Colectomy among Fee-for-Service Medicare Enrollees Coded as DRG 330: A Potential Platform to Allow Consumer Cost Transparency?

The use of Centers for Medicare and Medicaid Services Diagnosis Related Group (CMS-DRG) codes define hospital reimbursement for Medicare beneficiaries. Our objective was to assess all patients with comorbidities on admission who were discharged in the DRG 330 category to determine the impact of post...

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Published inHealthcare (Basel) Vol. 8; no. 4; p. 529
Main Authors Hughes, Byron D., Sommerhalder, Christian, Sieloff, E Martin, Williams, Kari E., Tyler, Douglas S., Senagore, Anthony J.
Format Journal Article
LanguageEnglish
Published Basel MDPI AG 02.12.2020
MDPI
Subjects
Beneficiaries
Colon
colorectal
Comorbidity
Cost control
Demographics
Diagnosis related groups
DRG
DRGs
Ethnicity
Health services
Hispanic people
Hospitals
Laparoscopy
Medicare
Mortality
outcomes
Patients
Subacute care
Surgery
Surgical outcomes
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Summary:The use of Centers for Medicare and Medicaid Services Diagnosis Related Group (CMS-DRG) codes define hospital reimbursement for Medicare beneficiaries. Our objective was to assess all patients with comorbidities on admission who were discharged in the DRG 330 category to determine the impact of postoperative complications on Medicare costs. The 5% Medicare Database was used to evaluate patients who underwent a colectomy and were coded as CMS-DRG 330. Patients were divided into two groups: No surgical complications (NSC) and surgical complications (SC). Length of stay (LOS), complications, hospital charges, CMS reimbursement, discharge destination, and inpatient mortality were assessed. Statistical significance was set at p < 0.05. In total, 13,072 patients were identified. The SC group had higher inpatient mortality, a longer LOS (p < 0.0001) and was more likely to be discharged with post-acute care support (p = 0.0005). The use of CMS-DRG coding has the potential to provide Medicare fiscal intermediaries, beneficiaries, and providers with a more accurate understanding of the relative impact of their baseline health. The data further suggest that providers may benefit by more fully understanding the cost of preventive measures as a means of reducing total cost of care for this population.
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ISSN:2227-9032
2227-9032
DOI:10.3390/healthcare8040529