Schwab C W, Young G, Civil I, Ross S E, Talucci R, Rosenberg L, Shaikh K, O'Malley K, Camishion R C
Department of Surgery, UMDNJ-Robert Wood Johnson Medical School, Camden.
J Trauma. 1988 Jul;28(7):939-46.
All institutional reimbursement for inpatient care in the State of New Jersey is administered by the DRG methodology (Prospective Payment System). This system is essentially identical to federal Medicare. In 1983 our hospital was designated the Level I trauma center for southern New Jersey (population, 2.6 million). Prehospital triage guidelines based on anatomic injury were implemented, and, as a result, an annual 30% increase in severe trauma cases (ISS greater than 16) was realized. In late 1984 serious financial shortfalls were noticed, especially in the higher ISS cases. A 1-year study (1985) of all patients admitted through the Trauma Center to an intensive care unit was completed (523 patients; mean ISS, 15.16; ISS greater than 16, 37.8%). All patients were stratified to one of five ISS groups (A: ISS 1-8; B: ISS 9-15; C: ISS 16-24; D: ISS 25-40; E: ISS greater than 40). Average cost, reimbursement, ISS, LOS, and mortality were reviewed for the entire aggregate and each severity group. The system of ISS grouping was an accurate method of cost analysis, and prospectively, ISS grouping allowed prediction of length of stay and total hospital cost. In addition, these data allowed early fiscal management decisions and resource allocation. As a reimbursement system, DRG falls short of the cost of care for all ISS levels and groups. As severity of injury rose, costs increased in a linear manner, but reimbursement did not, resulting in a substantial financial loss. The net loss to the hospital in 1 year was $1.86 million.(ABSTRACT TRUNCATED AT 250 WORDS)
新泽西州所有住院护理的机构报销均采用诊断相关分组方法（前瞻性支付系统）进行管理。该系统与联邦医疗保险基本相同。1983年，我院被指定为新泽西州南部（人口260万）的一级创伤中心。基于解剖损伤的院前分诊指南得以实施，结果，严重创伤病例（损伤严重度评分大于16）每年增加30%。1984年末，出现了严重的资金短缺，尤其是在损伤严重度评分较高的病例中。1985年，完成了一项针对通过创伤中心收治到重症监护病房的所有患者的为期一年的研究（523例患者；平均损伤严重度评分15.16；损伤严重度评分大于16的患者占37.8%）。所有患者被分为五个损伤严重度评分组之一（A组：损伤严重度评分1 - 8；B组：损伤严重度评分9 - 15；C组：损伤严重度评分16 - 24；D组：损伤严重度评分25 - 40；E组：损伤严重度评分大于40）。对整个总体以及每个严重程度组的平均成本、报销金额、损伤严重度评分、住院时长和死亡率进行了审查。损伤严重度评分分组系统是一种准确的成本分析方法，并且前瞻性地看，损伤严重度评分分组能够预测住院时长和医院总成本。此外，这些数据有助于早期的财务管理决策和资源分配。作为一种报销系统，诊断相关分组无法满足所有损伤严重度评分水平和组别的护理成本。随着损伤严重程度的增加，成本呈线性上升，但报销金额却没有，导致了巨大的财务损失。该医院一年的净损失为186万美元。（摘要截取自250字）
