Diagnosis related groups, resource utilization, age, and outcome for hospitalized nephrology patients

Economic incentives are rapidly changing for hospitals under the prospective Diagnosis Related Group (DRG) hospital reimbursement scheme. The purpose of this project was to study resource use, age, and outcome for nephrology admissions to a large academic medical center. Total hospital costs for the 784 nephrology admissions (January 1, 1985 to December 31, 1986) were $5,037,460. Mean hospital cost per patient and mortality generally increased with age. DRG payment for patients in the 13 nephrology DRGs analyzed would have produced an aggregate loss of $483,584; however, all age categories of patients 55 years of age and over generated significant losses (the highest was for patients 85 years and above, $5,343 loss per patient). Diabetic nephrology patients generated greater resource consumption compared with nondiabetic nephrology patients, as well as patients in medical and surgical DRGs with chronic renal failure compared with patients in these same DRGs without chronic renal failure. Older nephrology patients also demonstrated higher emergency and ICU admission and blood requirements than younger patients. This study suggests that the current DRG reimbursement scheme may be inequitable vis a vis older nephrology patients, as well as those with diabetes mellitus and chronic renal failure. Financial disincentives by DRGs may affect both the access and quality of care for groups of nephrology patients in the future.