Abstract: Diagnostic Related Group (DRG) codes are used to classify hospitalized patients into groups with predefined payments, and to control medical expenses. The National Health Insurance Administration, Ministry of Health and Welfare (NHI) has implemented 155 DRG code groups since 2010, and will complete implementation in five years. When a hospital implements this payment system, it needs to control costs. But it cannot just lower outcomes or increase staff workload because this affects service quality. In addition, it cannot discharge patients early because this incurs medical complaints or readmissions. Hospitals should study the major outcomes to refine it or to make suggestions to NHI.
This paper investigates at the expensive tests included in DRG124: cardiac catheterization with complex diagnosis. We focus on patients in 2010 and 2011 whose medical expenses are higher, and track back through their medical records to analyze data alongside their medical histories. Methods developed in this study can also be applied to other DRGs to improve performance of hospitals.
This study finds that medical expenses relate to referral source of patients, inpatient days and related expenses, principle diagnosis, and test items. Patients with heart failure, emergency admission, and ICU stays are the most costly group. For patients and hospitals, it is important to screen for related syndromes and actively control progression. For NHI, we suggest dividing this code into two DRGs according to disease type: coronary artery syndrome (4111, 4140) or heart failure (42X.*), to clearly define reasonable expenses.
Keywords: Diagnostic Related Group, cardiac catheterization, medical expense, hospitalization days, coronary artery syndrome.
Title: A MEDICAL EXPENSE STUDY OF IMPLEMENTING DRG 124 IN A REGIONAL HOSPITAL
Author: Chun-Lieh Chen, Chin-Shu Tsuan, Yaw-Jen Lin
International Journal of Healthcare Sciences
ISSN 2348-5728 (Online)
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