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

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

    Research output: Contribution to journalArticlepeer-review

    3 Scopus citations

    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)
    Pages (from-to)493-496
    Number of pages4
    JournalAmerican Journal of Surgery
    Volume215
    Issue number3
    DOIs
    StatePublished - Mar 2018

    Keywords

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

    ASJC Scopus subject areas

    • Surgery

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