Abstract
In response to concerns over the equity of diagnosis-related group (DRG)-based prospective payment, the New Jersey Department of Health conducted a Severity of Illness evaluation study in which severity of illness, DRG, and uniform cost information were collected for 76,798 patients in 25 hospitals. Severity of illness was measured using the Computerized Severity Index (CSI) and was found to be a significant determinant of hospital cost in 76 DRGs that accounted for 41.4 percent of the total direct hospital patient care costs and 27 percent of the patients. The addition of CSI severity levels to the 76 DRGs reduced the coefficient of variation of cost in these DRGs by 17.4 percent and improved the overall reduction in variance of cost within the 76 DRGs by 38.2 percent. The change in total hospital payments due to the addition of severity for the 76 DRGs varied from a positive 5.71 percent to a negative 5.48 percent. These results demonstrate that a severity adjustment to this subset of DRGs would result in a more equitable DRG-based prospective payment system.
Full text
PDF



















Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Ament R. P., Dreachslin J. L., Kobrinski E. J., Wood W. R. Three case-type classifications: suitability for use in reimbursing hospitals. Med Care. 1982 May;20(5):460–467. doi: 10.1097/00005650-198205000-00003. [DOI] [PubMed] [Google Scholar]
- Calore K. A., Iezzoni L. Disease staging and PMCs. Can they improve DRGs? Med Care. 1987 Aug;25(8):724–737. doi: 10.1097/00005650-198708000-00006. [DOI] [PubMed] [Google Scholar]
- Coulton C. J., McClish D., Doremus H., Powell S., Smookler S., Jackson D. L. Implications of DRG payments for medical intensive care. Med Care. 1985 Aug;23(8):977–985. doi: 10.1097/00005650-198508000-00005. [DOI] [PubMed] [Google Scholar]
- Horn S. D., Buckle J. M. Severity indices: potential uses in quality measurement. Top Health Rec Manage. 1989 Dec;10(2):45–55. [PubMed] [Google Scholar]
- Horn S. D., Horn R. A., Sharkey P. D., Chambers A. F. Severity of illness within DRGs. Homogeneity study. Med Care. 1986 Mar;24(3):225–235. doi: 10.1097/00005650-198603000-00005. [DOI] [PubMed] [Google Scholar]
- Horn S. D., Horn R. A., Sharkey P. D. The Severity of Illness Index as a severity adjustment to diagnosis-related groups. Health Care Financ Rev. 1984;Suppl:33–45. [PMC free article] [PubMed] [Google Scholar]
- Horn S. D. Measuring severity of illness: comparisons across institutions. Am J Public Health. 1983 Jan;73(1):25–31. doi: 10.2105/ajph.73.1.25. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Horn S. D., Sharkey P. D., Buckle J. M., Backofen J. E., Averill R. F., Horn R. A. The relationship between severity of illness and hospital length of stay and mortality. Med Care. 1991 Apr;29(4):305–317. doi: 10.1097/00005650-199104000-00001. [DOI] [PubMed] [Google Scholar]
- Iezzoni L. I., Ash A. S., Cobb J. L., Moskowitz M. A. Admission MedisGroups score and the cost of hospitalizations. Med Care. 1988 Nov;26(11):1068–1080. doi: 10.1097/00005650-198811000-00005. [DOI] [PubMed] [Google Scholar]
- Iezzoni L. I., Ash A. S., Coffman G. A., Moskowitz M. A. Admission and mid-stay MedisGroups scores as predictors of hospitalization charges. Med Care. 1991 Mar;29(3):210–220. doi: 10.1097/00005650-199103000-00003. [DOI] [PubMed] [Google Scholar]
- Iezzoni L. I., Restuccia J. D., Shwartz M., Schaumburg D., Coffman G. A., Kreger B. E., Butterly J. R., Selker H. P. The utility of severity of illness information in assessing the quality of hospital care. The role of the clinical trajectory. Med Care. 1992 May;30(5):428–444. doi: 10.1097/00005650-199205000-00005. [DOI] [PubMed] [Google Scholar]
- Jencks S. F., Dobson A. Refining case-mix adjustment. The research evidence. N Engl J Med. 1987 Sep 10;317(11):679–686. doi: 10.1056/NEJM198709103171106. [DOI] [PubMed] [Google Scholar]
