DRG migration: A novel measure of inefficient surgical care in a value-based world

Hughes, Byron D.; Mehta, Hemalkumar B.; Sieloff, Eric M.; Shan, Yong; Senagore, Anthony J.

doi:10.1016/j.amjsurg.2017.09.035

Cited by 4 publications

(12 citation statements)

References 10 publications

(12 reference statements)

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“…Among DRG 331, 1,107 patients had benign disease and 2,316 patients had colon cancer. Of those patients that migrated from DRG 331 to DRG 330 as a result of post‐admission complications, a concept described in full elsewhere, there were a total of 87 patients in the benign disease cohort and 20 in the colon cancer cohort. Therefore, this results in 7.3% and 0.9% migration rates for the benign and oncologic cohorts, respectively (Appendix B).…”

Section: Resultsmentioning

confidence: 99%

“…We also found in the benign cohort a greater rate of patients with higher CC's and SSIs, which likely contributed to a longer LOS in the benign cohort (7.25 ± 4.65 vs 6.92 ± 4.17, P < .002). This effect is further delineated by the DRG migration, which remained higher in the benign disease cohort even after controlling for comorbidities by removing any DRG 330 coded patients at admission . Moreover, those patients in the benign disease cohort were more likely to require additional services (ie, home health) or be admitted to a post‐acute care facility upon discharge after the risk‐adjusted analysis was completed.…”

Section: Discussionmentioning

confidence: 95%

“…Our secondary outcome was DRG migration. This was defined as patients originally coded as DRG 331 and was assigned to the DRG 330 cohort as a result of post‐admission complications after surgery . In brief, the DRG migration rate is a ratio of patients coded as DRG 331 relative to patients coded as DRG 330 upon discharge (DRG 330 total/(DRG 330 total + DRG 331 total).…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Cost of benign versus oncologic colon resection among fee‐for‐service Medicare enrollees

Hughes

Hancock

Shan

et al. 2019

Journal of Surgical Oncology

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Background and Objectives Reimbursement for colonic pathology by the Centers for Medicare and Medicaid Services (CMS) are grouped in the Medicare Severity‐Diagnosis Related Groups (MS‐DRG). With limited available data, we sought to compare the relative impact of malignant vs benign colonic pathology on reimbursement under the MS‐DRG system. Methods We used 5% national Medicare data from 2011 to 2014. Patients were classified as having benign disease or malignancy. Descriptive statistics and multivariate regression analysis were used to evaluate the surgical approach and health resource utilization. Results Of 10 928 patients, most were Non‐Hispanic White women. The majority underwent open colectomy in both cohorts (P < .001). Colectomy for benign disease was associated with higher total charges (P < .001) and a longer length of stay (P = .0002). Despite higher charges, payments were not significantly different between the cohorts (P = .434). Both inpatient mortality and discharge to a rehab facility were higher in the oncologic group (P < .001). Conclusion Payment methodology for colectomy under the CMS MS‐DRG system does not appear to accurately reflect the episode cost of care. The data suggest that inpatient costs are not fully compensated. A transition to value‐based payments with expanded episode duration will require a better understanding of unique costs before adoption.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 95%

Section: Methodsmentioning

confidence: 99%

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Cost of benign versus oncologic colon resection among fee‐for‐service Medicare enrollees

Hughes

Hancock

Shan

et al. 2019

Journal of Surgical Oncology

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“…This three-tier system adopted in 2007 reimburses hospitals by incremental costs in accordance with their DRG class: DRG 331 = $9913, DRG 330 = $15,150, and DRG 329 = $29,586. DRG 331 indicates patients without complication or comorbidity (CC), DRG 330 includes patients with at least one CC but no major complication or comorbidity (MCC), and 329 for patients with MCCs [ 3 ]. Individual patients are designated a class on hospital admission, which may be amended prior to discharge based on the post-admission course.…”

Section: Introductionmentioning

confidence: 99%

“…Our group has previously explored this concept by defining the concept of “DRG migration” which is defined by patient assignment to a higher cost DRG due only to post admission comorbidity or complications (CC) [ 3 ]. This analysis confirmed the significant cost impact of converting a patient from DRG 331 to the more highly reimbursed DRG 330 due to surgical complications from the perspective of the payor, however, the provider was better reimbursed to manage those surgical complications.…”

Section: Introductionmentioning

confidence: 99%

Colectomy among Fee-for-Service Medicare Enrollees Coded as DRG 330: A Potential Platform to Allow Consumer Cost Transparency?

et al. 2020

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The use of Centers for Medicare and Medicaid Services Diagnosis Related Group (CMS-DRG) codes define hospital reimbursement for Medicare beneficiaries. Our objective was to assess all patients with comorbidities on admission who were discharged in the DRG 330 category to determine the impact of postoperative complications on Medicare costs. The 5% Medicare Database was used to evaluate patients who underwent a colectomy and were coded as CMS-DRG 330. Patients were divided into two groups: No surgical complications (NSC) and surgical complications (SC). Length of stay (LOS), complications, hospital charges, CMS reimbursement, discharge destination, and inpatient mortality were assessed. Statistical significance was set at p < 0.05. In total, 13,072 patients were identified. The SC group had higher inpatient mortality, a longer LOS (p < 0.0001) and was more likely to be discharged with post-acute care support (p = 0.0005). The use of CMS-DRG coding has the potential to provide Medicare fiscal intermediaries, beneficiaries, and providers with a more accurate understanding of the relative impact of their baseline health. The data further suggest that providers may benefit by more fully understanding the cost of preventive measures as a means of reducing total cost of care for this population.

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Diagnosis-Related Group in Colon Surgery: Identifying Areas of Improvement to Drive High-Value Care

Hughes

Moore

Mehta

et al. 2019

The American Surgeon

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Diagnosis-related group (DRG) migration is defined as the reassignment of colectomy patients from DRG 331 to 330 based exclusively on postoperative complications. Strategic and comparative application of this metric has the potential to demonstrate baseline and excessive rates of complications related directly to patient care differences across institutions. The aim of this study was to report the variability of DRG migration across United States hospitals and its impact on overall cost and length of stay (LOS). This study investigated the variability of DRG migration rates across United States hospitals polling 5 per cent of the national Medicare data. The study end-points were total cost, LOS, and DRG migration rate. Hospitals were classified into tertiles for low (0.1–16.6%), moderate (16.7–23.0%), and high (23.1–83.3%) DRG migration rates. The study included 5120 patients from 615 hospitals. DRG migration rates for hospitals ranged from 0.1 per cent to 83.3 per cent, with 157 in the low, 183 in the moderate, and 364 in the high tertile. DRG migration resulted in a progressively increased LOS and hospital costs from the lowest to highest tertile. Several diagnoses were identified which are suggestive of failure to integrate evidence-based processes of care across the tertiles. The data confirm a wide variation in DRG migration rates from DRG 331 to 330 based only on postoperative complications. These ranges allow for the potential definition of both best practice, and opportunities for quality improvement with respect to postoperative complications, identification of hospital outliers, and the economics of care as part of a value-based care program.

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DRG migration: A novel measure of inefficient surgical care in a value-based world

Cited by 4 publications

References 10 publications

Cost of benign versus oncologic colon resection among fee‐for‐service Medicare enrollees

Cost of benign versus oncologic colon resection among fee‐for‐service Medicare enrollees

Colectomy among Fee-for-Service Medicare Enrollees Coded as DRG 330: A Potential Platform to Allow Consumer Cost Transparency?

Diagnosis-Related Group in Colon Surgery: Identifying Areas of Improvement to Drive High-Value Care

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