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[DRG and gastrointestinal surgery]
S Leardi1, F Altilia, R Pietroletti
1Dipartimento di Discipline Chirurgiche, Università di L'Aquila.
Insights
The diagnosis-related-groups (DRG) reimbursement system shows significant financial disparities in gastrointestinal surgery. Minimal invasive procedures are profitable, while major surgeries incur substantial losses.
Area of Science:
- Healthcare economics
- Surgical outcomes analysis
- Hospital reimbursement systems
Context:
- The current hospital reimbursement model, diagnosis-related-groups (DRG), aims for cost-based payments but often fails to align proceeds with actual costs.
- This study investigates the financial viability of specific gastrointestinal surgery DRGs within a university surgical clinic.
Purpose:
- To analyze the profitability of various gastrointestinal surgery DRGs (147, 155, 158, 162, 165, 198) by comparing their reimbursement proceeds against calculated costs.
- To identify financial discrepancies within the DRG system for different surgical procedures.
Summary:
- A financial analysis of 30 gastrointestinal surgery patients revealed significant profit variations across DRGs.
- Major gastrointestinal surgeries (e.g., anterior resection, total gastrectomy) resulted in substantial financial losses.
- Minimal invasive procedures, such as hemorrhoidectomy and videolaparocholecystectomy, demonstrated considerable profitability.
Impact:
- The findings highlight a significant disparity in the current DRG reimbursement system, suggesting a need for revision.
- Surgeons, acting as managers, must carefully manage resources to optimize DRG-related financial outcomes.
Abstract:
The diagnosis-related-groups (DRG) is the cost-based system for hospital reimbursement. However, the proceeds does not coincide with the costs. Aim of the study was to identify the profit, which we could gained with 147, 155, 158, 162, 165, 198 gastrointestinal surgery DRG. 30 consecutive patients, undergone to surgery in Clinica Chirurgica of L'Aquila University, had been studied. We had calculated the daily costs of medical and nursing practice, diagnostic tests, drugs, hospitalization, surgical instruments for every patient's therapy. The DRG-proceeds had been correlated with the DRG-costs. The "major gastrointestinal surgery" had not profit (147 DRG: anterior resection of rectum = -354428 Pounds, Miles = -94020 Pounds; 155 DRG: total gastrectomy = -1920641 Pounds). On the contrary, "minimal surgery" had good profits (158 DRG: hemorroidectomy with local anestesia = 1469605 Pounds;162 DRG: sutureless groin hernioplasty = 1561200 Pounds; 198 DRG: videolaparochole-cystectomy: 1208807 Pounds). The study seems to demonstrate the disparity of the reimbursement system related to DRG. However, the surgeons, as managers, must employ warily the resources for producing DRG.