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 B.
AU - Sieloff, Eric
AU - Shan, Yong
AU - Senagore, Anthony J.
N1 - Funding Information:
Researched reported in this publication was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health ( T32DK007639 ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/3
Y1 - 2018/3
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
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U2 - 10.1016/j.amjsurg.2017.09.035
DO - 10.1016/j.amjsurg.2017.09.035
M3 - Article
C2 - 29117915
AN - SCOPUS:85032837011
VL - 215
SP - 493
EP - 496
JO - American Journal of Surgery
JF - American Journal of Surgery
SN - 0002-9610
IS - 3
ER -