Abstract
BackgroundDiagnostic-related groups (DRGs) are a principle type of hospital payment systems worldwide. Laparoscopic cholecystectomy (LC) is a common surgical procedure for cholelithiasis paid by DRGs. However, acute cholecystitis (AC) patients usually have heterogeneous conditions that can negatively impact the successful implementation of DRGs. We evaluated the quality and efficiency of treating AC patients under the DRG system in Taiwan.MethodsAll AC patients who underwent LC between October 2015 and December 2016 were included. Patient demographics, comorbidities, laboratory tests, AC severity, treatment outcomes and financial results were recorded and compared. Patients were reimbursed by one of the two DRG schemes based on their comorbidities or complications (CC): DRG-1, LC without CC; and DRG-2, LC with CC. Hospitals were reimbursed with the lower threshold if costs were below the lower threshold (sector A); with the outlier threshold if costs were between the lower and outlier thresholds (sector B); and with the outlier threshold plus 80% of the exceeding cost if costs were higher than the outlier threshold (sector C). The lower and outlier thresholds for DRG-1 and DRG-2 were TWD 38,716 and TWD 64,146 and TWD 39,997 and TWD 81,843, respectively (TWD = Taiwan dollars, one US dollar is approximately 30 TWD).ResultsAmong 246 patients, 114 were paid by DRG-1, and 132 were paid by DRG-2. The sex ratio and AC severity were similar between groups, but DRG-2 patients were older and had more comorbidities. In total, 195 of 246 patients (79.3%) underwent LC within one day after admission, and patients with mild AC had shorter hospital stays than those with moderate or severe AC. The complication rate was 7.3%, and there was only one mortality. In total, 105 of 114 patients in DRG-1 and 120 of 132 patients in DRG-2 fell into sector B (the profitable sector). The average margin per patient was 11,032 TWD for DRG-1 and 24,993 TWD for DRG-2.ConclusionsDRGs can be well adopted for acute care surgery. Under such a system, hospitals can still provide efficient and quality medical services without losing profit.Trial registration:None, the current study is not a clinical trail
Acute Care Surgery Billing, Coding and Documentation Series Part 3: Coding of Additional Select Procedures; Modifiers; Telemedicine Coding; Robotic Surgery
