Bankowitz RA, Pickens G, Neikirk HJ; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented by: Richard A. Bankowitz, M.D., M.B.A., Senior Director, Clinical Information Management, University HealthSystem Consortium, 2001 Spring Road, Suite 700, Oak Brook IL 60521. Tel: 630-954-3798; Fax: 630-954-8668; E-mail: bankowitz@uhc.edu.
Research Objective: To determine which factors predict higher resource utilization among patients within a single DRG, whether a disproportionate share of these patients is transferred to teaching hospitals, and the implications of the finding to gross margins. Study Design: Patients in DRG 1: Craniotomy non-trauma from 12 states were classified by primary diagnosis (PDX) into one of 260 AHCPR-defined diagnostic categories, one (109 Acute Cerebral Vascular Disease [ACVD]) examined at the ICD9 code level. Patients had Intracerebral bleeding ("bleed") if PDX = 430 (subarachnoid hemorrhage) or 431 (intercerebral hemorrhage), otherwise they were classified as "non-bleed". Transfer-in was defined as a patient admitted directly from another acute care facility. Inpatient costs were imputed from charges based upon hospital specific ratios of cost to charges (RCC) available from HCRIS. Hospitals were classified into one of six categories: Major Teaching [MT] (Intern and Resident to Bed Ratio [IRB] == 0.35), Minor Teaching ( 0.35 < IRB < 0.05), Non-Teaching (IRB <= 0.05), Major Teaching - Safety Net [MTSN] (IRB = 0.35 and Medicaid / Self-pay [MSP] == 0.25) Minor Teaching - Safety Net (0.35 < IRB < 0.05 and MSP == 0.25) and Non-Teaching - Safety Net (IRB < 0-.05 and MSP = 0.25) Revenues were estimated based on two models that kept total payment for all payors constant (beak even): a DRG model and a per-diem model. Gross margins were determined using institution specific costs and revenues from each model. Population Studied: DRG 1, Craniotomy non-trauma from the 1996 databases of the following states: AZ, CA, CO, FL, MA, NJ, NY, OR, PA, VA, WA, WI. Principal Findings: Sample averages: N = 51,466; cost = $ 16,897; LOS = 9.3 days; age = 49; female = 52%. In-hospital mortality rate = 6.6%. Transfers-in = 8.5%. Approx. average cost transfer-in: $28,000; non-transfer: $16,000. AHCPR diagnostic categories 109 ACVD: [n= 12,908, av. cost $24,491, av. LOS 13.0]. ICD9-CM 430 [n=4943, av. cost $34,434 av. LOS 15.5] and ICD9-CM 431 [n-= 3,177, av. cost $23,630, av. LOS 13.2. Average cost bleed: $30,145; non-bleed $14,341. Average LOS bleed: 14.6; non-bleed: 8.3. Transfers-in with bleed: 41%. MT hospitals had most transfers-in [2023],followed by Minor Teaching [753]. MT had most transfers-in with bleed [921]. Among transfer-in patients with bleed, MTSN had the highest cost per patient [$36,565] followed by MT [$33,584] Range by class = [$36,565, $25,554] The largest payor was commercial pay [n=23,557] followed by Medicaid / self [n=18,124] and Medicare [n=6,608]. The per case break-even rate was $16,987 and the per diem break-even rate was $1,818 / day. Under the per case model, MTSN hospitals had the worst margins of the six [aggregate loss of $43.5 M] followed closely by MT hospitals [aggregate loss of $36.7M] Range [($43.5M), $39.6M] Under per-diem model, MT hospitals did sharply worse [aggregate loss of $80.8M] Range [($80.8M), $39.1M). When transfers-in and bleeds were removed, MT margins under per case improved to to $90.3M , and under per diem to ($38.6M).Conclusions:. A single parameter - intercerebral bleed, served to define a significantly more resource intensive population within a "homogeneous" DRG. Major teaching hospitals admitted the highest proportion of intercerebral bleeds many through transfers. They had significantly negative gross margins compared to non-teaching hospitals under two reimbursement models. Implications for Policy, Delivery or Practice: Teaching hospitals serve a disproportionate share of complex patients, many of whom are transferred in from other acute care facilities. Payors and policy makers must consider the role of the teaching hospital in this setting. Teaching hospitals may wish to examine their contracts with payors with regard to patients transferred in from other institutions. Primary Funding Source: The University Health System Consortium
Publication Types:
Keywords:
- Academic Medical Centers
- Animals
- Antigua
- Costs and Cost Analysis
- Diagnosis-Related Groups
- Female
- Health Resources
- Hospital Mortality
- Hospitals, Teaching
- Humans
- Inpatients
- Medicaid
- Medicare
- Research
- Single Person
- economics
- hsrmtgs
Other ID:
UI: 102272505
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