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Biomedical subjects

E Muñoz

Publications and source records attributed to E Muñoz.

At least 217 records · Page 12Linked to original sources
PubMed1988

Health care financing policy for hospitalized nephrology patients.

The Medicare diagnosis-related group (DRG) prospective payment system is now entering its 6th year, with no reported major adverse effects on the health status of the American people. Currently 13 states are using DRG prospective "all-payer systems" for hospital reimbursement; other state may adopt DRG all payer systems. In DRG all-payer systems, Medicare, Medicaid, Blue Cross, and other commercial insurers pay by the DRG mode; New York state has been all-payer since January 1, 1988. This study simulated DRG all-payer methods on a large sample (n = 558) of adult nephrology patients for a 2-year period using both federal and New York DRG reimbursements now in effect. Both Medicare and Medicaid patients had (on average) longer hospital lengths of stay and higher total hospital costs compared with patients from Blue Cross and other commercial payers. Medicare and Medicaid patients also had greater severity of illness than patients from Blue Cross or other payers. However, all payers (ie, Medicaid, Blue Cross, Medicare, and commercial insurers) generated significant financial risk under our DRG all-payer scheme. These data suggest that federal, state, and private payers may be underreimbursing for the care of hospitalized nephrology patients using the DRG prospective hospital payment scheme. As DRG payment rates are further reduced compared with the real hospital costs of treating patients, both the access to and the quality of care for many nephrology patients may be jeopardized.

Aged↗
PubMed1988

Hospital costs, cancer patients and medical diagnosis-related groups.

This study analyzed hospital resource consumption for 5,065 Medicare patients in 90 noncancer designated medical diagnosis-related groups (DRGs) by whether or not patients had a diagnosis of a malignancy (i.e. cancer). Patients with cancer had greater hospital resource utilization than noncancer patients in these medical DRGs. Cancer patients had a greater percentage of outliers (p less than 0.02), twice the financial loss under DRGs, more diagnoses (p less than 0.001) and procedures (p less than 0.0001) per patient, and a greater mortality (p less than 0.0001) than noncancer patients. These findings raise the question of the equity of DRG payment vis-à-vis medical cancer patients in many medical DRGs, and whether the DRG scheme may provide disincentives to treat some elderly Americans with cancer.

Costs and Cost Analysis↗
PubMed1988

Costs of pulmonary medicine and DRGS. Access and quality of care for the future.

Many changes are under way for the payment of physician and hospital care of patients in medicine and the medical subspecialties, i.e., the hospitalized pulmonary medicine patient. The purpose of this study was to characterize hospital resource consumption and outcome by age for pulmonary patients. All pulmonary medicine admissions treated at a large academic medical center from January 1, 1985 through December 31, 1986 were analyzed using the Diagnostic Related Group (DRG) format. Total costs (exclusive of physician fees) for the 2,647 pulmonary patients studied were $19,751,192. Mean hospital cost per patient, hospital length of stay, percentage of outliers, and mortality increased with age. Under the DRG reimbursement mechanism (i.e., All Payor System), a loss was incurred for all patients 45 yr of age and older, which led to an overall fiscal deficit for pulmonary medicine admissions. Medicare patients (n = 930) demonstrated a stronger expression of these trends. DRG case-mix index and the mean number of diagnoses per patient increased steadily with age. Emergency admissions were highest for the young (i.e., 18 to 35 yr of age), for some middle-aged (i.e., 45 to 65 yr of age), and for the very old (80 yr of age). Utilization of the intensive care unit and blood transfusions was higher for older patients; utilization of plasma products showed a more variable pattern, although older patients had greater consumption than their younger cohorts. This study demonstrated several trends with regard to resource utilization and age for pulmonary patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis↗
PubMed1988

Financial risk, hospital cost, and complications and comorbidities (CCs) in the non-CC-stratified pulmonary medicine diagnostic-related group Medicare hospital payment system.

The purpose of this study was to analyze hospital resource consumption in the 8 noncomplicating condition-stratified pulmonary medicine diagnostic-related groups (DRGs). We analyzed 427 Medicare patients treated during a 2-yr period in these 8 noncomplicating condition-stratified DRGs. Patients with a greater number of complicating conditions (CCs) had higher total hospital costs, a longer hospital length of stay, more procedures per patient, increasing financial risk under DRGs, a larger number of outliers, and a higher mortality than did patients in these same DRGs with a fewer number of CCs. These findings raise the question of the equity of DRG reimbursement at our hospital vis-à-vis the non-CC-stratified pulmonary medicine DRGs. If these findings are generalizable at other teaching hospitals, the current DRG system may provide financial incentives to not treat certain types of pulmonary medicine patients likely to have many CCs, and potentially effect these patient's access and quality of care in the future.

Diagnosis-Related Groups↗
PubMed1988

Neurology, age, hospital costs, and DRGs.

The DRG payment scheme is causing hospitals to examine the financial consequences of treating various patient populations. The purpose of this study was to examine resource utilization for hospitalized neurology patients treated during a 2-year period at an academic medical center. All patients (N = 1,993) were stratified by payor (Medicare, Medicaid, Blue Cross, and other) and age (0-35 years, 35-65 years, and 65 years and above). Mean hospital cost per patient (exclusive of MD fees) for each payor generally rose with age. Patients 35 years of age and over consumed a disproportionately larger share of resources than younger patients. DRG payment under an all payor system would have produced a substantial deficit for this group of patients. The mean hospital length of stay, number of diagnoses per patient, and mortality, as well as percent of admission through the emergency department generally rose with age. This study demonstrated that neurology patients 35 years of age and older generated higher resource utilization than their younger counterparts and were underpaid by the current DRG reimbursement. In this study, DRG payment appeared to provide significant financial disincentives to treat older neurology patients. If our findings are widespread, the quality of neurologic care and the elderly's access to it could become limited in the future.

Aged↗
PubMed1988

DRG prospective, "all payor systems," financial risk, and hospital cost in pulmonary medicine non CC stratified DRGs.

Previous work by our group had suggested that some pulmonary medicine diagnosis-related group (DRGs) did not adequately compensate for patients with multiple complications and comorbidities. Congress has recommended no major changes to pulmonary medicine DRGs along these lines. The purpose of this study was to analyze resource consumption in any of the seven noncomplicating conditions (CC), stratified pulmonary medicine DRGs using the new DRG prospective "all payor system" in effect at our hospital. Analysis of 858 pulmonary medicine patients by payor (Medicare, Medicaid, Blue Cross, and commercial insurance) in these non-CC stratified pulmonary medicine DRGs for a three-year period demonstrated that patients with more CCs per DRG for each payor generated higher total hospital costs, a longer hospital length of stay, a greater percentage of procedures per patient, financial risk under DRG payment, more outliers, and a higher mortality, compared to patients in these same DRGs with fewer CCs. Both hospital length of stay and total cost per patient (adjusted for DRG weight index) increased with CCs. Financial risk per patient under DRGs also increased as CCs accumulated. These findings suggest that new prospective DRG "all payor systems" may be inequitable to certain groups of patients or types of hospitals vis-a-vis the non-CC stratified pulmonary medicine DRGs. Many pulmonary medicine DRGs should be stratified by the numbers and types of CCs to more equitably reimburse hospitals under DRG all-payor systems.

Academic Medical Centers↗
PubMed1988

Hospital cost, resource use, and diagnostic related groups for gynecology patients.

The purpose of this study was to analyze hospital resource consumption by age for gynecology patients and to examine whether the assumptions made when the Diagnostic Related Groups payment was structured appear to be valid for our hospital. All gynecology admissions (N = 2232) at a large academic medical center during a 15-month period were analyzed by age using the Diagnostic Related Group format. Older patients generally consumed a disproportionately higher share of resources. Length of hospital stay, intensive care unit use, blood transfusion requirements, and overall hospital cost generally increased with age. Although mean Diagnostic Related Group reimbursement per patient also rose with age, it plateaued for patients 65 years of age and older. However, our hospital did not sustain a loss in providing care under Diagnostic Related Groups for older patients, except for the group of patients between the ages of 75-79 years. Although older gynecology patients generally had higher hospital resource consumption than younger patients, the current Diagnostic Related Group system seemed to adequately reimburse our hospital for their care.

Adolescent↗
PubMed1988

Age, resource consumption, and outcome for surgical patients at an academic medical center.

Many changes are under way in the payment for physician and hospital care of the surgical patient. Relatively little data have been analyzed on resource consumption for hospitalized surgical patients. The purpose of this study was to characterize hospital resource consumption and outcome by age for surgical patients. All surgical admissions at a large academic medical center from Jan. 1, 1985, through March 31, 1986, were analyzed by means of the diagnostic related group (DRG) format. Total costs (exclusive of physician fees) for the 7341 surgical patients studied were $58,206,815. Mean cost per patient, length of stay, percent of outliers, and mortality increased with age. DRG case-mix index and the number of procedures per patient peaked at age 69 and then decreased. Emergency admission was high for the young (i.e., aged 18 to 24 years) and for very elderly patients (i.e., aged over 75 years). Blood transfusions increased steadily as the age of the patient increased; use of surgical intensive care units increased until age 64 years, then plateaued. This study demonstrated a number of trends in surgical patient age and use of resources. Under prospective payment systems (i.e., DRG reimbursement) financial risk increased with the age of the patient. Length of hospital stay and mortality increased with age; however, DRG case-mix index and the number of procedures per patient peaked at age 69, which suggests that elderly surgical patients (i.e., those above 70 years of age) may be more severely ill on average than younger patients.

Academic Medical Centers↗
PubMed1988

DRGs, costs, and outcome for plastic surgical patients.

The purpose of this study was to analyze hospital cost, resource utilization, and outcome by age for a large group of hospitalized plastic surgical patients using the DRG format. Hospital cost per patient for all plastic surgical admissions (both inpatient and potentially ambulatory patients) treated (N = 1632) at an academic medical center increased with age and peaked for plastic surgical patients 75 to 80 years of age ($11,585 per patient). Although DRG payment would have produced an aggregate profit of $2,404,854, older plastic surgical patients (65 years of age and above) generally produced losses. Older plastic surgical patients demonstrated a longer hospital length of stay, a greater severity of illness, a higher percent of outliers, and a greater mortality than younger plastic surgical patients. In addition, older plastic surgical patients had higher clinical resource utilization based on a number of clinical parameters such as emergency admission, SICU utilization, need for blood transfusions, and need for plasma product infusions. This study suggests that the current DRG reimbursement methodology may be inequitable vis-à-vis the older plastic surgical patient. As additional pressures encourage the performance of more ambulatory procedures (previously performed as inpatients), our profit margins may decline and possibly affect our ability to provide quality plastic surgical care.

Adult↗
PubMed1988

The identifier concept: variables to stratify patient costs within cardiothoracic surgical diagnostic related groups.

Prospective payment systems using the diagnostic related group payment mechanism are changing the economic incentives offered to hospitals. This study of all cardiothoracic surgical patients (N = 1825) treated during a 2-year period at an academic medical center demonstrated that patients within cardiothoracic diagnostic related groups could be stratified as to resource consumption (i.e., hospital cost) by four clinical variables: intensive care unit or emergency admission and blood and plasma product utilization. Patients within each diagnostic related group with the variable had higher hospital costs as follows: intensive care unit (100% of patients had higher costs per diagnostic related group for intensive care unit versus non-intensive care unit admissions), blood (100% of patients), plasma product (100%), and emergency admission (92.2%). In addition, hospital costs increased as the factors accumulated. This study demonstrates that costs within cardiothoracic diagnostic related groups may be grouped by four clinical parameters that occur during the patient's hospital stay. One of these variables (i.e., emergency admission) may be suitable to modify diagnostic related group payment. The other variables could segment higher cost patients within a diagnostic related group; cost containment efforts directed at these patients might then provide savings for the hospital.

Blood Transfusion↗
PubMed1988

Financial risk and hospital cost for elderly patients in non-age stratified surgical DRGS.

Hospitals face increasing uncertainty under prospective payment systems such as Medicare's DRG system. We analyzed the equity of the DRG system for 2622 Medicare surgical patients in the 82 non-age stratified surgical DRGs. Patients age 70 and over had higher total hospital costs (P less than .05), a longer hospital length of stay, more diagnoses per patient, losses under DRG payment (P less than .01), a greater percentage of outliers (P less than .05) and higher mortality than patients in these same DRGs under 70 years of age. This data suggests that the current DRG classification scheme may be inequitable vis-a-vis older Medicare patients in the non-age stratified surgical DRGs, and could provide financial disincentives that limit both their access and quality of care in the future.

Age Factors↗
PubMed1988

The identifier concept: clinical parameters to stratify hospital patient costs for patients with hypertension.

Hospital administrators, nurses, and physicians must strive to improve efficiency as new payment systems constrain health care spending. Our purpose in this project was to confirm the hypothesis that four clinical variables (emergency or intensive care unit [ICU] admission, and blood or plasma product use) could predict hospital costs and outcome for adult patients with hypertension. We analyzed hospital costs (exclusive of physician fees) for all patients with either a primary or secondary diagnosis of hypertension (N = 4289) receiving treatment during a 2-year period at an academic medical center. In addition to predicting outcome (i.e., whether the patient lived or died), these four clinical variables predicted differences in hospital cost per patient, and financial risk per Diagnosis-Related Group (DRG) as measured by percentage of "outliers" (patients whose length of stay exceeds the cutoff point) or profit/loss per patient under DRG prospective hospital payment. The cost and predictive effect on cost and mortality of the variables were also cumulative; patients with hypertension with one variable had two times the cost of patients with no variables; patients with hypertension with two variables, 2.2 times the cost; patients with three variables, 4.3 times; and patients with four variables, 6.8 times. The mortality of patients with no variables was 0.8%; one variable, 7.7%; two variables, 12.7%; three variables, 15.7%; and four variables, 25.8%. Patients with hypertension can thus be stratified by cost and outcome by clinical events that occur during the patient's hospital stay.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Health care financing policy for hospitalized black patients.

The Medicare diagnostic-related group (DRG) prospective payment model is changing hospital payment. Currently many states are using DRG prospective "all payer systems" for hospital reimbursement. In all payer systems, Medicare, Medicaid, Blue Cross, and other commercial insurers pay by the DRG mode; New York State has had an all payer system since January 1, 1988. This study simulated DRG all payer methods on a large sample (N = 6,134) of adult black medical and surgical patients for a three-year period using both federal and New York DRG reimbursement. Both Medicare and Medicaid patients had, on average, a longer hospital stay and total hospital cost compared with patients covered by Blue Cross and other commercial insurers. Medicare and Medicaid patients also had a greater severity of illness compared with those of Blue Cross and others. All insurers (ie, Medicaid, Blue Cross, Medicare, and commercial) generated substantial financial risk under the DRG all payer scheme. These data suggest that federal, state, and private payers may be under-reimbursing for the care of the hospitalized black patient using the DRG prospective hospital payment scheme. Health care financing policy such as that demonstrated in this study may limit both the access and quality of care for many black patients in the future.

Adult↗
PubMed1987

The identifier concept: clinical variables to manage costs for surgical patients.

Previous studies at Long Island Jewish Medical Center had shown that certain clinical variables (identifiers) would differentiate hospital charges within surgical diagnosis-related groups (DRGs). This current project demonstrated that the clinical variables of mode of admission (emergency versus nonemergency), blood transfusion, and surgical intensive care unit admission could stratify both differences in severity of illness and charges for patients in general surgical DRGs. These findings suggest that these three identifiers may be useful to physicians and hospital administrators in evaluating surgical patients for differences in resource consumption during their hospitalization, for better management of hospital-based inpatient costs.

Blood Transfusion↗
PubMed1987

The identifier concept: clinical parameters to stratify hospital costs within gastroenterology DRGs.

Prospective payment systems using the diagnostic related group (DRG) payment mechanism are changing the incentives offered to hospitals. We studied hospital costs of all gastroenterological (GI) patients (n = 2500) treated during a 2-yr period at our academic medical center. We showed that patients within GI DRGs could be grouped regarding hospital costs by four clinical variables: intensive care unit or emergency admission, and blood or plasma product consumption. Patients within each DRG with the variable usually had higher total hospital costs, a longer stay in the hospital, a greater number of diagnoses, more outliers, and a poorer outcome than patients without the variables. As the variables accumulated, these differences became more pronounced. This study demonstrated that hospital costs may be stratified within GI DRGs by clinical parameters that occur during the patient's hospital stay. These four variables could identify higher cost patients within a DRG; cost containment could then be directed at these patients with, hopefully, resultant savings.

Blood Transfusion↗