Thomas F, Fox J, Clemmer T P, Orme J F, Vincent G M, Menlove R L
Chest. 1987 Mar;91(3):418-23. doi: 10.1378/chest.91.3.418.
To evaluate the financial effects of diagnosis-related groups, we compared 128 Medicare and 183 non-Medicare cardiac patients aeromedically evacuated to a major referral center for critical care. A significant difference (p less than 0.05) was found between Medicare patients vs non-Medicare patients for age (71 +/- 7 vs 51 +/- 9 years) and mortality (13 percent vs 6 percent). No significant difference was found for admissions to the intensive care unit (95 percent vs 95 percent), mean length of stay in intensive care (4.7 +/- 5.3 vs 3.9 +/- 5.4 days), mean length of hospitalization (9.6 +/- 7.5 vs 7.9 +/- 7.0 days), mean number of International Classification Diagnoses (ICD-9) surgical operations (0.8 +/- 1.3 vs 0.6 +/- 1.2), and mean number of ICD procedures (3.0 +/- 2.3 vs 3.3 +/- 2.1). The average cost of care ($13,427 +/- $12,700 per patient) for Medicare patients was higher but not statistically different from non-Medicare patients ($10,474 +/- $10,114 per patient). Prior cost-based Medicare payments ($10,594 +/- $9,861 per patient) have been significantly (p less than 0.01) reduced by 24 percent under the Medicare diagnosis-related group (DRG) prospective payment system ($8,024 +/- $4,824). The DRG payments are significantly less than (p less than 0.001) and provide only 60 percent of the true hospital cost required to care for Medicare cardiac patients referred for tertiary care ($13,427 +/- $12,700 per patient). A Medicare DRG system adopted by third-party payers would reduce present hospital revenues from $9,524 +/- $8,422 per patient to $7,968 +/- $4,800 per patient and would provide only 68 percent of the cost required in the care of all cardiac patients referred for tertiary care ($11,690 +/- $11,344). The results of this study indicate that hospitals that receive large numbers of seriously ill cardiac patients, especially Medicare patients, referred for critical care are at a significant financial disadvantage under the Medicare DRG system. Future economic pressures may prohibit critical care treatment centers from accepting large numbers of cardiac patients referred for intensive care and reimbursed under the current Medicare DRG payment policy.
为评估诊断相关分组的财务影响，我们比较了128名通过空中医疗转运至一家主要重症护理转诊中心的医疗保险（Medicare）患者和183名非医疗保险心脏患者。医疗保险患者与非医疗保险患者在年龄（71±7岁 vs 51±9岁）和死亡率（13% vs 6%）方面存在显著差异（p<0.05）。在重症监护病房的收治率（95% vs 95%）、重症监护的平均住院时长（4.7±5.3天 vs 3.9±5.4天）、平均住院时长（9.6±7.5天 vs 7.9±7.0天）、国际疾病分类诊断（ICD - 9）手术操作的平均数量（0.8±1.3 vs 0.6±1.2）以及ICD诊疗程序的平均数量（3.0±2.3 vs 3.3±2.1）方面未发现显著差异。医疗保险患者的平均护理成本（每位患者13,427±12,700美元）高于非医疗保险患者，但在统计学上无显著差异（每位患者10,474±10,114美元）。在医疗保险诊断相关分组（DRG）前瞻性支付系统下，基于成本的医疗保险先前支付（每位患者10,594±9,861美元）显著降低（p<0.01）了24%（降至8,024±4,824美元）。DRG支付显著低于（p<0.001）照顾转诊至三级护理的医疗保险心脏患者所需的实际医院成本（每位患者13,427±12,700美元），仅为其60%。第三方支付方采用的医疗保险DRG系统将使当前每位患者的医院收入从9,524±8,422美元降至7,968±4,800美元，并且仅能提供照顾所有转诊至三级护理的心脏患者所需成本（11,690±11,344美元）的68%。本研究结果表明，接收大量转诊至重症护理的重症心脏患者（尤其是医疗保险患者）的医院，在医疗保险DRG系统下处于显著的财务劣势。未来的经济压力可能会阻止重症护理治疗中心接收大量根据当前医疗保险DRG支付政策报销的转诊至重症护理的心脏患者。
