Potential economic impact of applying DRG-based prospective payment categories to inflammatory bowel disease patients.

New incentives regarding delivery of inpatient care by physicians and administrators have resulted from Medicare's DRG-based prospective reimbursement system. As these payment systems become widely adopted by other third-party payors, implications for adequate hospital reimbursement and quality inpatient care will intensify. This study of inflammatory bowel disease inpatients examines discharge data for 300 patients comprising 507 admissions from 1983 to 1987 at a large tertiary center hospital. While only 10.8% of these discharges were Medicare patients, all discharges were assigned a diagnosis-related-group reimbursement to derive a theoretical monetary loss or gain for the hospital. Overall hospital losses averaged $127.24 per case for this patient population, in which the medical and pediatric cases were adequately reimbursed, and the surgical admissions represented greater losses. The average length of stay for all patients decreased from 11.9 to 7.4 days over the study period, mostly a result of reductions in surgical hospital stays. We conclude that reimbursement for medical and pediatric discharges under DRG 179 appear adequate for this hospital, while surgical inflammatory bowel disease reimbursement is not. These data will be useful for comparison of future trends of inpatient utilization for inflammatory bowel disease patients as prospective reimbursement practices become more widespread.

Teaching cost containment to house officers at Charlotte Memorial Hospital.

A cost containment program initiated in 1975 on the medical teaching service of an 890-bed university affiliated hospital has led to a significant improvement in house staff utilization of facilities and procedures. During the first three and one-half years of the program the average length of stay on the general medical service was reduced by 21 percent; and the cost per admission rose at a rate of only 4.3 percent per annum, while the cost per admission on other services rose at an average rate of 14.5 percent per year. In the outpatient setting eliminating unnecessary laboratory procedures resulted in an actual reduction in patient-encounter cost initiated by interns despite price increases on all procedures. Overall cost advantage gained by reduction in utilization will rapidly be negated, however, if the current rate of inflation continues.

Practice habits in a group of eight internists.

A method was devised to offer a group of internists a system by which to analyze their practices, allowing them to identify areas where a change in practice habits might be beneficial. More than 3000 encounters between patients and internists in an eight-man group were analyzed for a number of variables. Significant differences existed between physicians as to the percentage of encounters that were physician-initiated rather than patient-initiated. Disposition of the encounters also varied significantly. The effect that the recycling of patients has on productivity, cost, and use of hospital facilities is discussed. In addition to geographic and specialty maldistribution, the maldistribution of physician time is a significant barrier to meeting the demands for medical care.