 | Wendy Mosiman, RN
is the manager of the Attending Nurse Program at Via Christi Regional Medical Center. She has a Master's Degree in nursing from Wichita State University. Wendy is an Advanced Registered Nurse Practitioner in the State of Kansas and is certified nationally as a Pediatric Nurse Practitioner. She can be reached at Via Christi Regional Medical Center, 929 North St. Francis, Wichita, Kansas 67214, (316) 268-5963 or by email at Wendy_Mosiman@via-christi.org |
Health & Medicine
2002-02-01 15:35:00
What is DRG?
: My 85-year-old mother was recently in the hospital for a broken hip. She was discharged before we felt she was ready. The nurse who assisted us was talking something about DRG days or something. What is DRG and how does it affect a person’s stay in the hospital?
Question: My 85-year-old mother was recently in the hospital for a broken hip. She was discharged before we felt she was ready. The nurse who assisted us was talking something about DRG days or something. What is DRG and how does it affect a person’s stay in the hospital?Answer: In the past, most health care was on a fee-for-service basis. It was referred to as retrospective payment because the fee for health care services was paid after all the needed services were provided. During the 1970s, a period of high inflation, health care costs skyrocketed. Most Americans had health insurance and were not worried about costs because the insurance company or Medicare and Medicaid would pay for all services provided. There was unprecedented growth in the types of services and therapies available, some of which were necessary for certain illnesses and some that were not. Long hospital stays, admissions for check-ups or leaving a child in over the weekend so the parents could have some time to rest are examples of how hospital services sometimes were used inappropriately. As a result, several cost containment and cost limiting programs were introduced in the 1980s. One such program was the prospective payment system initiated by Medicare and other payer groups. Each illness or disease is assigned a Diagnosis Related Group (DRG) and the doctor and hospital receives a fixed payment for the hospitalization no matter how many days the patient stays or how many services are required. The payment is based on an average length of stay in the hospital, a limited number of laboratory tests and a certain amount of nursing and other care. The doctor, hospital and/or the patient must absorb any additional costs themselves. It is in everyone's best interest to get patients well enough to go home or to another level of care as quickly as possible. However, their own physician evaluates each patient's care and the dismissal is based upon the physician's best medical knowledge, rather than on DRG guidelines alone. It is important for the patient and the family to discuss reasons they feel the patient isn't "ready" to go home, but to understand that there may not be anything we are doing for them that has to be done in the hospital. However, in some cases the patient may qualify for additional care outside the hospital, such as the services provided by a skilled nursing facility, rehabilitation hospital or home health agency.
