This change was not accompanied by commensurate increases in disease severity but was associated with increased payment. The observed DRG shifts were associated with at least $1.2 billion in increased payment.Ĭonclusions and Relevance In this cohort study, between 20, the proportion of admissions assigned to a DRG with major complication or comorbidity increased for 15 of the top 20 reimbursed DRG families. Among 19 DRG families with a calculable mortality rate, the risk-adjusted mortality rate significantly decreased in 8 (42%), did not change in 9 (47%), and increased in 2 (11%). Over the same period, comorbidity scores were largely stable, with a decrease in 6 DRG families (30%), no change in 10 (50%), and an increase in 4 (20%). Within 15 of these DRG families (75%), the proportion of DRGs with a major complication or comorbidity increased significantly over time. Results Between 20, there were 62 167 976 hospitalizations for the 20 highest-reimbursed DRG families the sample was 32.9% male and 66.8% White, with a median age of 57 years (interquartile range, 31-73 years). Payment changes were estimated for each DRG by calculating the Centers for Medicare & Medicaid Services weighted payment using 20 case mix and hospitalization counts. Changes in assigned DRGs, comorbidity scores, and risk-adjusted mortality rates were analyzed by linear regression. Secondary outcomes were comorbidity scores, risk-adjusted mortality rates, and estimated payment. Main Outcomes and Measures The primary outcome was the proportion of DRGs with a major complication or comorbidity. Data were analyzed from July 10, 2018, to May 29, 2019.Įxposures Quarter year of hospitalization. Objective To examine temporal trends in DRGs with a major complication or comorbidity, compare these findings with 2 alternative measures of disease severity, and estimate associated changes in payment.ĭesign, Setting, and Participants This retrospective cohort study used data from the all-payer National Inpatient Sample for admissions assigned to 1 of the top 20 reimbursed DRG families at US acute care hospitals from January 1, 2012, to December 31, 2016. Hospitals have made substantial investment in efforts to document these complications and comorbidities. Importance Hospitals are reimbursed based on Diagnosis Related Groups (DRGs), which are defined, in part, by patients having 1 or more complications or comorbidities within a given DRG family. ![]()
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