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Major Small and Large Bowel Procedures: Emerging Realities With Decreasing Length of Stay and Payments - Impact on Translational Research
Pushwaz Virk*1, Charu Paranjape1, Maged K. Rizk2
1Akron General Medical Center, Akron, OH; 2Cleveland Clinic, Cleveland, OH
Background: Centers for Medicare and Medicaid Services (CMS) released hospital level Diagnosis Related Group (DRG) payment data for the first time in 2013. Two DRGs related to major bowel procedures are in the top 100. This study aims to assess trends of payments, length of stay to inform translational efforts.
Methods: Data obtained from CMS MEDPAR database between 2008 to 2011 was analyzed through descriptive statistics. Hospitals with at least 11 discharges in 2011 were included. DRG 329 is Major Small & Large Bowel Procedures With Major Complications or Comorbidities (MCC) and DRG 330 is With Complications or Comorbidities (CC). The third DRG 331 signifying procedures with No complications or comorbidities was evaluated at national level. Covered charges submitted by each hospital and reimbursements were averaged over the year.
Results: For DRG 329, there was 12.1% increase in covered charges to $7,459,191,487 from 2008 to 2011. The payments increased 6.7% to $1,618,540,466 in this time period. The total discharges in 2011 were 56,960 with average total days of stay 14.9 in 2011. Both decreased from 2008 to 59,040 and 15.6 respectively. The highest average charge was submitted by Doctors Medical Center, CA ($557,900) and lowest by Civista Medical Center, MD ($31,804). The highest average payment was to Westchester Medical Center, NY ($101,796) and lowest to Canonsburg General Hospital, PA ($20,298). Ratio of highest to lowest statewide average charge was 5.6x and for payment was 2.1x.
For DRG 330, the covered charges increased 30.5% to $4,916,170,373 in 2011 while the Medicare reimbursement fell by 3.3% $977,007,149 despite 8.6% increase in number of discharges. For DRG 330, the highest average covered charge was submitted by Regional Medical Center of San Jose, CA ($307,161), the lowest was by Morton Hospital, MA ($15,809). The highest average payment was to Contra Costa Regional Medical Center, CA ($61,218) while the lowest was to South Texas Surgical Hospital, TX (12,201). The highest average charge was in CA, NJ, NV and average payment was for AK, MD, HI. Lowest average charge was in MD, ND, VT and lowest average payment was to AL, IA, AR. Highest state average charge was 4.9x the lowest while the ratio was 1.9x for payments.
DRG 331 also saw 30.8% increase in covered charges to $1,395,635,575 but a 6.9% decrease in reimbursements. There was 8.9% increase in total number of discharges and average total stay fell by half day.
County wise average payments are displayed in attached heat maps.
Conclusion: There are significant variations in hospital charges. The Medicare payments and DRGs are falling necessitating need for translation research to address these challenges.
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