Pediatric critical care and hospital costs under reimbursement by diagnosis-related group: Effect of clinical and demographic characteristics

Abstract

To determine the relationship of demographic and clinical variables to cost, to revenue based on diagnosis-related groups, and to profit in patients in a pediatric intensive care unit (PICU). Prospective collection of clinical and demographic data of patients sampled. Detailed financial data for all patients discharged from the hospital were compiled by the office of financial planning. A combined data set was used for analysis. A multidisciplinary PICU within a general, tertiary-care, teaching hospital in an urban environment. Consecutive sample of 1174 pediatric patients discharged from the PICU during a 24-month period. Hospital cost (not charges) determined according to industry standards. Revenue was determined by the DRG system. Of the 1174 cases identified, DRG coding and financial data were 97% complete. The mean loss (negative profit) per patient was $9218 +/- $33,676. Profit was significantly and adversely affected by outlier status, death, high risk of death, interhospital transfer, emergency admission, young age, and mechanical ventilation. Multivariate analysis revealed that duration of stay, death, interhospital transfer, and age negatively correlated with profit. Under a DRG-based reimbursement system, the operation of an active PICU with a broad referral base may not be desirable from a financial perspective. Similar studies at other institutions could help establish a data base with which the DRG system can be refined.