PMID: 2498527May 1, 1989Paper

Incidence, costs, and DRG-based reimbursement for traumatic brain injured patients: a 3-year experience

The Journal of Trauma
B R BennettR J Schwartz

Abstract

A 3-year prospective study was conducted to establish the incidence of traumatic brain injury (TBI) and related characteristics of age, sex, length of stay (LOS), intensive care unit LOS (ICU/LOS), direct hospital charges, and reimbursement using a prospective DRG-based reimbursement system. The study identified TBI patients using ICD-9-Codes. The mean LOS for the two groups of patients with intracranial injury differed (p less than 0.05). Those with such an injury accompanied by a fracture stayed 1.8 days less in the ICU and 6.0 days less overall. Direct hospital charges for all TBI patients were $14,138,036 (mean, $11,645). Using Medicare weights and hospital-specific rates/DRG, the DRG reimbursement was $6,689,293. Thirty-day outliers (those who stayed ten times the geometric mean length of stay) provided an additional $526,389 leaving a total non-reimbursable figure of $6,922,354, or 49% of total charges. Of the 71 DRGs assigned to the study population, 15 reimbursed more than the actual charges. The severity of TBI victims and the complexity of caring for them in a Level I trauma center generates hospital charges of which only half are reimbursed through an all-payor DRG system. Strategies to correct what could be a financ...Continue Reading

Citations

Jan 8, 2000·The Surgical Clinics of North America·L M Jacobs
Jun 12, 2003·Computer Methods and Programs in Biomedicine·Gustav Mikkelsen, Jan Aasly
Feb 1, 1994·Brain Injury : [BI]·S L VaughnJ Sylvester
Mar 24, 1998·American Journal of Medical Quality : the Official Journal of the American College of Medical Quality·M T HalpernF G Estafanous
Feb 1, 1996·Emergency Medicine Clinics of North America·B J Zink

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brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.