Access and quality of care for urology patients under diagnostic related group reimbursement

The Diagnostic Related Group payment mechanism is rapidly changing economic incentives for hospitals. We studied resource consumption and age for a large group of urology patients under Diagnostic Related Group reimbursement. Total hospital costs (exclusive of Diagnostic Related Group reimbursement. Total hospital costs (exclusive of physician fees) for the 1,281 urology patients studied were $8,895,264. Older urological patients consumed a disproportionately larger share of hospital resources. Mean hospital cost per patient, mean number of procedures, hospital length of stay and mortality generally increased with age. Under Diagnostic Related Group reimbursement, financial risk increased with age; patients 75 years and older generated significant financial risk to the hospital. Older patients often had a more intense resource use as measured by emergency or surgical intensive care unit admission, and blood and plasma protein requirements. These findings suggest that the current Diagnostic Related Group payment scheme may provide significant financial disincentives to hospitals vis-à-vis older urology patients and, thus, it could limit the access and quality of care for the older urology patient in the future.