Pediatric patients, race, and DRG prospective hospital payment
E. Munoz, E. Barrios, H. Johnson, J. Goldstein, K. Mulloy, D. Chalfin and L. Wise
Department of Surgery, Long Island Jewish Medical Center, New Hyde, NY 11042.
The diagnosis related group (DRG) prospective hospital payment system
contains inequities in hospital payment for certain groups of patients.
Patients of lower socioeconomic status may be underreimbursed by DRGs. We
analyzed pediatric patients and hospital resource consumption by race
(white, Hispanic, and black) using a DRG prospective payment "all payer"
system. All hospitalized pediatric admissions over a 3-year period (N =
14,489) were analyzed by race at a large academic medical center. Mean
hospital length of stay and cost per patient (adjusted for DRG weight
index) was significantly greater for black and Hispanic pediatric patients
compared with whites. Financial risk as measured by outliers and losses
under DRGs was greater for blacks and Hispanics compared with whites. Black
and Hispanic patients had a higher proportion of emergency admission to the
hospital compared with whites, a greater severity of illness (as measured
by total International Classification of Diseases, ninth revision, Clinical
Modification codes), and (on average) higher diagnostic costs for each
episode of illness. Our data suggest that black and Hispanic pediatric
patients have a greater hospital resource consumption (adjusted for DRG
group case mix) compared with whites, at least at our large medical center
in the Northeast. Hospitals that treat greater numbers of black and
Hispanic pediatric patients may be at a substantial disadvantage under
per-case DRG payment.
