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Background: American hospitals are required to provide price transparency data (known as a chargemaster) for medical services, which is intended to allow consumers to accurately estimate the cost of medical services. Our purpose was to identify hospital compliance in publishing chargemaster documents and to assess the price information published for common upper-extremity services and procedures. Methods: We performed a cross-sectional analysis of publicly available chargemaster data from 122 hospitals, which included the top-20-ranked Honor Roll hospitals from US News and World Report and 2 top-ranked hospitals from each state. Chargemaster files were accessed for each hospital, and price information was recorded for 10 common upper-extremity procedures including radiographs, injections, and surgeries. Mean procedural prices were compared between academic and nonacademic hospitals. Results: Chargemaster files were able to be accessed for 107 (88%) of 122 institutions. Price estimates for imaging studies were more frequently reported (73%) than those of procedures (23%-41%). With 50 hospitals reporting a price estimate, carpal tunnel injection was the most frequently reported procedure, whereas trigger finger release was the least frequently reported (41% and 23%, respectively). Wide price ranges were noted, with mean charges for a total shoulder arthroplasty listed as US $51 723 (range, US $247-US $364 024). Mean prices between academic and nonacademic hospital systems were similar. Conclusions: While most (88%) of the included hospitals have been compliant with publishing their price transparency files, price estimates for common upper-extremity procedures and imaging studies are inconsistently reported and, when present, demonstrate high levels of price variability between and within hospital systems. [ABSTRACT FROM AUTHOR]

Adverse events (AEs) are a significant concern for healthcare systems. However, it is difficult to evaluate their influence because of the complexity of various medical services. This study aimed to assess the influence of AEs on the outcomes of hospitalized patients using a diagnosis-related group (DRG) database. We conducted a case–control study of hospitalized patients at a multi-district tertiary hospital with 2200 beds in China, using data from a DRG database. An AE refers to an unintended physical injury caused or contributed to by medical care that requires additional hospitalization, monitoring, treatment, or even death. Relative weight (RW), a specific indicator of DRG, was used to measure the difficulty of diagnosis and treatment, disease severity, and medical resources utilized. The primary outcomes were hospital length of stay (LOS) and hospitalization costs. The secondary outcome was discharge to home. This study applied DRG-based matching, Hodges–Lehmann estimate, regression analysis, and subgroup analysis to evaluate the influence of AEs on outcomes. Two sensitivity analyses by excluding short LOS and changing adjustment factors were performed to assess the robustness of the results. We identified 2690 hospitalized patients who had been divided into 329 DRGs, including 1345 patients who experienced AEs (case group) and 1345 DRG-matched normal controls. The Hodges–Lehmann estimate and generalized linear regression analysis showed AEs led to prolonged LOS (unadjusted difference, 7 days, 95% confidence interval [CI] 6–8 days; adjusted difference, 8.31 days, 95% CI 7.16–9.52 days) and excess hospitalization costs (unadjusted difference, $2186.40, 95% CI: $1836.87-$2559.16; adjusted difference, $2822.67, 95% CI: $2351.25-$3334.88). Logistic regression analysis showed AEs were associated with lower odds of discharge to home (unadjusted odds ratio [OR] 0.66, 95% CI 0.54–0.82; adjusted OR 0.75, 95% CI 0.61–0.93). The subgroup analyses showed that the results for each subgroup were largely consistent. LOS and hospitalization costs increased significantly after AEs in complex diseases (RW ≥ 2) and in relation to high degrees of harm subgroups (moderate harm and above groups). Similar results were obtained in sensitivity analyses. The burden of AEs, especially those related to complex diseases and severe harm, is significant in China. The DRG database serves as a valuable source of information that can be utilized for the evaluation and management of AEs. [ABSTRACT FROM AUTHOR]

Background. A wide range of endosurgical treatment methods in various medical care profiles and the need for uniformity of calculations required developing a unified approach to the formation of diagnosis-related groups (DRGs) for cases of surgical medical care provided by laparoscopic access.Objective: to develop a methodology for the formation of a DRG model for cases of medical care using surgery performed by laparoscopic access in the context of the following medical care profiles: “coloproctology”, “urology”, “surgery (abdominal)”, “obstetrics and gynecology”, “pediatric urology-andrology”, “pediatric surgery”.Material and methods. The methodology for the formation of DRGs to pay for cases of medical care using surgery with laparoscopic access included the implementation of several stages: analysis of scientific and methodological documents, analysis of regulatory legal documents on the research topic, standardized expert survey of federal and regional medical centers (carried out in August 2023), formation of DRGs in the context of each profile, and calculation of cost-intensity coefficients.Results. Due to significant increase in the cost-intensity coefficient in nine newly formed DRGs to pay for cases of medical care provided by surgery with laparoscopic access, financial support of this type of surgical medical care almost doubled. The formed DRGs with appropriate cost-intensity coefficients were included in the Program on State Guarantees to Deliver Free Medical Care to the Citizens for 2024 and for the planning period of 2025 and 2026.Conclusion. The methodology of forming DRGs to pay for cases of medical care using surgery performed by laparoscopic access with a unified methodology for calculating costs for medical care provided an integrated approach to the process of forming DRGs for cases of surgical medical care, and unification of calculations for different medical care profiles.

Abstract Adverse events (AEs) are a significant concern for healthcare systems. However, it is difficult to evaluate their influence because of the complexity of various medical services. This study aimed to assess the influence of AEs on the outcomes of hospitalized patients using a diagnosis-related group (DRG) database. We conducted a case–control study of hospitalized patients at a multi-district tertiary hospital with 2200 beds in China, using data from a DRG database. An AE refers to an unintended physical injury caused or contributed to by medical care that requires additional hospitalization, monitoring, treatment, or even death. Relative weight (RW), a specific indicator of DRG, was used to measure the difficulty of diagnosis and treatment, disease severity, and medical resources utilized. The primary outcomes were hospital length of stay (LOS) and hospitalization costs. The secondary outcome was discharge to home. This study applied DRG-based matching, Hodges–Lehmann estimate, regression analysis, and subgroup analysis to evaluate the influence of AEs on outcomes. Two sensitivity analyses by excluding short LOS and changing adjustment factors were performed to assess the robustness of the results. We identified 2690 hospitalized patients who had been divided into 329 DRGs, including 1345 patients who experienced AEs (case group) and 1345 DRG-matched normal controls. The Hodges–Lehmann estimate and generalized linear regression analysis showed AEs led to prolonged LOS (unadjusted difference, 7 days, 95% confidence interval [CI] 6–8 days; adjusted difference, 8.31 days, 95% CI 7.16–9.52 days) and excess hospitalization costs (unadjusted difference, $2186.40, 95% CI: $1836.87-$2559.16; adjusted difference, $2822.67, 95% CI: $2351.25-$3334.88). Logistic regression analysis showed AEs were associated with lower odds of discharge to home (unadjusted odds ratio [OR] 0.66, 95% CI 0.54–0.82; adjusted OR 0.75, 95% CI 0.61–0.93). The subgroup analyses showed that the results for each subgroup were largely consistent. LOS and hospitalization costs increased significantly after AEs in complex diseases (RW ≥ 2) and in relation to high degrees of harm subgroups (moderate harm and above groups). Similar results were obtained in sensitivity analyses. The burden of AEs, especially those related to complex diseases and severe harm, is significant in China. The DRG database serves as a valuable source of information that can be utilized for the evaluation and management of AEs.

Abstract Background This study reviews the research status of Diagnosis-related groups (DRGs) payment system in China and globally by analyzing topical issues in this field and exploring the evolutionary trends of DRGs in different developmental stages. Methods Abstracts of relevant literature in the field of DRGs were extracted from the China National Knowledge Infrastructure (CNKI) database and the Web of Science (WoS) core database and used as text data. A probabilistic distribution-based Latent Dirichlet Allocation (LDA) topic model was applied to mine the text topics. Topical issues were determined by topic intensity, and the cosine similarity of the topics in adjacent stages was calculated to analyze the topic evolution trend. Results A total of 6,758 English articles and 3,321 Chinese articles were included. Foreign research on DRGs focuses on grouping optimization, implementation effects, and influencing factors, whereas research topics in China focus on grouping and payment mechanism establishment, medical cost change evaluation, medical quality control, and performance management reform exploration. Conclusions Currently, the field of DRGs in China is developing rapidly and attracting deepening research. However, the implementation depth of research in China remains insufficient compared with the in-depth research conducted abroad.

Background: This study reviews the research status of Diagnosis-related groups (DRGs) payment system in China and globally by analyzing topical issues in this field and exploring the evolutionary trends of DRGs in different developmental stages. Methods: Abstracts of relevant literature in the field of DRGs were extracted from the China National Knowledge Infrastructure (CNKI) database and the Web of Science (WoS) core database and used as text data. A probabilistic distribution-based Latent Dirichlet Allocation (LDA) topic model was applied to mine the text topics. Topical issues were determined by topic intensity, and the cosine similarity of the topics in adjacent stages was calculated to analyze the topic evolution trend. Results: A total of 6,758 English articles and 3,321 Chinese articles were included. Foreign research on DRGs focuses on grouping optimization, implementation effects, and influencing factors, whereas research topics in China focus on grouping and payment mechanism establishment, medical cost change evaluation, medical quality control, and performance management reform exploration. Conclusions: Currently, the field of DRGs in China is developing rapidly and attracting deepening research. However, the implementation depth of research in China remains insufficient compared with the in-depth research conducted abroad. [ABSTRACT FROM AUTHOR]

Aim: To examine birth characteristics that influence infant respiratory syncytial virus (RSV) hospitalisation risk in order to identify risk factors for severe RSV infections. Methods: Retrospective cohort study of 460 771 Sicilian children under 6 months old from January 2007 to December 2017. Hospital discharge records were consulted to identify cases and hospitalisations with International Classification of Diseases, Ninth Revision, Clinical Modification codes 466.11 (RSV bronchiolitis), 480.1 (RSV pneumonia) and 079.6 (RSV). RSV hospitalisation risk was estimated using adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Results: Overall, 2420 (5.25 per 1000 infants) RSV‐related hospitalisations were identified during the study, with girls accounting for 52.8%. RSV hospitalisation risk increased for full‐term, transferred, extreme immature, and preterm neonates with serious issues (aOR 3.25, 95% CI 2.90–3.64; aOR 1.86, 95% CI 1.47–2.32; aOR 1.54, 95% CI 1.11–2.07; and aOR 1.48, 95% CI 1.14–1.90). Compared to children born in June, the risk of RSV hospitalisation was significantly higher in children born in January (aOR 28.09, 95% CI 17.68–48.24) and December (aOR 27.36, 95% CI 17.21–46.99). Conclusion: This study identified birth month and diagnosis‐related groups as key predictors of RSV hospitalisations. This could help manage monoclonal antibody appropriateness criteria. [ABSTRACT FROM AUTHOR]

Abstract Objective According to the diagnosis-related group (DRG) requirement, issues of diagnosis and procedure coding in the gastroenterology department of our hospital were analyzed and improvement plans were proposed to lay the foundation for effective implementation of DRGs. Methods The title page of case-history of 1600 patients admitted to the Department of Gastroenterology of this hospital from January 1, 2021 to December 31, 2021 was sampled as a data source, and the primary and other diagnostic codes, operation or procedure codes involved in the title page of case-history were categorized and statistically analyzed. Results Of the 531 cases treated with gastrointestinal endoscopy in our hospital in 2021, coding errors were identified in 66 cases and unsuccessful DRG enrollment in 35 cases, including 14 cases with incorrect coding of the primary diagnosis (8 cases with unsuccessful DRG enrollment), 37 cases with incorrect coding of the primary operation (23 cases with unsuccessful DRG enrollment), and 8 cases with incorrect coding of both the primary diagnosis and the primary operation (4 cases with unsuccessful DRG enrollment). Analysis of 66 inpatient cases with coding problems showed a total of 167 deficiencies, including 36 deficiencies in major diagnoses, 84 deficiencies in other diagnoses, and 47 deficiencies in surgery or operation coding. Conclusion The accuracy of coding of disease diagnosis and surgical operation is the basis for the smooth implementation of DRGs. The medical staff of this hospital has poor cognition of DRGs coding and fails to recognize the important role of the title page of case-history quality to DRGs system, and their attention to DRGs and knowledge base of disease classification coding should be improved. In addition, the high incidence of coding errors, especially the omission of disease diagnosis, requires increased training of physicians and nurses on clinical knowledge and requirements for DRGs medical records, thereby improving the quality of medical cases and ensuring the accuracy of DRGs information.

Objective: According to the diagnosis-related group (DRG) requirement, issues of diagnosis and procedure coding in the gastroenterology department of our hospital were analyzed and improvement plans were proposed to lay the foundation for effective implementation of DRGs. Methods: The title page of case-history of 1600 patients admitted to the Department of Gastroenterology of this hospital from January 1, 2021 to December 31, 2021 was sampled as a data source, and the primary and other diagnostic codes, operation or procedure codes involved in the title page of case-history were categorized and statistically analyzed. Results: Of the 531 cases treated with gastrointestinal endoscopy in our hospital in 2021, coding errors were identified in 66 cases and unsuccessful DRG enrollment in 35 cases, including 14 cases with incorrect coding of the primary diagnosis (8 cases with unsuccessful DRG enrollment), 37 cases with incorrect coding of the primary operation (23 cases with unsuccessful DRG enrollment), and 8 cases with incorrect coding of both the primary diagnosis and the primary operation (4 cases with unsuccessful DRG enrollment). Analysis of 66 inpatient cases with coding problems showed a total of 167 deficiencies, including 36 deficiencies in major diagnoses, 84 deficiencies in other diagnoses, and 47 deficiencies in surgery or operation coding. Conclusion: The accuracy of coding of disease diagnosis and surgical operation is the basis for the smooth implementation of DRGs. The medical staff of this hospital has poor cognition of DRGs coding and fails to recognize the important role of the title page of case-history quality to DRGs system, and their attention to DRGs and knowledge base of disease classification coding should be improved. In addition, the high incidence of coding errors, especially the omission of disease diagnosis, requires increased training of physicians and nurses on clinical knowledge and requirements for DRGs medical records, thereby improving the quality of medical cases and ensuring the accuracy of DRGs information. [ABSTRACT FROM AUTHOR]

Background: General medicine is an integral part of health services, yet there is little data highlighting their contribution to acute hospital care in Australia. Aims: To utilise the Victorian Department of Health's administrative dataset for hospital admissions to evaluate the relative contribution and trends over time of general medical services to acute multiday inpatient hospital separations in the Victorian public healthcare system. Methods: A retrospective time‐series study of general medical activity compared to other major specialties using hospital‐level data provided by the Department of Health: (i) extrapolation from diagnosis‐related group (DRG) activity data (2011–2021) and, (ii) directly reported discharge unit‐based activity (available from 2018). Acute multiday separations of all patients aged ≥18 years from all metropolitan and rural Victorian public hospitals were included. Results: Using the DRG‐based data, general medicine ranked as the largest care provider of all specialties studied, accounting for 12.1% of separations. Despite the largest increase at a rate of 2831 separations/year (0.336%/year of total, P < 0.001) compared to others, mean length of stay declined by 0.08 days/year (P < 0.001). These findings were significant for metropolitan and rural hospitals. The use of directly reported discharge unit‐based data also ranked general medicine as the largest care provider accounting for 32.9% of total separations, with rural hospital general medical services contributing nearly 50% of all multiday separations. Conclusions: Both DRG‐based data and discharge unit‐based data indicate that general medicine is the largest provider of acute multiday inpatient care in Victorian hospitals. The estimate of contribution of general medicine differed between the two datasets as DRG data likely over‐represents the role of other specialties possibly due to assumptions regarding specialty management of varying groups of diagnoses. [ABSTRACT FROM AUTHOR]

Conversion hip arthroplasty is defined as a patient who has had prior open or arthroscopic hip surgery with or without retained hardware that is removed and replaced with arthroplasty components. Currently, it is classified under the same diagnosis-related group as primary total hip arthroplasty (THA); however, it frequently requires a higher cost of care. A retrospective study of 228 conversion THA procedures in an orthopaedic specialty hospital was performed. Propensity score matching was used to compare the study group to a cohort of 510 primary THA patients by age, body mass index, sex, and American Society of Anesthesiologists score. These matched groups were compared based on total costs, implants used, operative times, length of stay (LOS), readmissions, and complications. Conversion THA incurred 25% more mean total costs compared to primary THA (P <.05), longer lengths of surgery (154 versus 122 minutes), and hospital LOS (2.1 versus 1.56 days). A subgroup analysis showed a 57% increased cost for cephalomedullary nail conversion, 34% increased cost for sliding hip screw, 33% for acetabular open reduction and internal fixation conversion, and 10% increased costs in closed reduction and percutaneous pinning conversions (all P <.05). There were 5 intraoperative complications in the conversion group versus none in the primary THA group (P <.01), with no statistically significant difference in readmissions. Conversion THA is significantly more costly than primary THA and has longer surgical times and greater LOS. Specifically, conversion THA with retained implants had the greatest impact on cost. [ABSTRACT FROM AUTHOR]

ABSTRACT In a complex environment, the managers of hospital organizations should take hard decisions all the time. Therefore, tools and techniques, which seek to understand the past and project the future, are very important. In some situations, the complexity encountered requires the transfer of knowledge from other areas, to find solutions and develop tools that provide efficient management of resources. In this scenario, this article has the main objective to present a theoretical discussion that brings the relationship between the Theory of Real Options and the Diagnosis Related Groups, to identify possible points that underlie the use of real options in Diagnosis Related Groups. The results demonstrate that, with the patient's condition as the focus, both are applied in the hospital environment with the objective of supporting decision-making, but not together. In addition, the differences observed make the combination of some of its concepts relevant for decision-making.

Objective  Diagnosis-related groups (DRGs) are used to summarize hospital morbidity and mortality. Each DRG has a weight which is important in calculating the case mix index (CMI), a numeric summary of disease complexity in a population of patients. We utilized DRG weight and resultant CMI to compare postnatal outcomes among singletons versus monochorionic and monoamniotic, monochorionic diamniotic, and dichorionic diamniotic twins. Study Design  This single-center and retrospective cohort study evaluated DRGs assigned by the investigators, birth weight, gestational age, length of stay (LOS), NICU admission rate, and mortality in twin births between 2014 and 2016. Twins were analyzed depending on chorionicity and amnionicity. Overall, 3 months of singleton births served as the control. The CMI derived from DRG weights were compared across groups. Results  Twins (n  = 288) had lower gestational ages and birth weights and higher mortality, LOS, NICU admission rates and DRG weights/CMI compared with singletons (n  = 327; p  < 0.001 for each). The LOS was no different between twin subtypes; monochorionic monoamniotic twins had the highest mortality and DRG weight (p  < 0.001). Conclusion  DRG weight and CMI values summarize in-hospital complexity and can be a useful tool to evaluate differences in care complexity among groups of patients. Key Points Using diagnosis-related group and case mix index to assess morbidities. Morbidities of twins are monochorionic-monoamniotic versus monochorionic-diamniotic versus dichorionic-diamniotic twins. Only seven diagnosis-related group in neonatology make it a valuable tool for clinicians. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis aimed to evaluate the impact of prospective payment systems (PPSs) on cholecystectomy. A comprehensive literature review was conducted, examining studies published until December 2023. The review process focused on identifying research across major databases that reported critical outcomes such as length of stay (LOS), mortality, complications, admissions, readmissions, and costs following PPS for cholecystectomy. The studies were specifically selected for their relevance to the impact of PPS or the transition from fee-for-service (FFS) to PPS. The study analyzed six papers, with three eligible for meta-analysis, to assess the impact of the shift from FFS to PPS in laparoscopic and open cholecystectomy procedures. Our findings indicated no significant changes in LOS and mortality rates following the transition from FFS to PPS. Complication rates varied and were influenced by the diagnosis-related group categorization and surgeon cost profiles under episode-based payment. There was a slight increase in admissions and readmissions, and mixed effects on hospital costs and financial margins, suggesting varied responses to PPS for cholecystectomy procedures. The impact of PPS on cholecystectomy is nuanced and varies across different aspects of healthcare delivery. Our findings indicate a need for adaptable, patient-centered PPS models that balance economic efficiency with high-quality patient care. The study emphasizes the importance of considering specific surgical procedures and patient demographics in healthcare payment reforms.

Background Since 2010, Israel has expanded the adoption of procedure-related group (PRG) based payments for hospitals. While there is a rich quantitative literature that assesses the effects of payment reforms on efficiency or quality of care, very few qualitative studies have focused on the impacts of diagnosis-related group (DRG)-like payments on hospitals from the perspective of hospital workers as change agents. Methods We used a qualitative, thematic analysis based on 33 semi-structured in-depth interviews with chief executive officers (CEOs), chief financial officers (CFOs), ward directors and physicians conducted in five public hospitals in Israel, sampled by maximum variation according to hospital characteristics. Results Interviewees reported that the payment reform led to organizational changes such as increased transparency and enhanced supervision. Interviewees also reported several actions in response to the economic incentives of PRGbased payment. These included (1) shifting activities to afterhours and using operating rooms (ORs) more efficiently to enable increased surgical volumes; (2) reducing costs by shortening lengths of stay and increasing cost-consciousness in procurement; and (3) increasing revenues by improving coding and selecting procedures. Moderating factors reduced the effects of the reform. For example, organizational factors such as the public nature of hospitals or the (un)availability of healthcare resources did not always allow hospitals to increase the number of cases treated. Also, conflicting incentives such as multiple payment mechanisms or underpricing of procedures blurred the incentives of the reform. Finally, managers and physicians have many other considerations that outweigh the economic ones. Conclusion PRG payments affected the organizational dynamics of hospitals and changed decision-making about admission and treatment policies. However, such effects were moderated by many other factors that should be considered when shaping and analyzing hospital payment reforms.

Introduction The Inpatient Prospective Payment System, the framework for categorization of admissions, is based upon physician documentation leading to International Classification of Diseases, Tenth Revision code generation and Medical Severity Diagnosis-Related Group (MS-DRG) assignment. In this curriculum, we introduced internal medicine residents to this inpatient coding framework and its effects on hospital quality metrics and reimbursement. We focused on educating learners about the importance of physicians being proficient in providing thorough and specific clinical documentation to produce appropriate DRG assignment. Methods Internal medicine residents participated in a 90-minute session that introduced the basic framework of inpatient coding, discussed effects of physician documentation on hospital quality metrics and reimbursement, and provided tips on opportunities for documentation improvement. In an interactive learning activity, residents were presented with clinical vignettes and earned reimbursement based on their documentation of appropriate diagnoses. Each scenario was followed by clinical definitions and actionable documentation recommendations for common diagnoses. Materials included a PowerPoint presentation, clinical vignettes, sample teaching points, and a rubric to calculate estimated reimbursement. Results Prior to the session, 38% of learners were confident in their understanding of how documentation affects hospital reimbursement, which improved to 90% postsession. Learners reported improvement in their knowledge of documentation requirements for all targeted diagnoses. Discussion This interactive curriculum improved resident knowledge of the inpatient coding system and documentation requirements for common diagnoses and addressed a deficiency in residency education on a topic of significant importance for the success of hospital systems.

Background: The federal health care price transparency regulation from 2019 is aimed at bending the health care cost curve by increasing the availability of hospital pricing information for the public. Objective: This study aims to examine the associations between publicly reported diagnosis-related group chargemaster prices on the internet and quality measures, process indicators, and patient-reported experience measures. Methods: In this cross-sectional study, we collected and analyzed a random 5.02% (212/4221) stratified sample of US hospital prices in 2019 using descriptive statistics and multivariate analysis. Results: We found extreme price variation in shoppable services and significantly greater price variation for medical versus surgical services (P=.006). In addition, we found that quality indicators were positively associated with standard charges, such as mortality (β=.929; P<.001) and readmissions (β=.514; P<.001). Other quality indicators, such as the effectiveness of care (β=-.919; P<.001), efficient use of medical imaging (β=-.458; P=.001), and patient recommendation scores (β=-.414; P<.001), were negatively associated with standard charges. Conclusions: We found that hospital chargemasters display wide variations in prices for medical services and procedures and match variations in quality measures. Further work is required to investigate 100% of US hospital prices posted publicly on the internet and their relationship with quality measures. [ABSTRACT FROM AUTHOR]

Background: Inpatient healthcare demand is influenced by demographic changes; however, existing research mainly focuses on age-related conditions among older age groups and lacks empirical evidence. We aimed to identify important indicator diagnoses by group, which best characterise age-specific conditions and their demand of inpatient services in Germany. Methods: Data stem from the general hospital diagnosis-related group (DRG) statistics in Germany from 2005 to 2010. To identify the indicator diagnosis groups, we used frequency analyses of individual diagnoses and combined them into common diagnosis groups, stratified by age and gender. We identified indicator diagnoses by the highest number of cases of inpatient hospital treatments in 2010 or the largest change in cases between 2005 and 2010. The most common diagnosis groups were then ranked using different weights. Changes were quantified using linear regression. Results: Across all ages, 13 diagnosis groups were identified as frequently reported hospitalisations such as injuries to the head (S00-S09) among patients aged 0 to 17 years, and ischemic heart diseases (I20-I25) among patients aged 18 to 64 years. As the number of hospitals decreased, the demand in inpatient services increased. From 75 years and above, males were more frequently inpatients than females, and overall length of stay in hospitals appeared to decrease. Conclusion: We empirically identified 13 diagnosis groups, which best describe the inpatient services utilised among various age groups in a ranked order. Findings from this study can provide a platform for determining future demand of inpatient services as well as the demographic-specific diagnoses that need attention. [ABSTRACT FROM AUTHOR]

Background: Since 2010, Israel has expanded the adoption of procedure-related group (PRG) based payments for hospitals. While there is a rich quantitative literature that assesses the effects of payment reforms on efficiency or quality of care, very few qualitative studies have focused on the impacts of diagnosis-related group (DRG)-like payments on hospitals from the perspective of hospital workers as change agents. Methods: We used a qualitative, thematic analysis based on 33 semi-structured in-depth interviews with chief executive officers (CEOs), chief financial officers (CFOs), ward directors and physicians conducted in five public hospitals in Israel, sampled by maximum variation according to hospital characteristics. Results: Interviewees reported that the payment reform led to organizational changes such as increased transparency and enhanced supervision. Interviewees also reported several actions in response to the economic incentives of PRGbased payment. These included (1) shifting activities to afterhours and using operating rooms (ORs) more efficiently to enable increased surgical volumes; (2) reducing costs by shortening lengths of stay and increasing cost-consciousness in procurement; and (3) increasing revenues by improving coding and selecting procedures. Moderating factors reduced the effects of the reform. For example, organizational factors such as the public nature of hospitals or the (un)availability of healthcare resources did not always allow hospitals to increase the number of cases treated. Also, conflicting incentives such as multiple payment mechanisms or underpricing of procedures blurred the incentives of the reform. Finally, managers and physicians have many other considerations that outweigh the economic ones. Conclusion: PRG payments affected the organizational dynamics of hospitals and changed decision-making about admission and treatment policies. However, such effects were moderated by many other factors that should be considered when shaping and analyzing hospital payment reforms. [ABSTRACT FROM AUTHOR]

Transplant centers were challenged by the Executive Order on Advancing Kidney health to increase access to kidney transplant (KTx) by accepting higher risk patients and organs. However, Medicare reimbursement for KTx does not include adjustment for major complicating comorbidities (MCCs) like other transplants. The prevalence of MCCs was assessed for KTx performed from 10/15 to 10/19 at a single academic center, using Medicare ICD10 MCC criteria exclusive of end‐stage kidney disease. KTx hospital resource utilization and estimated margin, assuming Medicare reimbursement, were determined for cases with and without MCC. Among 260 KTx recipients, 49 (19%) had an MCC. Patients with MCCs had longer wait times (1121 days vs 703 days, P <.001); however, there were no differences in age, gender, race, or diagnosis. Donor characteristics associated with an MCC included greater cold ischemic time (1042 vs 670 minutes, P <.001) and fewer living donor KTx (9% vs 32%, P <.001). KTx cost, exclusive of organ acquisition, was 31% higher (MCC: $38 293 vs No MCC: $29 132) and estimated margin was markedly lower (‐$7750 vs ‐$1001, P =.001). In conclusion, KTx with qualifying MCCs resulted in significant financial losses and modification of KTx payment methodology to align with other organ transplants is needed. [ABSTRACT FROM AUTHOR]

Abstract Background The PRediction of short-term Outcome in preGNant wOmen with Suspected preeclampsIa Study (PROGNOSIS) demonstrated that a soluble fms-like tyrosine kinase 1/placental growth factor (sFlt-1/PlGF) ratio ≤ 38 ruled out the occurrence of preeclampsia in the next week with a negative predictive value of 99.3%; a ratio > 38 indicates an increased risk of developing preeclampsia in the next 4 weeks. We performed an assessment of the economic impact of the sFlt-1/PlGF ratio test for short-term prediction of preeclampsia in Germany. Methods We adapted a cost-effectiveness model, which had been developed to estimate the incremental value of adding the sFlt-1/PlGF ratio test with a cut-off ratio of 38 to standard diagnostic procedures for guiding the management of women with suspected preeclampsia in the UK. We used the adapted model to estimate the incremental value of the sFlt-1/PlGF ratio test (cut-off 38) for guiding the management of women with suspected preeclampsia from a German Diagnosis-Related Group (DRG) payer perspective. The economic model estimated costs associated with diagnosis and management of preeclampsia in women managed in either a ‘no-test’ scenario in which clinical decisions are based on standard diagnostic procedures alone, or a ‘test’ scenario in which the sFlt-1/PlGF test is used in addition to standard diagnostic procedures. Test characteristics and rates of hospitalization were derived from patient-level data from PROGNOSIS. The main outcome measure from the economic model was the total cost per patient. Results In the model adapted to the German DRG payer system, introduction of the sFlt-1/PlGF ratio test with a cut-off value of 38 could reduce the proportion of women hospitalized in Germany from 44.6 to 24.0%, resulting in an expected cost saving of €361 per patient. Conclusions The sFlt-1/PlGF ratio test is likely to reduce unnecessary hospitalization of women with a low risk of developing preeclampsia, and identify those at high risk to ensure appropriate management. Even within the restrictions of the DRG system in Germany, this results in substantial cost savings for women with suspected preeclampsia.

In our level-1 trauma institution, polytrauma patients with an Injury Severity Score of 16 or higher are facing waiting times for transfer to a rehabilitation facility, causing a negative financial outcome for our institution. The purpose of this study is to stimulate rapid transfer to a rehabilitation facility. In a single-centre case study, care management for (poly)trauma patients was started to ensure time-directed treatment for trauma patients related to Diagnosis-Related Groups (DRG). In the period of 2013–2018 there was an increase in trauma admissions up to 14 % (n = 16 157) with a mean length of hospital stay of 6.4 days, together with a reduction in the number of trauma bed capacity from 50 to 42. In relation to the DRGs, regular trauma patients who were not in need of a stationary rehabilitation facility stayed in line with the expected time of hospital stay. But (poly)trauma patients (n = 1831) with the need of a stationary stay in a rehabilitation centre were faced with waiting times before they could be transferred. The average excess waiting time in relation to DRG for polytrauma patients was 5.1 days. Trauma patients for a rehabilitation centre have a higher Case Mix Index (CMI) compared to those who do not require inpatient rehabilitation (4.22 versus 1.04, p <0.0001). With about 280 trauma patients annually waiting an extra 5.1 days for transfer to a rehabilitation facility, the financial burden for our department amounts to Swiss francs 885,360 without reimbursement. Since no extra bed capacities in rehabilitation facilities are available in our area, it may be advised to set up an early in-hospital trauma rehabilitation program in a level-1 trauma centre in order to reduce financial loss. [ABSTRACT FROM AUTHOR]

Abstract Background Patients with methicillin-resistant S. aureus (MRSA) are thought to incur additional costs for hospitals due to longer stay and contact isolation. The aim of this study was to assess the costs associated with MRSA in Norwegian hospitals. Methods Analyses were based on data fromSouth-Eastern Norway for the year 2012 as registered in the Norwegian Surveillance System for Communicable Diseases and the Norwegian Patient Registry. We used a matched case-control method to compare MRSA diagnosed inpatients with non-MRSA inpatients in terms of length of stay, readmissions within 30 days from discharge, as well as the Diagnosis-Related Group (DRG) based costs. Results Norwegian patients with MRSA stayed on average 8 days longer in hospital than controls, corresponding to a ratio of mean duration of 2.08 (CI 95%, 1.75–2.47) times longer.A total of 14% of MRSA positive inpatients were readmitted compared to 10% among controls. However, the risk of readmission was not significantly higher for patients with MRSA. DRG based hospital costs were 0.37 (95% CI, 0.19–0.54) times higher among cases than controls, with a mean cost of EUR13,233(SD 26,899) and EUR7198(SD 18,159) respectively. Conclusion The results of this study indicate that Norwegian patients with MRSA have longer hospital stays, and higher costs than those without MRSA.

Cristina Lucidi,1 Vincenza Di Gregorio,1 Giancarlo Ceccarelli,2 Mario Venditti,2 Oliviero Riggio,1 Manuela Merli1 1Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy; 2Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Background: Early diagnosis and appropriate treatment of infections in cirrhosis are crucial. As new guidelines in this context, particularly for health care-associated (HCA) infections, would be needed, we performed a trial documenting whether an empirical broad-spectrum antibiotic therapy is more effective than the standard one for these infections. Because of the higher daily cost of broad-spectrum than standard antibiotics, we performed a cost analysis to compare: 1) total drug costs, 2) profitability of hospital admissions. Methods: This retrospective observational analysis was performed on patients enrolled in the trial NCT01820026, in which consecutive cirrhotic patients with HCA infections were randomly assigned to a standard vs a broad-spectrum treatment. Antibiotic daily doses, days of treatment, length of hospital stay, and DRG (diagnosis-related group) were recorded from the clinical trial medical records. The profitability of hospitalizations was calculated considering DRG tariffs divided by length of hospital stay.Results: We considered 84 patients (42 for each group). The standard therapy allowed to obtain a first-line treatment cost lower than in the broad-spectrum therapy. Anyway, the latter, being related to a lower failure rate (19% vs 57.1%), resulted in cost saving in terms of cumulative antibiotic costs (first- and second-line treatments). The mean cost saving per patient for the broad-spectrum arm was €44.18 (–37.6%), with a total cost saving of about €2,000. Compared to standard group, we observed a statistically significant reduction in hospital stay from 17.8 to 11.8 days (p

This article proposes a differential game model, in order to analyze markets in which regional regulation is operative and competition is based on quality. The case we have in mind is healthcare public service, where consumers (patients) choose the provider mainly basing on the providers' location and the quality of services, while prices play a more limited role. In most European countries, within the same State, regional (or local) providers compete on quality to attract demand. Market regulation is set at national and/or regional level. Our model highlights the features of equilibrium in such a framework and specifically investigates how the differences in product quality evolve among regions and how inter-regional demand flows behave. Differently from some available similar models, that do not take into account the regional dimension of the decision process, we find that quality differentials among regions may persist in equilibrium. [ABSTRACT FROM AUTHOR]

In several countries, health care services are provided by public and/or private subjects, and they are reimbursed by the government, on the basis of regulated prices (in most countries, diagnosis-related group). Providers take prices as given and compete on quality to attract patients. In some countries, regulated prices differ across regions. This paper focuses on the interdependence between regional regulators within a country: It studies how price setters of different regions interact, in a simple but realistic framework. Specifically, we model a circular city as divided in two administrative regions. Each region has two providers and one regulator, who sets the local price. Patients are mobile and make their choice on the basis of provider location and service quality. Interregional mobility occurs in the presence of asymmetries in providers' cost efficiency, regulated prices, and service quality. We show that the optimal regulated price is higher in the region with the more efficient providers; we also show that decentralisation of price regulation implies higher expenditure but higher patients' welfare. [ABSTRACT FROM AUTHOR]

Korea introduced a new diagnosis-related group (NDRG), which is a mixed-bundle reimbursement system. We evaluated the effects of NDRGs on laboratory test quality by analyzing data over three years (2016–2018) from the Korean Association of External Quality Assessment Service (KEQAS). A total of 42 NDRG-participating hospitals (CASE), 84 non-participating similar size-hospitals (CON-1), and 42 tertiary hospitals (CON-2) were included. We assumed the proportion of KEQAS results with a larger than 2 standard deviation index (SDI) to be a bad laboratory quality marker (BLQM). CASE BLQMs were lower than CON-1 BLQMs for more than 2 years in alkaline phosphatase (ALP), alanine aminotransferase (ALT), chloride, glucose, sodium, and total protein, and higher in creatinine. CASE BLQMs were higher than CON-2 BLQMs for more than 2 years in ALP, chloride, creatinine, glucose, lactate dehydrogenase (LDH), phosphorus, potassium, sodium, total calcium, total cholesterol, triglyceride, and uric acid. Mean SDIs for general chemistry tests were not significantly different depending on NDRG participation. However, the NDRG is currently a pilot program that compensates the amount of each institution’s reimbursement based on the fee-for-service system, and most participants were public hospitals. Thus, the effects of NDRGs on laboratory test quality should be re-evaluated after the NDRG program has stabilized and more private hospitals are participating.

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Objective: To explore the impact of mandatory adoption of diagnosis-related groups (DRGs) on the use of outpatient care in Korea.Data Sources: National Health Claim data from 2,022 hospitals and 1,029,101 admission cases during 2011-2014: tonsillectomy/adenoidectomy, inguinal/femoral hernia operation, and hemorrhoidectomy.Study Design: Outcome variables included probability of outpatient visit, number of outpatient visits, and outpatient medical expenditures within 30 days. Presurgery examination before hospitalization for surgery, including basic and other examination, was conducted to evaluate a possible shift in health care service. A difference-in-difference research design was used to evaluate the impact of the DRG system on the use of outpatient care.Principal Findings: Before the introduction of the DRG system, 384,609 (91.1 percent) participants used an outpatient clinic either before or after hospitalization. In our study, the number of outpatient visits and outpatient medical expenditures within 30 days increased after mandatory adoption of the DRG system. After adoption of the DRG system, volume and costs for presurgery examinations increased before hospitalization.Conclusion: We observed a spillover effect after mandatory adoption of the DRG system. A future payment system should be designed for spillover effects, and the introduction of a new payment system that expands the DRG-based reimbursement system should be considered. [ABSTRACT FROM AUTHOR]

In order to allow a deep knowledge of the nonfatal injuries, recently the European Commission adopted the maximum abbreviated injury scale classification which is based on medical diagnosis. This classification will open the door to a new source of information based on international hospital data such as diagnosis-related group and international classification of diseases. In this study, we seek to explore these clinical metrics, which are used to describe the diagnosis and the medical treatment, and to infer consequences of crashes mainly through the costs and severity. Therefore, statistical analyses were applied using generalized linear models selected depending on the type of response variable, i.e. discrete or continuous. Relationships between these metrics were identified revealing for instance that head is the region of the body associated with high severity as well as to higher health care costs. Additionally, a discussion is presented regarding study results and future developments of clinical metrics are pointed out. [ABSTRACT FROM AUTHOR]

Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are currently grouped under the same Diagnosis-Related Group (DRG). With the introduction of bundled payments, providers are accountable for all the costs incurred during the episode of care, including the costs of readmissions and management of complications. However, it is unclear whether readmission rates and short-term complications are similar in primary THA and TKA.Methods: The National Surgical Quality Improvement Project database was queried from 2011 to 2015 to identify 248,150 primary THA/TKA procedures using Current Procedural Terminology codes. After excluding 1602 hip fractures and 5062 bilateral procedures, 94,326 THAs and 147,160 TKAs were included in the study. Length of stay, discharge disposition, and 30-day readmission, reoperation and complication rates were compared between THA and TKA using multivariate regression models.Results: After adjusting for baseline characteristics, length of stay (P = .055) and discharge disposition (P = .304) were similar between THA and TKA. But the 30-day rates of readmission (P < .001) and reoperation (P < .001) were higher in THA. Of the 18 complications evaluated in the study, 7 were higher in THA, 3 were higher in TKA, and 8 were similar between THA and TKA.Conclusion: THA patients had higher 30-day rates of readmission and reoperation. As both readmissions and reoperations can result in higher episode costs, a common target price for both THA and TKA may be inappropriate. Further studies are required to fully understand the extent of differences in the episode costs of THA and TKA. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to understand the financial ramifications of performing nonemergent inpatient and emergency department (ED) adult thyroid ultrasound studies at a US quaternary care center.Methods: A HIPAA-compliant, institutional review board-exempt retrospective review of 10,334 thyroid ultrasound studies performed between February 2012 and December 2015 was conducted. Demographic, imaging, clinical, and financial data were reviewed. Labor cost analysis was calculated using national salary data and local scheduling practices. Professional and technical reimbursement and utilization trends were compared across 149 payers, multiple time spans, and visit settings (outpatient, ED, and inpatient).Results: Most thyroid ultrasound studies were performed on outpatients (97.4% [10,069 of 10,334]), with a minority performed on inpatients (2.1% [217 of 10,334]) or in the ED (0.5% [48 of 10,334]). Man-hour cost of performing thyroid ultrasound was higher in the inpatient and ED settings ($15.30) compared with the outpatient setting ($7.65). Professional reimbursement was highest in the outpatient setting (mean, $37.39) and varied by payer (proprietary data; SD, $21.36 per examination). Technical reimbursement loss due to diagnosis-related group billing for inpatients and admitted-via-ED patients was $44,376; this was partly compensated ($9,309) by technical reimbursement from discharged-from-ED patients (mean technical reimbursement loss, $746 per month). Utilization increased year by year and correlated with Medicare volumes. Inpatient utilization was highest in Medicare patients; outpatient and ED utilization was highest for patients with private payers.Conclusions: Net revenue loss from and imaging volumes of inpatient and ED nonemergent adult thyroid ultrasound studies are low. [ABSTRACT FROM AUTHOR]

The shortage of nursing staff in Germany compromises public healthcare in deference to profits explaining why this is on the daily political and media agenda. In Germany, over a 22 year period, significant savings were achieved by decreases in: (1) hospital beds by −29.3% saving 119 000 beds, (2) patient care and treatment days by −23% saving 43.1 million patient days, and (3) length of hospital stay in days by −39% saving 4.7 days. This occurred together with the parallel increase of treated patient cases by +26.5% with an additional burden of 4.1 million patients. Since 2010, as birth rates increase again treatment cases will also increase. In parallel, the percentage of total nurses has decreased (−2.1%) as well as that of registered nurses in hospitals between 1999 (325 539) and 2009 (324 337) have decreased (−0.4%), in conjunction with nurses employed in preventive and rehabilitation facilities (+15.1%) and/or in outpatient care facilities (+41.1%) and/or nursing homes (+24.8%) and/or nurses working in retirement homes (+77.9%). This “profititis” endangers both patient care and detracts from people joining the nursing profession. It might even be a short-sighted tightrope act which, in the end, might counteract the marketing strategy of “patient safety” by risking quality of patient care. Maybe healthcare politics would be well-advised to re-think the fact that as the population gets older and as birth rates and immigration increases, these factors could result in increased patient caseloads in hospitals which need to be addressed now so as to avert a future crisis.

Background: Patients with methicillin-resistant S. aureus (MRSA) are thought to incur additional costs for hospitals due to longer stay and contact isolation. The aim of this study was to assess the costs associated with MRSA in Norwegian hospitals. Methods: Analyses were based on data fromSouth-Eastern Norway for the year 2012 as registered in the Norwegian Surveillance System for Communicable Diseases and the Norwegian Patient Registry. We used a matched case-control method to compare MRSA diagnosed inpatients with non-MRSA inpatients in terms of length of stay, readmissions within 30 days from discharge, as well as the Diagnosis-Related Group (DRG) based costs. Results: Norwegian patients with MRSA stayed on average 8 days longer in hospital than controls, corresponding to a ratio of mean duration of 2.08 (CI 95%, 1.75-2.47) times longer.A total of 14% of MRSA positive inpatients were readmitted compared to 10% among controls. However, the risk of readmission was not significantly higher for patients with MRSA. DRG based hospital costs were 0.37 (95% CI, 0.19-0.54) times higher among cases than controls, with a mean cost of EUR13,233(SD 26,899) and EUR7198(SD 18,159) respectively. Conclusion: The results of this study indicate that Norwegian patients with MRSA have longer hospital stays, and higher costs than those without MRSA. [ABSTRACT FROM AUTHOR]