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Diagnosis-related group-based reimbursement is unrealistic for ICUs
Critical Care volume 13, Article number: P485 (2009)
The objective of this study was to compare the results from a microcosting analysis of a cohort of ICU patients with the reimbursement based on existing diagnosis-related group (DRG) systems. Hence, we open the discussion on resource allocation using ICD-10 coding and its impact on intensive care.
A prospective study costing 58 consecutive admissions over a 2-month period in a mixed medical/surgical ICU. Subsequently, aligning these patient costs with the attributed costs using ICD-10 coding. Medical records in Ireland are coded using ICD-10 for diagnoses and for procedures. Experienced clinical coders assign codes, which are entered into the code mapping program (AR-DRG V5.0).
Our microcosting study demonstrated that the median daily ICU cost (IQR) was €2,205 (€1,932 to €3,073) and the median total ICU cost was €10,916 (€4,294 to €24,091). The microcosting study demonstrated that the total ICU cost for 58 admissions was €1,200,524. Reimbursement for the total hospital stay including the ICU stay based on DRGs was €782,077. During our study, use of antifungals, hemodialysis and blood products were found to be independent predictors of increased ICU cost. These frequently used intensive care treatments are not adequately costed.
Advances in intensive care diagnostics and treatment contribute to the high cost of this specialty. Current DRG-based funding fails to adequately capture and cost ICU activity, and thus underfunds intensive care. We recommend that an ICU-specific DRG coding be developed for intensive care.
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Mclaughlin, A., Hardt, J., Canavan, J. et al. Diagnosis-related group-based reimbursement is unrealistic for ICUs. Crit Care 13, P485 (2009). https://doi.org/10.1186/cc7649
- Mapping Program
- Code Mapping
- Intensive Care Treatment
- Total Hospital Stay
- Consecutive Admission