Ephgrave K, Hunt J
Arch Surg. 1985 Jun;120(6):703-7. doi: 10.1001/archsurg.1985.01390300053009.
Diagnosis-related groups (DRGs) have been mandated by the federal government to promote fiscal responsibility and insure cost containment. A retrospective analysis of demographic and cost data was conducted on 115 patients operated on for pancreatic pseudocyst. The DRG 191 criteria are as follows: major pancreas, liver plus shunt procedure; mean length of stay (LOS), 20.8 days; outlier cutoff LOS, 41 days; hospital reimbursement, $11,367.82; and day outlier rate, $86.57. The overall LOS was 34.6 days (range, one to 138 days). Sixty-six percent of the patients exceeded the DRG LOS and 37% exceeded the day outlier cutoff of 41. The number of days from admission to surgery varied from one to 65 (mean, 15.7 days). Hospital charges and DRG reimbursement were compared in 23 patients. In nine patients with a LOS of 19.9 days, DRG reimbursement exceeded charges by $34,308. In 14 patients whose charges exceeded reimbursement, the loss was $142,156. Hospital costs and LOS seem to be related to the natural history of the disease and its necessary treatment, rather than to unnecessary diagnostic procedures. Unless surgeons assess and establish medical standards, economic pressures will have a negative impact on patient care and physicians' practice.
联邦政府已强制推行诊断相关分组（DRGs），以促进财政责任并确保成本控制。对115例接受胰腺假性囊肿手术的患者进行了人口统计学和成本数据的回顾性分析。DRG 191标准如下：主要涉及胰腺、肝脏加分流手术；平均住院时间（LOS）为20.8天；异常值截止住院时间为41天；医院报销金额为11,367.82美元；每日异常值费率为86.57美元。总体住院时间为34.6天（范围为1至138天）。66%的患者超过了DRG住院时间，37%的患者超过了41天的每日异常值截止时间。从入院到手术的天数从1天到65天不等（平均为15.7天）。对23例患者的医院收费和DRG报销进行了比较。在9例住院时间为19.9天的患者中，DRG报销比收费高出34,308美元。在14例收费超过报销的患者中，损失为142,156美元。医院成本和住院时间似乎与疾病的自然病程及其必要治疗相关，而非与不必要的诊断程序相关。除非外科医生评估并确立医疗标准，否则经济压力将对患者护理和医生的执业产生负面影响。
