Journal article
DRG Reimbursement for Trauma: The Demise of the Trauma Center (The Use of ISS Grouping as an Early Predictor of Total Hospital Cost)
The journal of trauma, v 28(7), pp 939-946
Jul 1988
PMID: 3135419
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
All institutional reimbursement for inpatient care in the State of New Jersey is administered by the DRG methodology (Prospective Payment System). This system is essentially identical to federal Medicare. In 1983 our hospital was designated the Level I trauma center for southern New Jersey (population, 2.6 million). Prehospital triage guidelines based on anatomic injury were implemented, and, as a result, an annual 30% increase in severe trauma cases (ISS > 16) was realized. In late 1984 serious financial shortfalls were noticed, especially in the higher ISS cases. A 1-year study (1985) of all patients admitted through the Trauma Center to an intensive care unit was completed (523 patients; mean ISS, 15.16; ISS > 16, 37.8%). All patients were stratified to one of five ISS groups (AISS 1–8; BISS 9–15; CISS 16–24; DISS 25–40; EISS > 40). Average cost, reimbursement, ISS, LOS, and mortality were reviewed for the entire aggregate and each severity group.The system of ISS grouping was an accurate method of cost analysis, and prospectively, ISS grouping allowed prediction of length of stay and total hospital cost. In addition, these data allowed early fiscal management decisions and resource allocation. As a reimbursement system, DRG falls short of the cost of care for all ISS levels and groups. As severity of injury rose, costs increased in a linear manner, but reimbursement did not, resulting in a substantial financial loss. The net loss to the hospital in 1 year was $1.86 million. Based on this experience, DRGʼs are not capable of supporting trauma care, and if adopted by other state agencies or third party payors, would end the concept of the trauma center.
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Details
- Title
- DRG Reimbursement for Trauma: The Demise of the Trauma Center (The Use of ISS Grouping as an Early Predictor of Total Hospital Cost)
- Creators
- C. Schwab - From the Department of Surgery, UMDNJ-Robert Wood Johnson Medical School, Camden, New Jersey, and the Cooper Hospital/University Medical Center, Camden, New JerseyGARY Young - Rowan UniversityIAN Civil - Rowan UniversitySTEVEN Ross - Rowan UniversityRAYMOND Talucci - Rowan UniversityLEROY Rosenberg - Rowan UniversityKHALEEL Shaikh - Rowan UniversityKEITH OʼMALLEYRUDOLPH Camishion - Rowan University
- Publication Details
- The journal of trauma, v 28(7), pp 939-946
- Publisher
- Williams & Wilkins
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:A1988P602900007
- Scopus ID
- 2-s2.0-0023705875
- Other Identifier
- 991021966748704721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Critical Care Medicine
- Surgery