Surgonomics: the cost of gastrointestinal hemorrhage, the identifier concept.

The Tax Equity and Fiscal Responsibility Act will pay hospitals a set price for Medicare patients by one of 467 Diagnostic Related Groups (DRGs). The purpose of this study was to examine one DRG and perform indepth financial analysis in order to develop strategies for cost containment. In addition, we tested the hypothesis that an entity called an identifier (here, the presence or absence of transfusions) could be used to group patients within a specific DRG and demonstrate differences in costs. All patients (n = 46) with gastrointestinal hemorrhage under 70 years old without complications and not requiring surgery (DRG 175) treated at the Long Island Jewish-Hillside Medical Center during 1983 had their hospital charges examined. Total charges (hospital charges exclusive of physician fees) were $3891 +/- 2128 (mean +/- SEM)/patient. Patients requiring transfusion (n = 26) had total charges of $4707 +/- 2292, whereas those not requiring transfusion (n = 20) had total charges of $2765 +/- $1300. Findings in this study are: 1) within a given DRG there is a wide variance of hospital charges, 2) identifiers (in this case transfusion) may be used to clinically aggregate patients with similar resource consumption within a DRG, 3) patients receiving transfusion had 170% greater total charges, 165% greater hematology charges, and 526% greater total blood charges than those not receiving transfusion.