Archive for the ‘Medical Intensive Care’ Category

Length of Stay and Deaths
Analysis of Medicare MICU vs nonMICU indicates an average length of stay of 24.9 days for patients receiving medical intensive care compared with 9.9 days for nonMICU patients in 1985. The average number of days in the MICU was 5.4 days (22 percent of the average total stay of 24.9 days in 1984). The average number of days in the MICU in 1985 was 6.8 days (26 percent of the total average stay). In 1984, average length of stay in the MICU for Medicare patients ranged from 1.5 to 9.1 days across the five highest volume MDCs, in comparison with a range of 21.9 to 29.1 total length of stay for these groups. In 1985, the average length of stay in the MICU ranged from 3.7 to 10.2 days across the five highest volume MDCs, in comparison with a range of 13.8 to 32.5 total length of stay for these groups. Medicare MICU patients who died during their hospital stay numbered 112 in 1984 and 95 in 1985, or 42 and 39.4 percent of the total, respectively. Of these, 59 died while in the MICU in 1984 and 63 in 1985. A chi-square test gave no significant difference in mortality rate or distribution of DRG assignments, with p values of 0.56 and 0.88, respectively. Read the rest of this entry »

Impact of Diagnosis-Related Groups' Prospective Payment on Utilization of Medical Intensive Care: ResultsTable 2 summarizes the financial impact of Medicare payments for patients receiving medical intensive care. In 1984, the average projected DRG payment for the 267 Medicare patients treated in the MICU was $10,683 per discharge. The average DRG weight per discharge was 1.94, in contrast to the overall hospital case mix index for medicare patients of 1.78. Total payments (including outlier payments) of $3,230,099 vs costs of $5,845,328 resulted in a total loss of $2,615,229. Payment amounted to only 55 percent of costs. In 1985, the average projected DRG payment for 241 Medicare patients treated in MICU was $10,605 per discharge. The average DRG weight was 1.90, in contrast to overall hospital case mix index of 1.85. Total payments (including outlier payments) of $2,982,697 vs costs of $6,383,942 resulted in a net loss of $3,401,245. Payment amounted to only 47 percent of costs. Payment and costs are for all days of the hospital stay, in both the MICU and other units. Read the rest of this entry »

Estimate of Medicare Payment
The Medicare prospective payment system of DRGs was implemented for hospital fiscal years beginning on or after October 1, 1983. Medicare DRG payment rates, as outlined in the Federal Register, are determined by multiplying a base rate (which differs by hospital during the four-year prospective payment implementation) by the DRG relative weight, a measure of relative costliness for each of the 468 DRGs. Three other types of payment can be made in addition to the DRG payment rate: 1) “pass-through” costs, which include capital-related and direct educational costs, paid in a lump sum rather than on a per-case basis; 2) “indirect” educational costs, which are determined by a hospitals full-time equivalent resident-to-bed ratio applied to the Federal portion of the DRG payments; and 3) “outlier” payments, which apply to patients staying beyond the DRG-specific length of stay threshold or incurring atypieally high costs for the DRG. Read the rest of this entry »

Impact of Diagnosis-Related Groups' Prospective Payment on Utilization of Medical Intensive CareMedicare prospective payment by diagnosis-related. A groups (DRGs) has resulted in radical transformation of the health care system in the United States. It has also raised fears that DRG-induced financial losses will result in admission policies and practice styles not always in the best interest of good patient care. A recent study from Rush-Presbyterian-St. Lukes Medical Center, Chicago, revealed significant institutional financial losses by an academic medical intensive care unit. In this study, (modeled after the Rush-Presbyterian-St. Lukes study) we examined the financial impact of DRG payments for Medicare patients receiving medical intensive care at another large multispecialty tertiary care referral center. We also looked for any change in admission practices or utilization of MICU beds by admitting physicians after one years experience with DRGs. website Read the rest of this entry »