Pediatric patients, DRG hospital payment, and comorbidities

Muñoz, Eric; Lory, Marc H.; Josephson, Jordan S.; Goldstein, Jonathan; Brewster, Jeffrey G.; Wise, Leslie

doi:10.1016/s0022-3476(89)80278-1

Cited by 7 publications

(12 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…They reported that hospital cost, LOS, percentage of LOS outliers, and mortality increased as the number of CCs per patient increased, even for patients categorized into medical noncomplications and comorbidity-stratified DRG groups, resulting in financial risk for hospitals without any DRG adjustments based upon CCs. In another study by Munoz et al [13], major inequities in the DRG prospective hospital payment system were confirmed for pediatric patients, generating a financial burden for hospital management. For example, if hospital cost correlates positively with LOS, hematological diseases or systemic infections may cause more financial loss, while eye diseases may not.…”

Section: Discussionmentioning

confidence: 94%

“…However, problems have emerged in situations where some patients are under-reimbursed if they have more CCs and have consumed more hospital resources than those with fewer CCs. Munoz et al [13] reported major inequities in Diagnosis-Related Group (DRG) prospective payment systems for pediatric patients. Jencks et al [14] showed that the number of recorded diagnoses was no higher for patients who died than for those who survived.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The association of the number of comorbidities and complications with length of stay, hospital mortality and LOS high outlier, based on administrative data

Kuwabara

Imanaka

Matsuda

et al. 2008

Environ Health Prev Med

View full text Add to dashboard Cite

Objectives With greater concern for efficient resource allocation and profiling of medical care, a case-mix classification was applied for the per-diem payment system in Japan. Many questions remain, one of which is the role of comorbidity and complication (CC) in grouping logic. We examined the association of the number of CC with the length of hospital stay (LOS) and hospital mortality as well as the proportion of LOS high outliers in 19 major diagnostic categories (MDCs).Methods This study was a secondary data analysis embedded in a government research project, including anonymous claims and clinical data during a 4-month period from July 2002. Every 19 MDC, LOS, hospital mortality or proportion of LOS high outliers was compared by the number of CC and presence of any procedures.Results From 82 special function hospitals, 241,268 patients were enrolled in this study. Among all patients, 50.5% were identified without any CCs, 32.4% with one or two, 13.4% with three or four, and 3.7% with over five CCs. The overall mean LOS was 22.15 days and hospital mortality 26.05 cases per 1,000 admissions. In any MDC, LOS and the proportion of outliers increased as the number of CC rose. The mortality rate increased prominently in the respiratory system and the hematology system. Conclusions This study demonstrated that the occurrence of more CC caused longer LOS and higher mortality in some major disease categories. Further study will clarify the association of the weighted CC with resource use through controlling procedures specific for MDC.

show abstract

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

The association of the number of comorbidities and complications with length of stay, hospital mortality and LOS high outlier, based on administrative data

Kuwabara

Imanaka

Matsuda

et al. 2008

Environ Health Prev Med

View full text Add to dashboard Cite

show abstract

“…In studies that focused mainly on adult patients, teaching hospitals delivered care at higher costs than other types of hospitals. 1 Although the reasons for higher costs varied among the many studies, the two major contributors were more adverse case-mix/severity of illness [2][3][4][5][6] and a larger proportion of poor patients at teaching hospitals compared with other hospitals. [7][8][9][10][11] Estimates of the importance of case-mix varied from 9% to 30% of costs, 12 but even after adjusting for case-mix, teaching hospitals still cost more.…”

mentioning

confidence: 99%

Comparison of Length of Stay for Asthma by Hospital Type

Samuels¹,

Novack

Martin³

et al. 1998

Pediatrics

View full text Add to dashboard Cite

show abstract

“…Of these, the majority (n = 28; 77.8%) were published in 1990 or before. [15][16][17][18][19][20][21]23,24,[27][28][29]31,34,35,[37][38][39][40][41][42][43][44][45][46]48,49 Most studies (n = 31; 86.1%) were set in the USA. [15][16][17][18][19][20][21][22][23][24][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]…”

Section: Resultsmentioning

confidence: 99%

Challenges and Adverse Outcomes of Implementing Reimbursement Mechanisms Based on the Diagnosis-Related Group Classification System: A systematic review

Barouni

Ahmadian

Anari

et al. 2020

Sultan Qaboos Univ Med J

View full text Add to dashboard Cite

In health insurance, a reimbursement mechanism refers to a method of third-party repayment to offset the use of medical services and equipment. This systematic review aimed to identify challenges and adverse outcomes generated by the implementation of reimbursement mechanisms based on the diagnosis-related group (DRG) classification system. All articles published between 1983 and 2017 and indexed in various databases were reviewed. Of the 1,475 articles identified, 36 were relevant and were included in the analysis. Overall, the most frequent challenges were increased costs (especially for severe diseases and specialised services), a lack of adequate supervision and technical infrastructure and the complexity of the method. Adverse outcomes included reduced length of patient stay, early patient discharge, decreased admissions, increased re-admissions and reduced services. Moreover, DRG-based reimbursement mechanisms often resulted in the referral of patients to other institutions, thus transferring costs to other sectors.Keywords: Health Insurance; Third-Party Payments; Reimbursement Mechanisms; Diagnosis-Related Groups; Quality of Health Care; Patient Outcome Assessment; Systematic Review.

show abstract

Pediatric patients, DRG hospital payment, and comorbidities

Cited by 7 publications

References 8 publications

The association of the number of comorbidities and complications with length of stay, hospital mortality and LOS high outlier, based on administrative data

The association of the number of comorbidities and complications with length of stay, hospital mortality and LOS high outlier, based on administrative data

Comparison of Length of Stay for Asthma by Hospital Type

Challenges and Adverse Outcomes of Implementing Reimbursement Mechanisms Based on the Diagnosis-Related Group Classification System: A systematic review

Contact Info

Product

Resources

About