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DRG payment for long-term ventilator patients--revisited
P S Douglass1, R C Bone, R L Rosen
1Department of Corporate Planning, Rush-Presbyterian-St. Luke's Medical Center, Chicago.
Chest
|March 1, 1988
Summary
New diagnosis related groups (DRGs) offer minimal financial relief for long-term ventilator patients. The current DRG system still financially disadvantages these Medicare patients, requiring a more inclusive approach.
Area of Science:
- Health Economics
- Healthcare Policy
- Medical Billing
Background:
- The financial impact of Diagnosis Related Group (DRG) payments on long-term ventilator-dependent Medicare patients was previously evaluated.
- The Health Care Financing Administration (HCFA) introduced new DRGs for respiratory diagnoses to address resource intensity.
Purpose of the Study:
- To re-evaluate the financial impact of DRG payments for long-term ventilator-dependent patients after HCFA's revisions.
- To assess the effectiveness of the new ventilator DRGs in mitigating financial losses.
Main Methods:
- Follow-up analysis of financial data for long-term ventilator-dependent Medicare patients.
- Recalculation of patient payments based on newly established ventilator DRGs.
Main Results:
- The overall financial loss for 95 patients decreased from $2.2 million to $1.9 million, a 13% reduction.
- The newly implemented ventilator DRGs only cover a small subset of long-term ventilator-dependent patients, offering limited financial relief.
Conclusions:
- HCFA's recent actions represent a partial improvement but do not resolve the systemic financial bias against these patients.
- A proposed alternative is a single DRG for chronic respiratory failure patients requiring prolonged mechanical ventilation (≥3 days).