Hughes J S, Lichtenstein J, Magno L, Fetter R B
Department of Medicine, Yale University School of Medicine, New Haven, Connecticut.
Med Care. 1989 Jul;27(7):750-7.
Medicare's diagnosis related groups (DRGs) payment system has been criticized for not making adequate allowances for severity of illness differences within DRGs. The respiratory diseases major diagnostic category (MDC) has been a particular target; therefore, ability of several procedure codes that identify patients with assisted respiration (temporary tracheostomy, endotracheal intubation, and mechanical respiratory assistance) to identify high-cost patients in that MDC was examined. Total charges were used as the dependent variable in a 10% sample of Medicare hospital discharges from 1985. A consistent and strong association was found between the procedures and total charges for both Medicare "outliers" and "nonoutliers." Patients requiring either intubation or mechanical respiratory assistance had average charges two to three times higher, and patients with tracheostomy four to five times higher than charges for patients without assisted respiration. Patients with assisted respiration tended to resemble each other more than they resembled the other patients in their respective DRGs without assisted respiration. These findings provide the basis for recent revisions in Medicare's classification scheme for the respiratory diseases MDC.
医疗保险的诊断相关分组（DRGs）支付系统因未充分考虑各DRG组内疾病严重程度差异而受到批评。呼吸系统疾病主要诊断类别（MDC）一直是特别的批评对象；因此，研究了几个用于识别接受辅助呼吸患者（临时气管切开术、气管插管和机械通气辅助）的程序代码在该MDC中识别高成本患者的能力。在1985年医疗保险医院出院患者10%的样本中，总费用被用作因变量。在医疗保险的“高费用病例”和“非高费用病例”中，均发现这些程序与总费用之间存在一致且强烈的关联。需要气管插管或机械通气辅助的患者平均费用比未接受辅助呼吸的患者高出两到三倍，气管切开术患者的费用则高出四到五倍。接受辅助呼吸的患者彼此之间的相似性高于他们与各自DRG组中未接受辅助呼吸的其他患者的相似性。这些发现为医疗保险呼吸系统疾病MDC分类方案的近期修订提供了依据。
