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Related Experiment Videos

Should DRG assignment be based on age?

S I DesHarnais1, J D Chesney, S T Fleming

  • 1Research Services Department, Commission on Professional and Hospital Activities, Ann Arbor, Michigan 48106.

Medical Care
|February 1, 1988
PubMed
Summary
This summary is machine-generated.

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Medicare's Diagnosis Related Group (DRG) system inappropriately groups older patients without complications with those who have them. Age alone slightly impacts care costs, making comorbidities and complications the better classification metric.

Area of Science:

  • Health Services Research
  • Healthcare Economics
  • Medical Classification Systems

Background:

  • The current Medicare Diagnosis Related Group (DRG) system utilizes 95 pairs for patient classification.
  • One DRG in each pair includes younger patients (<70) without comorbidities or complications (CCs).
  • The other DRG includes older patients (≥70) or those with CCs.

Purpose of the Study:

  • To evaluate the appropriateness of current Medicare DRG grouping for reimbursement.
  • Specifically, to assess if patients aged 70+ without CCs should be grouped with patients who have CCs.

Main Methods:

  • Comparative analysis of DRG classification based on age and CCs.
  • Examination of length of stay and cost of care variations within DRG groups.

Related Experiment Videos

  • Statistical evaluation of within-group variance reduction.

    • Main Results:

    • Age alone, without CCs, demonstrates only a marginal increase in length of stay and care costs.
    • Excluding age and using only CCs for classification significantly reduces within-group variance.
    • The current DRG classification based on both age and CCs is less effective than using CCs alone.

    Conclusions:

    • Grouping Medicare patients aged 70+ without CCs with those who have CCs is inappropriate for reimbursement.
    • Comorbidities and complications (CCs) are more significant factors than age alone in DRG classification.
    • Revising the DRG system to prioritize CCs over age could improve accuracy and fairness in reimbursement.