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Hospital costs and resource characteristics for cardiothoracic surgical hospital deaths
1Division of Cardiothoracic Surgery, Long Island Jewish Medical Center, New Hyde Park, NY 11042.
Insights
Dying cardiothoracic surgical patients incur substantial financial losses under Medicare
Area of Science:
- Health Economics
- Healthcare Policy
- Thoracic Surgery
Background:
- The federal Medicare diagnostic-related group (DRG) prospective hospital payment system is a primary reimbursement mechanism.
- No significant recent modifications have been made to the DRG system by Congress.
- Hospital resource consumption varies significantly based on patient outcomes.
Purpose of the Study:
- To analyze hospital resource utilization and financial risk for cardiothoracic surgical patients under the current DRG payment system.
- To identify patient characteristics associated with increased resource consumption and financial deficits.
- To assess the equity of the DRG system for patients who die.
Main Methods:
- Analysis of hospital resource consumption for 1,567 cardiothoracic surgical patients.
- Comparison of resource utilization between survivors (1,491) and nonsurvivors (76).
- Evaluation of financial impact based on length of stay, admission type, and referral status.
Main Results:
- Nonsurvivors exhibited significantly higher hospital resource utilization and financial risk compared to survivors.
- Patients with prolonged hospital stays (over 60 days) generated substantial financial deficits.
- Emergency admissions and non-referred patients among nonsurvivors showed higher financial risk.
Conclusions:
- The current DRG prospective payment system presents significant inequities for cardiothoracic surgical patients who die.
- Longer hospital stays, nonemergency admissions, and direct admissions predict greater resource utilization.
- Future methods should aim to improve the equity of DRG payments for cardiothoracic surgical nonsurvivors.
Abstract:
No major changes in the federal Medicare diagnostic-related group (DRG) prospective hospital payment system have been implemented by the United States Congress. We analyzed hospital resource consumption for 1,567 cardiothoracic surgical patients by outcome (ie, survivors versus nonsurvivors). The 76 patients who died had a much greater intensity of hospital resource utilization and represented a substantial financial risk under DRG pricing schemes compared with the 1,491 survivors. Only patients who died within 1 week of admission to the hospital generated a financial surplus under DRGs. A long hospital stay for nonsurvivors produced a substantial deficit (patients with a stay greater than 60 days generated a $154,433 loss per patient). The cardiothoracic patients admitted on an emergency basis who died tended to have a shorter length of stay and represented a lower financial risk under DRGs compared with patients admitted on a nonemergency basis who died. Among nonsurvivors, patients referred for cardiothoracic surgical procedures from other clinical services had lower resource utilization and financial risk under DRGs compared with nonreferrals. These data suggest significant inequities in the current DRG prospective payment system vis-à-vis cardiothoracic surgical patients who die. Variables predictive of greater hospital resource utilization by outcome included a longer hospital stay, nonemergency admission, and admission directly to the cardiothoracic surgical service. Methods to improve the equity of DRG payment vis-à-vis cardiothoracic surgical nonsurvivors should be implemented in the future.