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DRG payment for long-term ventilator patients. Implications and recommendations.

P S Douglass, R L Rosen, P W Butler

    Chest
    |March 1, 1987
    PubMed
    Summary

    The Medicare Prospective Payment System

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    Chest·1997

    Area of Science:

    • Health Economics
    • Healthcare Policy

    Background:

    • Medicare Prospective Payment System (PPS) concerns regarding patient access to care.
    • Diagnosis-Related Group (DRG) payment structure's financial implications.
    • Limited research on financial impact for chronic ventilator-dependent patients.

    Purpose of the Study:

    • To analyze the financial impact of DRG payments on chronic ventilator-dependent Medicare patients.
    • To assess potential access to care issues stemming from DRG reimbursement.

    Main Methods:

    • Retrospective analysis of 95 Medicare patients requiring continuous ventilator treatment for at least three days.
    • Calculation of payments versus costs for these patients over a one-year period.
    • Exclusion of patients with surgical intensive care unit stays.

    Main Results:

    • A total loss of $2.2 million below costs was observed for the studied patient cohort.
    • An average loss of $23,129 per discharge was calculated.
    • Patients averaged 26.6 days of stay, with 14.2 days on a ventilator.

    Conclusions:

    • The DRG system demonstrates a financial bias against chronic ventilator-dependent patients.
    • This bias may lead to significant access-to-care challenges.
    • Recommendations for DRG payment system adjustments and further large-scale analysis are proposed.

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