Joy S A, Yurt R W
Department of Surgery, Cornell University Medical College, New York, NY.
J Trauma. 1990 Jul;30(7):866-73. doi: 10.1097/00005373-199007000-00017.
To assess the financial impact of the new all-payor prospective payment system (PPS), data for 430 patients admitted to a Level I Trauma Center were compared to all hospital discharges (n = 35,309). Trauma patients had a LOS of 13.1 days, average Trauma Score of 15, and operating loss for trauma patients totalled $1,310,625. Trauma as compared to all patients showed a greater variance in LOS (6.3 vs. 2.0 days), a higher case mix index (CMI) (1.93 vs. 1.40), and a greater loss per case (-$3,404 vs. -$979), respectively. The trauma group DRG weights correlated with revenue (r = 0.89; p less than 0.0001); however, there was no relation to profit/loss. Review of trauma patients' records revealed inaccurate coding. Corrections led to an increase in reimbursement of $132,000. Five DRGs were added in 1989 for multiple significant trauma (MST). Using the 1989 grouper, 30 patients were reassigned, with an increase in reimbursement of $250,000. Although these strategies reduce operating deficit by 29%, reimbursement for trauma care must be addressed further.
为评估新的全付费方前瞻性支付系统（PPS）的财务影响，将一家一级创伤中心收治的430例患者的数据与所有医院出院患者（n = 35,309）的数据进行了比较。创伤患者的住院时间为13.1天，平均创伤评分为15分，创伤患者的运营亏损总计1,310,625美元。与所有患者相比，创伤患者的住院时间差异更大（6.3天对2.0天），病例组合指数（CMI）更高（1.93对1.40），每例亏损更大（-3,404美元对-979美元）。创伤组的诊断相关分组（DRG）权重与收入相关（r = 0.89；p小于0.0001）；然而，与利润/亏损无关。对创伤患者记录的审查发现编码不准确。更正导致报销增加了132,000美元。1989年增加了五个用于多发性严重创伤（MST）的DRG。使用1989年的分组器，重新分配了30例患者，报销增加了250,000美元。尽管这些策略使运营赤字减少了29%，但创伤护理的报销问题仍需进一步解决。
