Abstract
Purpose:State-based Medicaid programs have begun using All Patient Refined–Diagnosis-Related Groups (APR-DRGs) to determine hospital reimbursement rates. Medicaid provides coverage for 45% of childhood cancer admissions. This study aimed to examine how well APR-DRGs reflect admission costs for childhood cancer chemotherapy to inform clinicians, hospitals, and policymakers in the wake of policy changes.Methods:We identified 25,613 chemotherapy admissions in the 2009 Kids’ Inpatient Database. To determine how well APR-DRGs explain costs, we applied a hierarchic linear regression model of hospital costs, allowing for a variety of patient, hospital, and geographic confounders.Results:APR-DRGs proved to be the most important predictors of admission costs (P < .001), with costs increasing by DRG severity code. Diagnosis, age, and hospital characteristics also predicted costs above and beyond those explained by APR-DRGs. Compared with admissions for patients with acute lymphoblastic leukemia, costs of admissions for patients with acute myelomonocytic leukemia were 82% higher; non-Hodgkin lymphoma, 20% higher; Hodgkin lymphoma, 25% lower; and CNS tumors, 27% lower. Admissions for children who were 10 years of age or older cost 26% to 35% more than admissions for infants. Admissions to children’s hospitals cost 46% more than admissions to other hospital types.Conclusion:APR-DRGs developed for adults are applicable to childhood cancer chemotherapy but should be refined to account for cancer diagnosis and patient age. Possible policy and clinical management changes merit further study to address factors not captured by APR-DRGs.
Highlights
Diagnosis-related groups (DRGs) are designed to classify clinically similar groups of patients with similar resource requirements.[1]
REAL-LIFE IMPLICATIONS: We found that All Patient Refined–Diagnosis-Related Group (APR-DRG) reflected many of the differences in costs of childhood cancer chemotherapy admissions
APR-DRGs proved to be the most important predictors of admission costs (P, .001), with costs increasing by DRG severity code
Summary
Diagnosis-related groups (DRGs) are designed to classify clinically similar groups of patients with similar resource requirements.[1] Since the early 1980s, the Centers for Medicare and Medicaid Services has used DRGs as e564 Volume 12 / Issue 5 / May 2016 n Journal of Oncology Practice part of a prospective reimbursement system under Medicare. In 2013, states began shifting Medicaid inpatient reimbursement to prospective strategies using All Patient Refined–DRGs (APRDRGs).[2,3,4,5,6,7] APR-DRGs further classify admissions within a DRG into one of four severity codes after considering factors such as severity of the primary illness, comorbidities and secondary diagnoses, and services used during the admission. Healthcare Cost and Utilization Project: NIS description of data elements.
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