Butler P W, Bone R C, Field T
Chest. 1985 Feb;87(2):229-34. doi: 10.1378/chest.87.2.229.
Medicare prospective payment by diagnosis-related groups (DRGs) has intensified the debate over the use and costs of medical technology. In this study, we examine the financial impact of DRG payment for medicare patients receiving medical intensive care. During a one-year period, payment for 446 Medicare patients receiving medical intensive care at a large teaching hospital was calculated to be +4.7 million below costs, representing an average loss per discharge of +10,567. Patients stayed an average of 21.6 days including an average of 5.0 days in the medical intensive-care unit--23 percent of the total stay. Twenty-eight percent of the MICU patients died during hospitalization. For this group, the average payment per discharge was projected to be +21,651 below the average per discharge cost. We conclude that the results send strong financial messages to hospitals providing medical intensive care to severely ill, elderly patients. Further exploration and research must occur to ensure hospital responses will be consistent with public policy expectations.
医疗保险按诊断相关分组（DRG）进行的前瞻性支付加剧了关于医疗技术使用和成本的争论。在本研究中，我们考察了DRG支付方式对接受医疗重症监护的医疗保险患者的财务影响。在为期一年的时间里，一家大型教学医院中446名接受医疗重症监护的医疗保险患者的支付费用经计算比成本低470万美元，这意味着每次出院平均亏损10567美元。患者平均住院21.6天，其中在医疗重症监护病房平均停留5.0天，占总住院时间的23%。28%的医疗重症监护病房患者在住院期间死亡。对于这组患者，预计每次出院的平均支付费用比每次出院的平均成本低21651美元。我们得出结论，这些结果向为重症老年患者提供医疗重症监护的医院传递了强烈的财务信息。必须进行进一步的探索和研究，以确保医院的应对措施符合公共政策预期。
