Hospital costs by clinical parameters for peripheral vascular surgical DRGs.

Health care in America has entered a new era. Administrators and U.S. physicians have begun to examine cost more extensively than before. Our study strived to examine whether clinical parameters existed by which we could predict cost per DRG for peripheral vascular surgery patients. We examined all peripheral vascular surgical admissions (N = 1,169) to our academic medical center from 1/1/85-12/31/86. Patients were separated within DRGs by four clinical variables as follows: emergency room admission, surgical intensive care unit admission (ICU), infusion of plasma product or blood transfusion of a patient. The four clinical variables predicted differences per patient in hospital cost per DRG, a poorer outcome and also potential financial risk to the medical center. Within each DRG, each of these variables (either alone or in combination) predicted higher patient cost. For the ICU identifier, 88.6% of the patients who had a positive identifier had higher costs than patients in the same DRG who were not ICU admissions, for emergency admission, 81.4% of patients, and for both the transfusion (infusion of blood) and the plasma products identifier (infusion of blood products), 100% of patients. We believe that peripheral vascular surgical DRGs may be stratified by cost and outcome by these clinical variables during the patient's hospitalization. Surgeons and administrators may be able to use this methodology to segment those higher cost patients and concentrate efforts of cost containment for these groups.