Do AR-DRGs adequately describe the trauma patient episode in New South Wales,Australia?

Kate Curtis, Rebecca Mitchell, Cara Dickson, Deborah Black, Mary Lam

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

The use of Diagnosis Related Groups (DRGs) may not be an accurate tool to provide reimbursement for trauma services. This study aimed to determine whether Australian Refined Diagnosis Related Groups (AR-DRGs) adequately describe the trauma patient episode and to identify AR-DRG groupings where reimbursement was not commensurate with actual cost. The AR-DRG allocated costs and actual costs of a sample of 206 trauma patient episodes were reviewed during a three-month period. Of the AR-DRG groups identified in the patient episodes, 62.8% were not commensurate with actual cost incurred, equating to an overall loss of $113,921 from under-funded acute trauma patient episodes over a three-month period. Assault-related penetrating trauma, traffic-related and sport-related incidents were all inadequately reimbursed using AR-DRGs compared with the actual cost of treatment. Cases involving female patients, patients aged 45 years or less and those with moderate injuries were similarly underfunded. AR-DRGs are not adequate to describe the extent of injuries experienced by trauma patients and there is a need to investigate alternative funding models for trauma services.

LanguageEnglish
Pages7-13
Number of pages7
JournalHealth Information Management Journal
Volume40
Issue number1
Publication statusPublished - 2011
Externally publishedYes

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South Australia
New South Wales
Diagnosis-Related Groups
Wounds and Injuries
Costs and Cost Analysis
Health Care Costs
Sports

Cite this

Curtis, Kate ; Mitchell, Rebecca ; Dickson, Cara ; Black, Deborah ; Lam, Mary. / Do AR-DRGs adequately describe the trauma patient episode in New South Wales,Australia?. In: Health Information Management Journal. 2011 ; Vol. 40, No. 1. pp. 7-13.
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abstract = "The use of Diagnosis Related Groups (DRGs) may not be an accurate tool to provide reimbursement for trauma services. This study aimed to determine whether Australian Refined Diagnosis Related Groups (AR-DRGs) adequately describe the trauma patient episode and to identify AR-DRG groupings where reimbursement was not commensurate with actual cost. The AR-DRG allocated costs and actual costs of a sample of 206 trauma patient episodes were reviewed during a three-month period. Of the AR-DRG groups identified in the patient episodes, 62.8{\%} were not commensurate with actual cost incurred, equating to an overall loss of $113,921 from under-funded acute trauma patient episodes over a three-month period. Assault-related penetrating trauma, traffic-related and sport-related incidents were all inadequately reimbursed using AR-DRGs compared with the actual cost of treatment. Cases involving female patients, patients aged 45 years or less and those with moderate injuries were similarly underfunded. AR-DRGs are not adequate to describe the extent of injuries experienced by trauma patients and there is a need to investigate alternative funding models for trauma services.",
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Do AR-DRGs adequately describe the trauma patient episode in New South Wales,Australia? / Curtis, Kate; Mitchell, Rebecca; Dickson, Cara; Black, Deborah; Lam, Mary.

In: Health Information Management Journal, Vol. 40, No. 1, 2011, p. 7-13.

Research output: Contribution to journalReview articleResearchpeer-review

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