Do DRG Payments Adequately Reimburse the Costs of Trauma Care in Geriatric Patients?

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Abstract
The records of 82 consecutive trauma patients over age 65 years were reviewed to determine the costs of trauma care as well as the projected DRG reimbursement in the seriously injured elderly. During the period of study, 636 additional trauma patients under the age of 65 were admitted. For all trauma victims, hospital costs exceeded projected reimbursement by $2.55 million (98,000 per month). In the elderly population, mean hospital costs dramatically exceeded mean projected reimbursement in patients over the age of 80 ($18,197 ± 3,682 vs. $7,069 ± 700; p < 0.001), in patients with severe overall injury ($18,992 ± 3,540 vs. $8,508 ± 643; p < 0.001), and in patients with more than one complication (25,504 ± 3,959 vs. $7,247 ± 626; p < 0.001). Hospital costs were also increased in elderly patients discharged to a nursing home ($22,811 ± 3,664) primarily as a result of prolonged hospital stay in older patients with more severe injury and with more frequent complications. The daily cost for trauma care in elderly patients who died was a staggering 1,735 ± 366, reflecting the aggressive care given these patients. In the elderly trauma population, the number of complications was the only factor that correlated with hospital costs (r=0.63; p < 0.001). There was no significant correlation between hospital costs and projected DRG reimbursement, suggesting that the current DRG system is a very poor predictor of actual costs for trauma care in this population. The data suggest that the present DRG system grossly underestimates hospital costs in patients more than 65 years old with severe injury and with complications. Additionally, the current system flagrantly underestimates costs for trauma care in all patients over 80. These factors may be appropriate identifiers to adjust DRG payments for trauma care in this high-cost population. Trauma centers will face progressive financial hardship as the geriatric population grows if the DRG reimbursement system is not modified.

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