Diagnosis Related Groups: Understanding Hospital Performance

Fetter, Robert B.

doi:10.1287/inte.21.1.6

Cited by 132 publications

(81 citation statements)

References 6 publications

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“…Cases are usually categorized based on clinical data (i.e., diagnoses, procedures), demographic data (i.e., age, gender), and resource consumption data (i.e., costs, length of stay) [2]. Initially developed as an information management tool for clinicians to monitor quality and use of services, patient classification systems now serve as a prospective payment system in many countries [3].…”

Section: Categorization Of Patient Classification Systemsmentioning

confidence: 99%

Methods to determine reimbursement rates for diagnosis related groups (DRG): A comparison of nine European countries

Schreyögg

Stargardt

Tiemann

et al. 2006

Health Care Manage Sci

176

121

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Over the past 20 years, most European countries have introduced DRGs or similar grouping systems as instruments for hospital reimbursement. This paper compares and analyzes the methods used to determine prices for inpatient care within DRGs or similar grouping systems employed in nine EU member states (i.e., Denmark, France, Germany, Hungary, Italy, Tthe Netherlands, Poland, Spain and England). It categorizes the systems of patient classification used in these nine countries and compares them according to the three steps necessary in order to set prices: 1.) definition of a data sample, 2.) use of trimming methods and plausibility checks and 3.) definition of prices. It concludes with a discussion on the typical development path of DRG systems and the role of additional reimbursement components in this context.

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Section: Categorization Of Patient Classification Systemsmentioning

confidence: 99%

Methods to determine reimbursement rates for diagnosis related groups (DRG): A comparison of nine European countries

Schreyögg

Stargardt

Tiemann

et al. 2006

Health Care Manage Sci

176

121

View full text Add to dashboard Cite

show abstract

“…hospital products [1,2]. DRGs are ‘diagnosis-related’ groups of patients that have (a) similar resource consumption patterns and that are (b) clinically meaningful [3]. They are defined by patient classification systems – i.e.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis-Related Groups for Stroke in Europe: Patient Classification and Hospital Reimbursement in 11 Countries

Peltola

Quentin²

2013

Cerebrovasc Dis

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Background: Diagnosis-related groups (DRGs) are increasingly being used for various purposes in many countries. However, there are no studies comparing different DRG systems in the care of stroke. As part of the EuroDRG project, researchers from 11 countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, the Netherlands, Poland, Sweden and Spain) compared how their DRG systems deal with stroke patients. The study aims to assist clinicians and national authorities to optimize their DRG systems. Methods: National or regional databases were used to identify hospital cases with a diagnosis of stroke. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually represent at least 1% of stroke cases. In addition, standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. Results: European DRG systems vary widely: they classify stroke patients according to different sets of variables (between 1 and 7 classification variables) into diverging numbers of DRGs (between 1 and 10 DRGs). In 6 of the countries more than half of the patients are concentrated within a single DRG. The countries’ systems also vary with respect to the evaluation of different kinds of stroke patients. The most complex DRG is considered 3.8 times more resource intensive than an index case in Finland. By contrast, in England, the DRG system does not account for complex cases. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the index case amount to only EUR 907 in Poland but to EUR 7,881 in Ireland. Conclusions: Large variations in the classification of stroke patients raise concerns whether all systems rely on the most appropriate classification variables and whether the DRGs adequately reflect differences in the complexity of treating different groups of patients. Learning from other DRG systems may help in improving the national systems. Clinicians and national DRG authorities should consider how other countries’ DRG systems classify stroke patients in order to optimize their DRG system and to ensure fair and appropriate reimbursement. In future, quantitative research is needed to verify whether the most important determinants of cost are considered in different patient classification systems, and whether differences between systems reflect country-specific differences in treatment patterns and, most importantly, what influence they have on patient outcomes.

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“…The modal Diagnosis-Related Group (DRG) weight for each procedure is shown in table 1. The resource-intensity weights are used by the Centers for Medicare and Medicaid Services (CMS) to estimate hospital resource use [10]. Coronary artery-bypass graft had the highest DRG-weight (5.65), whereas hysterectomy had the lowest (0.77).…”

Section: Model Of Market Capturementioning

confidence: 99%

Market Capture of Inpatient Perioperative Services Using DEA

O’Neill

Dexter

2004

Health Care Manage Sci

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We develop and validate a method to measure "market capture" of inpatient, elective surgery. Data envelopment analysis (DEA) is used to measure the efficiency of the market capture for Perioperative Services at 53 non-metropolitan Pennsylvania hospitals. Eight procedures are studied, representing a wide spectrum of elective, scheduled, inpatient surgery (e.g., abdominal aortic aneurysm resection and hip replacement). Our results address issues in operating room management, such as: How should additional resources be allocated to each surgical specialty? Given existing market conditions, for which specialties can we expect to be able to increase our current workloads? Our results demonstrate DEA's potential as a valuable tool for operating room managers' strategic decision-making.

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Diagnosis Related Groups: Understanding Hospital Performance

Cited by 132 publications

References 6 publications

Methods to determine reimbursement rates for diagnosis related groups (DRG): A comparison of nine European countries

Methods to determine reimbursement rates for diagnosis related groups (DRG): A comparison of nine European countries

Diagnosis-Related Groups for Stroke in Europe: Patient Classification and Hospital Reimbursement in 11 Countries

Market Capture of Inpatient Perioperative Services Using DEA

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