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May 1989, Vol 143, No. 5 >
Article | May 1989

Pediatric Patients, Race, and DRG Prospective Hospital Payment FREE

Eric Munoz, MD, MBA; Eugenio Barrios, MS; Houston Johnson, MD; Jonathan Goldstein, MPA; Katherine Mulloy, AS; Donald Chalfin, MD; Leslie Wise, MD
[+] Author Affiliations

Accepted for publication December 22, 1988.

Reprint requests to Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, NY 11042 (Dr Munoz).


Am J Dis Child. 1989;143(5):612-616. doi:10.1001/archpedi.1989.02150170114035.
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• The diagnosis related group (DRG) prospective hospital payment system contains inequities in hospital payment for certain groups of patients. Patients of lower socioeconomic status may be underreimbursed by DRGs. We analyzed pediatric patients and hospital resource consumption by race (white, Hispanic, and black) using a DRG prospective payment "all payer" system. All hospitalized pediatric admissions over a 3-year period (N=14 489) were analyzed by race at a large academic medical center. Mean hospital length of stay and cost per patient (adjusted for DRG weight index) was significantly greater for black and Hispanic pediatric patients compared with whites. Financial risk as measured by outliers and losses under DRGs was greater for blacks and Hispanics compared with whites. Black and Hispanic patients had a higher proportion of emergency admission to the hospital compared with whites, a greater severity of illness (as measured by total International Classification of Diseases, ninth revision, Clinical Modification codes), and (on average) higher diagnostic costs for each episode of illness. Our data suggest that black and Hispanic pediatric patients have a greater hospital resource consumption (adjusted for DRG group case mix) compared with whites, at least at our large medical center in the Northeast. Hospitals that treat greater numbers of black and Hispanic pediatric patients may be at a substantial disadvantage under per-case DRG payment.

(AJDC. 1989;143:612-616)

REFERENCES

1 +
Iglehart JD.  Medicare begins prospective payment for hospitals . N Engl J Med . 1983;; 308:1428-1432.
2 +
Department of Health and Human Services,  Medicare Program: Changes to the inpatient hospital prospective payment system and fiscal year 1989 rates; proposed rule . Federal Register . (May 27) ,1988;;53:103:19497-19686.
3 +
Munoz E, Soldano R, Gross H, et al.  DRGs and the transfer of surgical patients between hospitals . Arch Surg . 1988;;123:68-71.
4 +
Feder J, Hadley J, Zuckerman S.  How did Medicare's prospective payment system affect hospitals? N Engl J Med . 1988;;317:867-873.
5 +
McCarthy CM.  DRGs: Five years later . N Engl J Med . 1988;;318:1683-1686.
6 +
Munoz E, Laughlin A, Regan DM, et al.  The financial effect of emergency room admissions under prospective payment systems . JAMA . 1985;; 254:1763-1771.
7 +
Munoz E, Soldano R, Gross H, et al.  DRGs and the transfer of surgical patients between hospitals . Arch Surg . 1988;;123;68-71.
8 +
Munoz E, Sterman H, Cohen Jr, et al.  Financial risk, hospital cost, complications and comorbidities (CCs) in surgical non-CC stratified DRGs . Ann Surg . 1988;;207:305-309.
9 +
Horn SD.  Measuring severity of illness comparisons across institutions . Am J Public Health . 1983;;73:35-31.
10 +
Epstein EM, Stern RS, Tognetti J, et al.  The association of patients socioeconomic characteristics with the length of hospital stay and hospital charges with DRGs . N Engl J Med . 1988;;318:1579-1585.
11 +
Munoz E, Regan DM, Margolis IB, et al.  Surgonomics: the identifier concept: hospital charges in general surgery and surgical specialities under prospective payment systems . Ann Surg . 1985;;202:119-125.
12 +
Munoz E. The cost dynamics of emergency hospitalized patients. Emergency Med Serv. In press.

Figures

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Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Iglehart JD.  Medicare begins prospective payment for hospitals . N Engl J Med . 1983;; 308:1428-1432.
2 +
Department of Health and Human Services,  Medicare Program: Changes to the inpatient hospital prospective payment system and fiscal year 1989 rates; proposed rule . Federal Register . (May 27) ,1988;;53:103:19497-19686.
3 +
Munoz E, Soldano R, Gross H, et al.  DRGs and the transfer of surgical patients between hospitals . Arch Surg . 1988;;123:68-71.
4 +
Feder J, Hadley J, Zuckerman S.  How did Medicare's prospective payment system affect hospitals? N Engl J Med . 1988;;317:867-873.
5 +
McCarthy CM.  DRGs: Five years later . N Engl J Med . 1988;;318:1683-1686.
6 +
Munoz E, Laughlin A, Regan DM, et al.  The financial effect of emergency room admissions under prospective payment systems . JAMA . 1985;; 254:1763-1771.
7 +
Munoz E, Soldano R, Gross H, et al.  DRGs and the transfer of surgical patients between hospitals . Arch Surg . 1988;;123;68-71.
8 +
Munoz E, Sterman H, Cohen Jr, et al.  Financial risk, hospital cost, complications and comorbidities (CCs) in surgical non-CC stratified DRGs . Ann Surg . 1988;;207:305-309.
9 +
Horn SD.  Measuring severity of illness comparisons across institutions . Am J Public Health . 1983;;73:35-31.
10 +
Epstein EM, Stern RS, Tognetti J, et al.  The association of patients socioeconomic characteristics with the length of hospital stay and hospital charges with DRGs . N Engl J Med . 1988;;318:1579-1585.
11 +
Munoz E, Regan DM, Margolis IB, et al.  Surgonomics: the identifier concept: hospital charges in general surgery and surgical specialities under prospective payment systems . Ann Surg . 1985;;202:119-125.
12 +
Munoz E. The cost dynamics of emergency hospitalized patients. Emergency Med Serv. In press.

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