Primary Article

DRG Reimbursement: Geriatric Hip Fractures in the Community Hospital Trauma Center

Authors: THOMAS CLANCY MD, STEVEN KITCHEN MD, PAIGE CHURCHILL BA, DEBORAH COVINGTON DrPH, JAMES HUNDLEY MD, JOHN GARY MAXWELL MD

Abstract

Abstract Background.The purpose of this paper was to determine whether Medicare reimbursement for hip fracture reaches cost in geriatric patients. Methods.We conducted a retrospective review using the hospital trauma registry. Demographics, operations, length of stay, clinical outcome, discharge disposition, hospital charges, and hospital costs were reviewed and compared with diagnosis-related group (DRG) reimbursement. Results.The study included 153 Medicare patients. Mortality was 3.9%, 71% were discharged to a nursing home or rehabilitation unit, and 25% went directly home. DRG reimbursement constituted 58% of charges. Compared with costs, the DRG amount represented a mean loss of nearly $1,000 per patient. Conclusion.DRG reimbursement undercompensates the community hospital trauma center for treating a common malady among the geriatric population. A population shift toward the elderly, decreasing Medicare remuneration, and the advance of managed care will make correct identification and control of costs extremely important for the hospital caring for hip fractures in the geriatric population.

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