PubMed · 10312608
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J G Ferko. 1988. The triage factor.. https://pubmed.ncbi.nlm.nih.gov/10312608/
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BACKGROUND: Upcoding id defined by a systematic and deliberate shift in the case mix of a hospital in order to improve reimbursement. Upcoding is frequently mentioned as a reason for ineffective reimbursement under a DRG payment system. METHOD: A systematic literature search identified relevant studies concerning the extent of the Upcoding. Results are used for estimating the magnitude of Upcoding in Germany. RESULTS: Studies showed different estimates for Upcoding. Transferred to Germany roughly up to 1% of the payments for inpatient care are estimated to Upcoding. After 4 to 5 years the level of Upcoding decreases. To what extent Upcoding could be taken into account when setting the DRG reimbursement fees, remains open. Regarding the creation of epidemiological time series Upcoding causes a abrupt change in statistics. However this disadvantage is offset by the more complete coding under a DRG payment system. CONSEQUENCES: When setting the DRG reimbursement fees the elimination of the contribution of Upcoding share to the total shift in case mix can only be done retrospectively. Thus a rule for compensation of subsequent years is likely. Likewise the possibly different distribution of Upcoding among hospitals and their departments requires further investigation.
OBJECTIVE: In a context of organization of care where the budget of hospitals is a function of the number and of the severity of the in-patients and not of the duration of stay, stays of long duration (SLD) in short-stay hospitals represent a problem of both medical and administrative management. To identify the characteristics of long-duration stays. METHODS: The data used in this retrospective study were drawn from the Standardized Discharge Summaries of the year 1997 of a University Hospital of the Paris area (France). A stay of long duration (SLD) was defined in an arbitrary way as a stay exceeding 30 days. The stays of long duration (> 30 days) were subdivided in "long stays" (from 31 to 60 days) and "very long stays" (more than 60 days). RESULTS: The SLDs represent 3.7% of the discharge summaries of our hospital, among them, 40% are medical DRGs and 60% surgical DRGs. The patients in SLD more often come from other structures of care than the patients having a short duration stay of (SDS) coming mainly from their residence and were also hospitalised in several different units during their stay. Patients having a long stay were more often classified in DRGs outside the principal activity of this hospital (i.e. cardiovascular diseases). CONCLUSION: This first approach suggests that a set of simple descriptive variables (pre-existing and acquired co-morbidity, admission in surgical ward, multi-unit stay...) makes it possible to identify the patients likely to have a long duration stay. Simple variables added to the current hospital minimum medical record would make it possible to consider a predictive approach.