Diagnosis-related groups and the salvagable trauma patient in the intensive care unit

We reviewed 59 patients with trauma treated in the surgical intensive care unit (SICU) in 1983 comparing hospital charges with payments calculated from diagnosis-related groups (DRG). There were 37 male and 22 female patients with a mean age of 38.3 years. The mechanism of injury was blunt trauma in 42 and penetrating injury in 17 patients. The mean injury severity score (ISS) was 30.7 +/- 13.8 (mean plus or minus standard deviation). The duration of SICU care was 5.4 +/- 6.1 days. Over-all, 18 patients died. For the entire group, payment based upon a DRG system would have resulted in an over-all loss of $1,468,094.00 or $24,883.00 dollars per patient. Calculated DRG payments would have accounted for only 32.3 per cent of the total hospital charges. Calculated losses for 41 survivors would have been $1,098,431.00 dollars. Length of stay had a significant relationship to the calculated DRG payment (r = 0.69, p less than 0.001) but account for only 48 per cent of the variance. DRG only accounted for 26 per cent of the variance in charges despite a statistically significant relationship (r = 0.51, p less than 0.001). No statistically significant relationship was found between ISS and hospital charge by linear regression (r = 0.20, p greater than 0.01) or between ISS and DRG payment (r = 0.14, p less than 0.4). DRG as presently formulated would only pay one-third of total hospital charges for patients with trauma requiring SICU care. Present DRG payment schedules reflect neither the elements of care currently expended nor the modifiers necessary to adjust for acuity and severity. The ISS score would not be a useful modifier to correct DRG payment in this high cost group.