The Annals of Thoracic Surgery, Vol 47, 735-740, Copyright © 1989 by The Society of Thoracic Surgeons
Hospital costs and resource characteristics for cardiothoracic surgical hospital deaths
E Munoz, J Luber, E Birnbaum, K Mulloy, JR Cohen and L Wise
Division of Cardiothoracic Surgery, Long Island Jewish Medical Center, New Hyde Park, NY 11042.
No major changes in the federal Medicare diagnostic-related group (DRG)
prospective hospital payment system have been implemented by the United
States Congress. We analyzed hospital resource consumption for 1,567
cardiothoracic surgical patients by outcome (ie, survivors versus
nonsurvivors). The 76 patients who died had a much greater intensity of
hospital resource utilization and represented a substantial financial risk
under DRG pricing schemes compared with the 1,491 survivors. Only patients
who died within 1 week of admission to the hospital generated a financial
surplus under DRGs. A long hospital stay for nonsurvivors produced a
substantial deficit (patients with a stay greater than 60 days generated a
$154,433 loss per patient). The cardiothoracic patients admitted on an
emergency basis who died tended to have a shorter length of stay and
represented a lower financial risk under DRGs compared with patients
admitted on a nonemergency basis who died. Among nonsurvivors, patients
referred for cardiothoracic surgical procedures from other clinical
services had lower resource utilization and financial risk under DRGs
compared with nonreferrals. These data suggest significant inequities in
the current DRG prospective payment system vis-a-vis cardiothoracic
surgical patients who die. Variables predictive of greater hospital
resource utilization by outcome included a longer hospital stay,
nonemergency admission, and admission directly to the cardiothoracic
surgical service. Methods to improve the equity of DRG payment vis-a-vis
cardiothoracic surgical nonsurvivors should be implemented in the future.
