Table 4.

Comparison of Payment to Actual Costs for Three DRG Systems for Neonates by Service Line

Neonates by
Service Line
Case TotalsRatio of Payment to Cost
Total
Cases
Total
Costs
(000s)
Average
Cost
per Case
Medicare
DRGs
(V 12.0)
AP-DRGs
(V 12.0)
AP-DRGs
versus
Medicare DRGs
APR-DRGs
(V 12.0)
APR-DRGs versus
Medicare DRGs
Neonates (Age 0–28 Days):
 Surgical   3880$ 209 068$53 8840.3180.869+173.3%1.004+215.8%
 Medical 61 452$ 591 673$  96280.9561.041+8.9%0.991+3.8%
 Other 95$     607$  63860.6491.282+97.5%1.127+73.7%
 Normal newborn427 131$ 264 942$  6201.2310.988−19.7%1.016−17.3%
Total492 558$1 066 290$ 21640.8990.994+10.6%1.000+11.4%
  • This is simplified payment simulation with entire payment based on DRG weight and no outlier or facility level adjustments.

    Costs include hospital operating and capital costs, exclusive of graduate medical costs, adjusted by HCFA area wage index.

    For purposes of this comparison, any patient in a surgical DRG in any of the three DRG systems is considered a surgical patient. Any patient in a normal newborn DRG in any of the three DRG systems is considered a normal newborn. Any patient in an obstetrical or mental health DRG in any of the three DRG systems (only possible in Medicare DRGs) is classified as “other.” All other patients are considered medical.