PEDIATRICS Vol. 79 No. 6 June 1987, pp. 874-881
This Article
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Berki, S. E.
Right arrow Articles by Schneier, N. B.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Berki, S. E.
Right arrow Articles by Schneier, N. B.

Frequency and Cost of Diagnosis-Related Group Outliers Among Newborns

S. E. Berki MA1 and Nancy B. Schneier MSc1

1 From the Department of Health Services Management and Policy, School of Public Health, The University of Michigan, Ann Arbor

Analysis of outliers, as defined by the Health Core Financing Administration, among 47,776 newborns discharged from 33 short-term hospitals in Maryland in 1981 shows that the three prematurity diagnosis-related groups (DRGs) (386 to 388) represented only 5.3% of all discharges of newborns, but more than one fifth of all outliers and more than three fifths of outlier days of care for newborns. The disparity in charges for outliers and inliers (not exceeding the "trim point") is even more dramatic. Newborns with "extreme immaturity" (DRG 386) and "prematurity with major problems" (DRG 387) together accounted for less than 3% of all newborn discharges but for nearly one fourth of all outlier discharges. The mean length of stay in hospitals for outliers in those two DRGs was more than 2 months. The mean charge per outlier discharge in DRG 386 was $27,061 in 1981. Nearly one third of the discharges and more than two thirds of the days of care in this DRG were for outliers. Outliers occurred up to five times more often among premature neonates than among normal newborns and occurred preponderantly in teaching hospitals, especially those with more than 400 beds. This finding may require a reevaluation of the outlier trim points and the reimbursement method for newborn DRGs to assure adequate payment to the providers of neonatal intensive care, mainly large teaching hospitals.

Key Words: diagnostic-related group • neonate

Submitted on March 31, 1986
Accepted on July 31, 1986




This article has been cited by other articles:


Home page
 PediatricsHome page
J. Rogowski
Cost-effectiveness of Care for Very Low Birth Weight Infants
Pediatrics, July 1, 1998; 102(1): 35 - 43.
[Abstract] [Full Text]

Home page
 CLIN PEDIATRHome page
B. E. Fleisher, K. VandenBerg, J. Constantinou, C. Heller, W. E. Benitz, A. Johnson, A. Rosenthal, and D. K. Stevenson
Individualized Developmental Care for Very-Low-Birth-Weight Premature Infants
Clinical Pediatrics, October 1, 1995; 34(10): 523 - 529.
[Abstract] [PDF]

Home page
 NEJMHome page
T. L. Callahan, J. E. Hall, S. L. Ettner, C. L. Christiansen, M. F. Greene, and W. F. Crowley
The Economic Impact of Multiple-Gestation Pregnancies and the Contribution of Assisted-Reproduction Techniques to Their Incidence
N. Engl. J. Med., July 28, 1994; 331(4): 244 - 249.
[Abstract] [Full Text]