Diagnosis related groups and the transfer of general surgical patients between hospitals

This study tested the hypothesis that financial risk would be generated by surgical patients transferred to our hospital from other acute care hospitals under diagnosis related group (DRG) reimbursement. Hospital costs by DRG (exclusive of physician fees) were analyzed for all adult general surgical patients transferred to our medical center from another acute care hospital between Jan 1, 1985, and Dec 31, 1986. Transferred patients (n = 97) had significantly higher resource utilization (ie, hospital costs) than nontransferred patients (n = 2976) within the same surgical DRGs as follows: total mean cost per patient, $17,348 vs $9,460; mean length of stay 21.4 days vs 10.9 days; mean laboratory cost per patient, $1849 vs $975; and mean radiologic cost per patient, $794 vs $397. Transferred patients generated a yearly deficit of $238,717 ($4922 loss per patient) for the hospital, whereas other patients within the same DRGs generated a profit of $727,632 ($489 profit per patient). These data support the hypothesis that DRG reimbursement will provide a financial disincentive for teaching hospitals to accept surgical transfer patients from other acute care hospitals, thus potentially decreasing the access of care for the complexly ill surgical patient.