Clinical Impact of DRG (Diagnosis-Related Group)-Based Physician Reimbursement

摘要

The purpose of the report is to evaluate the DRG system as a physician reimbursement tool from the clinical perspective. The 1982 Medicare data from New Jersey and North Carolina were used to model the performance of the hospital DRG system for physician reimbursement. To guide this clinical analysis of the medical DRGs, seven diagnostic areas were examined in depth (Cerebrovascular Disease, Pneumonia, Respiratory Neoplasms, Athersclerosis, Gastro Intestinal Hemmorage, Diabetes Mellitus and Red Blood Cell Disorders). The goal of each study was to address the question: What clinical factors influence physician costs for the diagnosis. Does the DRG methodology adequately capture these factors. The answer to these questions was framed along four clinical parameters as follows: definitional precision, severity of illness, discretionary resources, differences in therepeutic approach. The 1982 Medicare data were employed to address a particular clinical concern in each of the seven examples. Each analysis concluded with speculation about potential changes in physician practices should a DRG system be adopted for physician reimbursement of that particular diagnosis.