DRGs and outliers in surgical critical care

The authors evaluated the charges, outcome, and characteristics of patients requiring prolonged stay in the Surgical Intensive Care Unit (SICU) as if all reimbursement was from the Medicare DRG system. The records of patients staying in the SICU longer than 20 days over an 18 month period were reviewed. Age, mortality, service, length of stay, hospital charge, and projected DRG reimbursement were recorded. Patients whose hospital stay exceeded the maximum expected for their DRG were considered day outliers. The 51 study patients had a mean age of 59 +/- 17.6 years. They comprised 1.3 per cent of all patients in the SICU and 30.7 per cent of all SICU patient days during the study period. Mortality was 39.2 per cent. Thirty-two patients (62.7%) were day outliers. The mean hospital charge per patient was $59,552 while the mean projected DRG reimbursement was $10,435, for a total projected loss in billed charges of $2,504,428. DRG reimbursement for patients requiring prolonged SICU stay is inadequate to meet their charges and may severely limit future SICU use.