Abstract
Diagnosis-related groups have been revised through more refined uses of secondary diagnoses. Under the refined diagnosis-related groups, patients are distinguished with respect to classes of secondary diagnoses that are disease- and procedure-specific. Each class represents a different level of utilization for a given principal diagnosis or surgical procedure. The refined system was evaluated with national data from the Medicare program. Estimates of hospital costs and utilization based on refined diagnosis-related groups were more precise than those based on unrefined diagnosis-related groups. This approach to diagnosis-related group refinement does not represent a radical departure from the current diagnosis- related group framework and does not require new data collection efforts. Moreover, a payment system based on the refined model is less affected by the ordering of the diagnoses than under the existing diagnosis-related group system. How the refined diagnosis-related group framework can accommodate future refinements at all levels of the classification scheme is also discussed.
Original language | English (US) |
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Pages (from-to) | 806-827 |
Number of pages | 22 |
Journal | Medical care |
Volume | 33 |
Issue number | 8 |
DOIs | |
State | Published - Aug 1995 |
Externally published | Yes |
Keywords
- Comorbidity
- Diagnosis-related group
- Prospective Payment System
- Severity of illness
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health