Doctor’s Diary October 12, 2017: What’s your DRG?

(Snippets from the frontline)

What’s your DRG?

Upon admission to a hospital, Medicare and some insurances assign patients a DRG code (Diagnosis Related Group).  This complex system is based on your diagnosis and pays a flat fee to the hospital for the entire stay.

For example, a pneumonia DRG pays about $7000, which covers 4 days.  If you stay two days, the hospital makes money.  If you stay longer than 4 days, they lose money.  It doesn’t matter how old or ill you are.

Therefore, the objective of a money-making hospital is to jettison patients as soon as possible even if you are still sick.

This is why Medicare patients are being discharged into nursing homes to complete care (like IV antibiotics or for congestive heart failure) instead of in-hospital monitoring for improvement, or watching for complications.

Worse yet, some hospitalized patients are needlessly shepherded into end-of-life hospice, a separately paid benefit.

For those who are ill and vulnerable, hospitals have become merely a triage service.

Gene Uzawa Dorio, M.D.

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