Effect of Disease Complications on Hospital Costs (Laboratory Management‪)‬

With the ongoing pressure to contain hospital costs, it is important to make every effort to avoid unnecessary complications because expenses increase with added problems. Certain diseases have been assigned by the Centers for Medicare and Medicaid Systems, formerly Healthcare Financing Administration, to different diagnosis-related groups (DRGs) [1] based on whether they are associated with complications. To identify the source of additional expenses that arise from complications that occur during patients' admissions to hospital, we accessed a database developed by the University HealthSystems Consortium (UHC) that comprises the costs attributable to the individual non-physician sources of costs for all DRGs in 60 University hospitals in 1995. For the majority of diseases classified by DRG, a single number includes all degrees of severity of the disease, regardless of the presence or absence of complications or comorbidities. However, 222, or 45.6% of all DRGs, are separately classified as having or not having complications and/or comorbidities. It should be recognized, however, that the simple classification into DRGs with and without complications does not reflect the considerable variation in disease severity for hospital patients. Many of the more complicated medical conditions, such as organ transplantations, are not stratified into categories with and without complications and/or comorbidities. A complication in the context of this study does not differentiate between preventable and unavoidable complications. Although we focused our efforts on diseases with and without complications, there are three additional conditions that have been classified as with and without "problems". Problems are essentially conditions that arise during the hospitalization of patients that cannot be ascribed to preexisting complications and/or comorbidities. The conditions with or without problems are vaginal delivery without problems (DRG 373) and with problems (DRG 372), prematurity without problems (DRG 388) and with major problems (DRG 387), and healthy newborns (DRG 391), neonates with major problems (DRG 389), and neonates with other significant problems (DRG 390). We separately studied these conditions.