The Journal of Thoracic and Cardiovascular Surgery, Vol 96, 376-381, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
The identifier concept: variables to stratify patient costs within cardiothoracic surgical diagnostic related groups
E Munoz, J Luber, L Ratner, J Goldstein, I Margolis and L Wise
Division of Cardiothoracic Surgery, Queens Hospital Center, Jamaica, N.Y.
Prospective payment systems using the diagnostic related group payment
mechanism are changing the economic incentives offered to hospitals. This
study of all cardiothoracic surgical patients (N = 1825) treated during a
2-year period at an academic medical center demonstrated that patients
within cardiothoracic diagnostic related groups could be stratified as to
resource consumption (i.e., hospital cost) by four clinical variables:
intensive care unit or emergency admission and blood and plasma product
utilization. Patients within each diagnostic related group with the
variable had higher hospital costs as follows: intensive care unit (100% of
patients had higher costs per diagnostic related group for intensive care
unit versus non-intensive care unit admissions), blood (100% of patients),
plasma product (100%), and emergency admission (92.2%). In addition,
hospital costs increased as the factors accumulated. This study
demonstrates that costs within cardiothoracic diagnostic related groups may
be grouped by four clinical parameters that occur during the patient's
hospital stay. One of these variables (i.e., emergency admission) may be
suitable to modify diagnostic related group payment. The other variables
could segment higher cost patients within a diagnostic related group; cost
containment efforts directed at these patients might then provide savings
for the hospital.
