583 NENATAL DIACNOSTIC RELATED GROUPS (DRC) PROSPECTIVE PAYMENT SYSTEM FOR TERTIARY NEONATAL INTENSIVE CARE CENTERS

Abstract

This study assessed the impact of the Federal Neonatal Diagnostic Related Group (DRG) payment system on the Neonatal Intensive Care Program of the State of Florida. Hospital charges of $118 million, representing 8500 neonates, from the State's ten regionalized neonatal intensive care centers born in fiscal years 1980-1984 were analyzed. When analyzed, Federal DRGs were not predictive of hospital charges (R2 = 0.15). We developed a stepwise regression model to evaluate the relative impact of neonatal variables such as lived/died, birth weight, sex, race, ventilation, surgery, in-born or transported on hospital fiscal charges; a threefold increase in R2 was achieved (0.55). Our analysis indicated four basic differences from the Federal DRGs: 1) respiratory distress syndrome is not justified in Federal DRC 386 associated with extreme prematurity ( ≤ 1000 grams); 2) Federal DRG 387, 1001-2500 grams, should be divided into two separate DRGs by birth weight groupings of 1001-1500 and 1501-2500 grams; 3) ventilation and major surgery were the primary factors associated with “major problem” Federal DRGs 387 and 389; 4) our population mas characterized by a longer geometric mean length of stay for each Federal DRG; this may be explained by the fact that our data came from tertiary regionalized neonatal intensive care centers, while the Federal DRGs were developed from community based hospitals. Our proposed neonatal intensive care prospective payment system requires knowledge of only mortality status, birth weight, ventilation, and major surgery, while the Federal DRG system requires utilization of over 500 neonatal diagnoses.