Abstract
The federal Medicare DRG pro spective payment system as entered its sixth year, with no major adverse effect so far on American health care regarding either access to or quality of surgical care. The authors ana lyzed hospital resourc consumption and outcome by age for peripheral vascular surgical patients from Ja nuay 1, 1985, through March 31, 1986, at a large academic medical center using the DRG format. Total costs (exclusive of MD fees) for the 211 peripheral vascular surgical pa tients studied were $2,933,623. Mean hospital cost per patient, hospital length of stay, percent of outliers, and mortality were higher for pa tients seventy-five years of age and over as compared with younger pa tients. DRG case-mix index and the number of procedures per patient was also higher for these older pa tients.
This study demonstrated that un der prospective payment systems (ie, DRG reimbursement) financial risk was higher for patients seventy-five years of age and over, as were hospi tal length of stay, the number of pro cedures per patient, and mortality. These data suggest that current DRG reimbursement may provide finan cial disincentives to treat elderly pe ripheral vascular surgical patients. As government continues to decrease DRG hospital payment for these pa tients relative to hospital costs, both their access to and quality of surgical care could be jeopardized in the fu ture.
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