Implications of malnutrition and diagnosis-related groups (DRGs)

The implications of malnutrition on the Medicare Prospective Payment System of diagnosis-related groups (DRGs) were examined in 185 Medicare patients, aged 65 to 69 years, admitted to an acute-care tertiary hospital. Upon admission, patients were classified as malnourished if they were below the acceptable level in at least two of four parameters: serum albumin concentration, total lymphocyte count, percent ideal body weight, and percent weight loss. On the basis of that criterion, 8.6% (no. = 16) of the 185 patients were classified as malnourished. Although patients were classified as malnourished, malnutrition was among several comorbidity and complication (CC) factors, and, therefore, coding for malnutrition in any of these cases would not have increased hospital reimbursement. If malnutrition had been the only CC factor, hospital reimbursement would have been enhanced.