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Age, resource consumption, and outcome for medical patients at an academic medical center
1University of Medicine and Dentistry of New Jersey, University Hospital, Newark 07103-2425.
Insights
The diagnosis-related group (DRG) hospital payment system may be inequitable for elderly patients. Older patients generated losses, potentially limiting access and quality of care.
Area of Science:
- Health Economics
- Hospital Administration
- Geriatric Medicine
Background:
- Growing national debate on the Diagnosis-Related Group (DRG) hospital payment system's impact on patient access and care quality.
- Recent DRG system changes removed age stratification and delayed equity improvements.
- Hospitals face increasing financial pressures.
Purpose of the Study:
- To characterize hospital resource consumption and patient outcomes by age using the DRG format.
- To assess the financial impact of the DRG system on different age groups.
- To evaluate the potential inequity of the DRG system for elderly patients.
Main Methods:
- Analysis of 31,838 medical admissions to a large academic medical center from 1985-1987.
- Characterization of hospital resource use (cost, length of stay, outliers) and mortality stratified by age.
- Calculation of DRG case-mix index and diagnostic codes per patient by age.
Main Results:
- Hospital costs, length of stay, outlier rates, and mortality increased with patient age.
- Mean DRG case-mix index and diagnostic codes per patient also rose with age.
- Patients aged 71 and older generated financial losses under the DRG system, with the highest losses in the 85+ age group.
Conclusions:
- The current DRG payment scheme may be inequitable for elderly medical patients (71+ years).
- The system may create financial disincentives for hospitals to treat older patients.
- This inequity could potentially limit future access to care and quality for the elderly.
Abstract:
At the national level debate is growing about the effects of the diagnosis related group (DRG) hospital payment system on patient access and quality of care. Recent changes to the DRG system have dropped any stratification by age and have delayed any other major change to improve payment equity. We characterized hospital resource consumption and outcome by age for all medical admissions (N = 31,838) to a large academic medical center (January 1, 1985, through December 31, 1987) using the DRG format. Mean hospital cost per patient, hospital length of stay, percentage of outliers, and mortality increased with age. The mean DRG case-mix index and the number of diagnostic codes per patient also rose with age. The DRG payment for all patients would have produced an aggregate profit of $34,426,951 ($1081 profit per patient); however, patients aged 71 years or older generated loses (the highest with patients aged 85 years or older--a $2177 loss per patient). As the financial position of American hospitals continues to deteriorate, these data suggest that the current DRG payment scheme may be inequitable for the medical patient aged 71 years or older, thus providing financial disincentives to treat the elderly medical patient and perhaps limiting their access and quality of care in the future.