Significance of Applying the New Diagnosis-Related Group Payment System in Patients With Mild Traumatic Brain Injury

The new diagnosis-related group (NDRG) payment combines the original diagnosis-related group (DRG) and the fee-for-service (FFS) system, covering basic hospital services through fixed hospitalization costs based on the DRG assigned to the patient, while separate fees were applied for surgical and procedural interventions by physicians. This study aimed to evaluate the impact of payment methodology on medical costs and outcomes in patients with mild traumatic brain injury (TBI).

This retrospective study included 1,247 patients who underwent inpatient neurosurgical treatment at a single regional trauma center from January 2016 to December 2022. Since the implementation of the NDRG payment system in 2019, patients were classified into the FFS and NDRG payment groups. Outcomes were evaluated using the Extended Glasgow Outcome Scale (GOS-E) at discharge and 3 months post-traumatic event; admission days were also assessed. Total medical and out-of-pocket expenses incurred at the time of discharge were also analyzed.

The NDRG payment group demonstrated poorer results in GOS-E at discharge and 3 months post-TBI. However, the admission days were notably shorter. Out-of-pocket expenses were significantly lower in the NDRG payment group. While age, total medical expenses, and out-of-pocket expenses were significantly associated with the GOS-E at discharge, the NDRG payment did not correlate with the GOS-E at discharge. Notably, only the NDRG payment was significantly correlated with lower out-of-pocket expenses.

Implementing the NDRG payment system for patients with mild TBI does not impact total medical costs but effectively reduces out-of-pocket expenses, without adversely affecting the GOS-E.