Colectomy among Fee-for-Service Medicare Enrollees Coded as DRG 330: A Potential Platform to Allow Consumer Cost Transparency?

ABSTRACT

The use of Centers for Medicare and Medicaid Services Diagnosis Related Group (CMS-DRG) codes define hospital reimbursement for Medicare beneficiaries. Our objective was to assess all patients with comorbidities on admission who were discharged in the DRG 330 category to determine the impact of postoperative complications on Medicare costs. The 5% Medicare Database was used to evaluate patients who underwent a colectomy and were coded as CMS-DRG 330. Patients were divided into two groups No surgical complications (NSC) and surgical complications (SC). Length of stay (LOS), complications, hospital charges, CMS reimbursement, discharge destination, and inpatient mortality were assessed. Statistical significance was set at p < 0.05. In total, 13,072 patients were identified. The SC group had higher inpatient mortality, a longer LOS (p < 0.0001) and was more likely to be discharged with post-acute care support (p = 0.0005). The use of CMS-DRG coding has the potential to provide Medicare fiscal intermediaries, beneficiaries, and providers with a more accurate understanding of the relative impact of their baseline health. The data further suggest that providers may benefit by more fully understanding the cost of preventive measures as a means of reducing total cost of care for this population.