Termination of Discriminatory Diagnosis Related Group Payments Is Indicated

For the sake of our nurses under far too much pressure ... For the sake of most Americans most behind that have suffered hundreds of hospital closures and untold damage to economics with significant losses of jobs, better health plans, and local leadership. To protect vulnerable populations and those remaining to serve them... For the sake of countless Americans killed by inappropriate discharges just because they had a diagnosis that resulted in discharge too soon... And for a more efficient health care design - Terminate DRG.

In the literature see Challenges and Adverse Outcomes of Implementing Reimbursement Mechanisms Based on the Diagnosis-Related Group Classification System A systematic review by Barouni,?Ahmadian,?Anari, and?Mohsenbeigi*1983 and 2017, 1,475 articles identified, 36 were relevant

Overall from the article, the most frequent challenges were increased costs (esp for severe diseases and specialised services), technical infrastructure and the complexity of the method Adverse outcomes - reduced length of patient stay, early patient discharge, decreased admissions, increased re-admissions, reduced services. Hospital inefficiency increased in all of 14 studies DRG-based mechanisms transferring costs to other sectors (12 of 13 studied) particularly elderly or rehab patients - to nursing homes and home care.

#HealthInsurance , #ThirdPartyPayments , #ReimbursementMechanisms , #DiagnosisRelatedGroups , #QualityofHealthCare , #PatientOutcomeAssessment , #SystematicReview

Overall , 15 studies (41.7% of 36) reported managerial challenges. Of these, 12 (80%) indicated that DRG-based reimbursement mechanisms were not suitable due to the high cost involved and the likelihood of financial loss, including skin care, trauma, fibrocystic disease, heart surgery, rare diseases, urology, mental, intensive care, elderly, pediatric.

Two studies (5.6%) examined environment challenges, including poor compliance with guidelines, potential loss of patients records and ---physicians being pressured to discharge patients prematurely.

Technical challenges in 9 studies (25%), particularly data coding and misclassification issues, DRG creeping (upcoding patients).

Readmission increases noted Personnel-related challenges - Learning the system, being pressured, added stresses in shorter stay, less efficient and lesser finances

My comments---

• DRG has killed hundreds of hospitals and although not all were needed, they were important contributors to the half of the nation most behind in health care dollars, workforce, and access.
• The countless losses of hospital personnel and their spouses has contributed to leadership declines in health and other areas where they are most needed.
• The losses also include better paying health insurance - for further decline by design
• There are cumulative impacts of more complex tasks to do in less time under a design with fewer team members to share the complexity load. The inevitable result is lesser team members as experienced team members have had enough - my term for this is MELTED Away team members, especially nurses.
• DRG contributes to the least experienced workforce in our history due to experienced team members driven off and massive expansions of RN and other health professionals to try to keep up flooding the workforce with higher and higher proportions that have low or no experience
• Hong Kong dumped DRG ten years ago after a short 3 year run citing many problems, particularly in hospitals with more complex patients. In these mainstream hospitals there were difficulties keeping adequate staffing levels. Notice how the US design avoided this by paying more to these larger hospitals and shaving the others not as able to protest. This of course widens disparities in a number of areas.
• Readmissions adds insult to financial injury. The closures have been small and medium size hospitals and have been specific to 2621 counties with the worst financial design and chronically lowest in health care workforce. In the graphic the outcomes and drivers of outcomes and complexities indicate the greater challenges. On the right is the raw result of top penalty at top levels multiple times higher than average and nearly 5 times the urban top penalty rate.
• Pay for performance is a really bad idea for these counties inherently behind where health care design is sending them backward.