital charges (P < 0.05) for their care compared to those requiring <96 hrs of ventilator support. Burn patients requiring endotracheal intubation and >or=96 hrs of ventilator support during their acute hospitalization consume significantly greater resources than those who do not require such treatment. The Center for Medicare & Medicaid Services should consider modifying DRG 504 for patients with extensive burns to permit a more appropriate resource-based reimbursement to burn center hospitals.

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Classifying Patients with Burns for Hospital Reimbursement: Diagnosis-Related Groups and Modifications for Severity

Cited by 12 publications

References 0 publications

Hospital Volume Outcome and Discharge Disposition of Burn Patients

Hospital Volume Outcome and Discharge Disposition of Burn Patients

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

DRG 504: The Effect of 96 Hours of Mechanical Ventilation on Resource Utilization

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