DRG 504: the effect of 96 hours of mechanical ventilation on resource utilization.

DRG (diagnosis related group) 504 is utilized for patients with extensive burn injuries with skin grafts along with the recent inclusion of patients with nonextensive full-thickness burns with skin grafts who require >or=4 days of mechanical ventilation. Since patients with extensive burns and/or inhalation injuries often required ventilator support, we elected to compare demographics, length of stay variables, and hospital charges for patients assigned to DRG 504 based upon the length of ventilator support. The American Burn Association's National Burn Repository was queried for all inpatients admitted from January 2000 through December 2001 and who were assigned to DRG 504. Demographic, resource utilization, and financial data were analyzed based upon the need for >or=96 hrs of mechanical ventilation. One hundred seven patients were identified of which 94 (87.9%) required >or=96 hrs of mechanical ventilation. While patients with inhalation injuries required significantly more days of ventilator support, length of stay and hospital charges were nearly identical. Patients who required >or=96 hrs of ventilator support, had a 10-fold greater number of ventilator and intensive care unit days (P < 0.0001) and twice the length of hospitalization (P < 0.005) and hospital charges (P < 0.05) for their care compared to those requiring <96 hrs of ventilator support. Burn patients requiring endotracheal intubation and >or=96 hrs of ventilator support during their acute hospitalization consume significantly greater resources than those who do not require such treatment. The Center for Medicare & Medicaid Services should consider modifying DRG 504 for patients with extensive burns to permit a more appropriate resource-based reimbursement to burn center hospitals.