PROSPECTIVE PAYMENT EXPERIENCE WITH DRGS IN HEADACHE PATIENTS

SYNOPSIS The new Diagnostic Related Group (DRG) Prospective Hospital Payment System pays a set fee to hospitals depending on the patient's diagnosis. Care of certain patients covered by Neurology DRGs has proven to be unprofitable. The purpose of this project was to study hospital resource consumption for hospitalized patients with a principal or secondary diagnosis of headache. We studied various resource parameters for patients in the three neurology DRGs for headache (#24‐seizure and headache, age greater than 69 and/or complicating condition; #25 and #26‐seizure and headache age 18–69 without complicating condition, and age 0–17, respectively) by whether or not the patients had a diagnosis of headache. As demonstrated in Table 1, patients with headache had (on average) lower hospital resource utilization than patients in these same DRGs without a headache diagnosis. Headache patients had lesser total hospital costs, a lower severity of illness, and generated profits under DRGs compared to non‐headache patients. We found that our headache patients were adequately reimbursed by the DRG hospital payment system and suggest that this could be a financially attractive population to hospitals. Copyright © 1990, Wiley Blackwell. All rights reserved