DRG migration

A novel measure of inefficient surgical care in a value-based world

Byron D. Hughes, Hemalkumar Mehta, Eric Sieloff, Yong Shan, Anthony J. Senagore

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Diagnosis-Related Group (DRG) migration, DRG 331 to 330, is defined by the assignment to a higher cost DRG due only to post admission comorbidity or complications (CC). Methods: We assessed the 5% national Medicare data set (2011-2014) for colectomy (DRG's 331/330), excluding present on admission CC's and selecting patients with one or more CC's post-admission to define the impact on payments, cost, and length of stay (LOS). Results: The incidence of DRG migration was 14.2%. This was associated with statistically significant increases in payments, hospital cost, and LOS compared to DRG 331 patients. Conclusions: When DRG migration rate was extrapolated to the entire at risk population, the results were an increase of Centers for Medicare and Medicaid Services (CMS) cost by $98 million, hospital cost by $418 million, and excess hospital days equaling 68,669 days. These negative outcomes represent potentially unnecessary variations in the processes of care, and therefore a unique economic concept defining inefficient surgical care.

Original languageEnglish (US)
JournalAmerican Journal of Surgery
DOIs
StateAccepted/In press - Jul 10 2017

Fingerprint

Diagnosis-Related Groups
Hospital Costs
Costs and Cost Analysis
Length of Stay
Centers for Medicare and Medicaid Services (U.S.)
Colectomy
Medicare
Comorbidity
Economics
Incidence

Keywords

  • Colectomy
  • DRG migration
  • Medicare
  • Value-based care

ASJC Scopus subject areas

  • Surgery

Cite this

DRG migration : A novel measure of inefficient surgical care in a value-based world. / Hughes, Byron D.; Mehta, Hemalkumar; Sieloff, Eric; Shan, Yong; Senagore, Anthony J.

In: American Journal of Surgery, 10.07.2017.

Research output: Contribution to journalArticle

Hughes, Byron D. ; Mehta, Hemalkumar ; Sieloff, Eric ; Shan, Yong ; Senagore, Anthony J. / DRG migration : A novel measure of inefficient surgical care in a value-based world. In: American Journal of Surgery. 2017.
@article{23ce10a078574156af63cdb6226ce0a4,
title = "DRG migration: A novel measure of inefficient surgical care in a value-based world",
abstract = "Background: Diagnosis-Related Group (DRG) migration, DRG 331 to 330, is defined by the assignment to a higher cost DRG due only to post admission comorbidity or complications (CC). Methods: We assessed the 5{\%} national Medicare data set (2011-2014) for colectomy (DRG's 331/330), excluding present on admission CC's and selecting patients with one or more CC's post-admission to define the impact on payments, cost, and length of stay (LOS). Results: The incidence of DRG migration was 14.2{\%}. This was associated with statistically significant increases in payments, hospital cost, and LOS compared to DRG 331 patients. Conclusions: When DRG migration rate was extrapolated to the entire at risk population, the results were an increase of Centers for Medicare and Medicaid Services (CMS) cost by $98 million, hospital cost by $418 million, and excess hospital days equaling 68,669 days. These negative outcomes represent potentially unnecessary variations in the processes of care, and therefore a unique economic concept defining inefficient surgical care.",
keywords = "Colectomy, DRG migration, Medicare, Value-based care",
author = "Hughes, {Byron D.} and Hemalkumar Mehta and Eric Sieloff and Yong Shan and Senagore, {Anthony J.}",
year = "2017",
month = "7",
day = "10",
doi = "10.1016/j.amjsurg.2017.09.035",
language = "English (US)",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - DRG migration

T2 - A novel measure of inefficient surgical care in a value-based world

AU - Hughes, Byron D.

AU - Mehta, Hemalkumar

AU - Sieloff, Eric

AU - Shan, Yong

AU - Senagore, Anthony J.

PY - 2017/7/10

Y1 - 2017/7/10

N2 - Background: Diagnosis-Related Group (DRG) migration, DRG 331 to 330, is defined by the assignment to a higher cost DRG due only to post admission comorbidity or complications (CC). Methods: We assessed the 5% national Medicare data set (2011-2014) for colectomy (DRG's 331/330), excluding present on admission CC's and selecting patients with one or more CC's post-admission to define the impact on payments, cost, and length of stay (LOS). Results: The incidence of DRG migration was 14.2%. This was associated with statistically significant increases in payments, hospital cost, and LOS compared to DRG 331 patients. Conclusions: When DRG migration rate was extrapolated to the entire at risk population, the results were an increase of Centers for Medicare and Medicaid Services (CMS) cost by $98 million, hospital cost by $418 million, and excess hospital days equaling 68,669 days. These negative outcomes represent potentially unnecessary variations in the processes of care, and therefore a unique economic concept defining inefficient surgical care.

AB - Background: Diagnosis-Related Group (DRG) migration, DRG 331 to 330, is defined by the assignment to a higher cost DRG due only to post admission comorbidity or complications (CC). Methods: We assessed the 5% national Medicare data set (2011-2014) for colectomy (DRG's 331/330), excluding present on admission CC's and selecting patients with one or more CC's post-admission to define the impact on payments, cost, and length of stay (LOS). Results: The incidence of DRG migration was 14.2%. This was associated with statistically significant increases in payments, hospital cost, and LOS compared to DRG 331 patients. Conclusions: When DRG migration rate was extrapolated to the entire at risk population, the results were an increase of Centers for Medicare and Medicaid Services (CMS) cost by $98 million, hospital cost by $418 million, and excess hospital days equaling 68,669 days. These negative outcomes represent potentially unnecessary variations in the processes of care, and therefore a unique economic concept defining inefficient surgical care.

KW - Colectomy

KW - DRG migration

KW - Medicare

KW - Value-based care

UR - http://www.scopus.com/inward/record.url?scp=85032837011&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032837011&partnerID=8YFLogxK

U2 - 10.1016/j.amjsurg.2017.09.035

DO - 10.1016/j.amjsurg.2017.09.035

M3 - Article

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

ER -