Clinical care pathways in a surgical epilepsy program: A comparison of costs by diagnostic related groups for program and nonprogram admissions

Abstract

Specific diagnostic related groups (DRGs) for patients investigated and treated in a surgical epilepsy program have not been established. This has raised concern that admissions into such a program are categorized into DRGs that do not accurately reflect resource consumption. Three DRGs commonly pertain to surgical epilepsy program admissions: 001, 024, and 025. We established clinical care pathways to allow for the diversity of clinical presentations and the differences in subsequent investigation with or without surgical treatment and categorized financial data for 50 patients completing the surgical epilepsy program from June 1993 through December 1994 for the purposes of comparing costs among clinical pathways along with that for 1,401 patients who were not in the program but who were discharged under the same DRGs during the same period. Four clinical pathways contained sufficient patient volume to allow comparison among the pathways and with nonprogram-related admissions under the same DRGs. A considerable range of cost ($1,576–$86,653) was identified among the four most common clinical care pathways. The two pathways involving intracranial electrode implantation followed by prolonged electrographic monitoring were distinguished by the necessity for a subsequent surgical admission as opposed to resection of the epileptogenic area at the time of electrode removal. The cost incurred by an additional admission increased by 14% to $64,305. The mean cost of program patients discharged under each DRG was significantly higher than that for other patients: DRG 001, $28,439 versus $22,289, p p p