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Gastroenterology, diagnosis-related groups, and age
E Muñoz1, R Greenberg, G Faust
1Division of Gastroenterology, Long Island Jewish Medical Center, New Hyde Park, NY 11042.
Insights
The current Diagnosis-Related Group (DRG) reimbursement system may unfairly impact older gastrointestinal (GI) patients, leading to financial losses for hospitals treating them. This inequity could affect future care quality and access for elderly individuals.
Area of Science:
- Healthcare economics
- Geriatric medicine
- Gastroenterology
Background:
- Hospitals utilize a prospective Diagnosis-Related Group (DRG) classification system for reimbursement.
- The Federal Medicare DRG system has remained largely unchanged for five years.
Purpose of the Study:
- To analyze gastrointestinal (GI) medicine admissions by age and resource utilization.
- To evaluate the financial impact of the DRG system on different age groups of GI patients.
Main Methods:
- Analysis of 3,598 GI patient admissions from January 1, 1985, to December 31, 1987.
- Comparison of hospital costs, length of stay, diagnoses, procedures, mortality, and resource utilization (ICU, blood) across age categories.
Main Results:
- While overall DRG reimbursement generated a profit, patients aged 65 and above, particularly those 85+, incurred significant losses.
- Older GI patients (65+) exhibited higher costs, longer stays, more complex cases, and increased mortality.
- Resource utilization, including ICU and blood, increased with age.
Conclusions:
- The current DRG reimbursement scheme appears inequitable for older GI medicine patients.
- Financial disincentives within the DRG system may negatively influence future access to and quality of care for elderly patients.
Abstract:
Hospitals are now being reimbursed by a prospective Diagnosis-Related Group (DRG) classification system. There have been no major changes in the Federal Medicare DRG classification system since its inception 5 years ago. In this project, we analyzed all gastrointestinal (GI) medicine admissions by age and resource utilization at a large academic medical center. Total hospital costs for the 3,598 GI patients (January 1, 1985, through December 31, 1987) were $18,460,604. Although DRG reimbursement for all patients for the 3-year period would have generated an aggregate profit of $957,760, four out of five age categories of patients 65 years of age and above would have generated losses; the highest loss was for patients 85 years and over, at $2,235 per patient. Older GI patients (i.e., 65 years and over) had higher hospital costs, longer lengths of stay, more diagnoses and procedures per patient, and a higher mortality rate than younger patients. Both intensive care unit (ICU) and blood utilization rose with age. Thus, older GI patients consumed a disproportionately larger share of hospital resources. Our study suggests that the current DRG reimbursement scheme may be inequitable relative to the older GI medicine patient; financial disincentives from DRGs may affect elderly patients' access to and quality of care in the future.