The ICD-9-CM DRGs: increased homogeneity through use of AS-SCORE.

AS-SCORE, applied to DRGs, has the potential for providing a system of case-mix measurement that will be more meaningful to physicians, nurses, and hospital administrators as they attempt to predict their patients' use of hospital resources. Urban hospitals and teaching hospitals may find such a system crucial to adequate reimbursement for the more severely ill patients they treat. The system is easily taught and gives reliable scores. The system is clinically coherent because it takes into account all of a patient's conditions and complications. When combined with a cost accounting system for nursing services, the system is sensitive to patients' nursing care requirements. Further studies should be conducted to determine the applicability of AS-SCORE to other nonhomogeneous medical and surgical groupings of the I-9 DRG system. Not all DRGs may need to be subcategorized by a severity-of-illness measure; some DRGs, for example, contain patients who are very similar, such as those who undergo tonsillectomy or normal vaginal delivery. Thus, if subcategorization by severity is not needed for all DRGs, it may be possible to use the AS-SCORE measure and, at the same time, to keep the number of groups small enough to be manageable. These studies should also be conducted in hospitals in other parts of the country to determine the replicability of the findings despite regional variations in facilities and practice methods.