Evaluating the efficacy of the current diagnosis-related group reimbursement system for laparoscopic appendectomy at a single institute in Korea

Abstract

PurposeThe diagnosis-related group (DRG) system has been adapted to reduce overall medical costs by grouping and classifying relatively homogenous patients based on similar resource consumption patterns in the treatment. However, despite its wide range of disease manifestation from early inflammation to severe peritonitis, acute appendicitis is included in the DRG system. Responding to a need to assess the DRG system for patients diagnosed with appendicitis, this study evaluates the efficacy of the current DRG system applied to a broad spectrum of the patients with appendicitis undergoing laparoscopic appendectomy.MethodsA retrospective review was conducted of the patients who underwent laparoscopic appendectomy. Based on the DRG codes' classification, the patients were analyzed for the amount of DRG reimbursement and the total in-patient cost in relation to the time sequence of the disease onset. Statistical analysis was performed to find factors correlated with the DRG reimbursement and total in-patient cost.ResultsFindings indicate that, as the symptom duration becomes prolonged, the CRP level and the use of peritoneal drainage increased. Patients with a symptom duration greater than 24 hours required approximately 5 days of hospital stay, 0.5 day longer in the length of hospital stay than that of patients with less than 12 hours of the onset time. As expected, the amount of DRG reimbursement and the total in-patient cost accumulated as the symptom duration increased.ConclusionThe current DRG reimbursement system for the patients undergoing laparoscopic appendectomy recompenses a broad spectrum of patients diagnosed with appendicitis effectively.

Positive predictive value of ICD-10 codes for acute myocardial infarction in Japan: a validation study at a single center

“…This observation may be relevant to the difference of the PPV of AMI in the studies conducted in Asian countries [ 12 , 13 ]. For example, Taiwan introduced the DRG in 2010 for a wide variety of diseases including AMI [ 30 ] while the fee-for-service reimbursement is currently used for AMI in Korea where the use of the DRG-based reimbursement is limited to seven different diseases [ 31 ]. This difference of the reimbursement scheme might at least in part explain why the PPV in the study conducted in Korea [ 12 ] was lower than that in Taiwan [ 13 ].…”

Early outcome of the Korean Diagnosis-Related Groups payment system for appendectomy

“…The Korean DRG payment system has recently introduced amid considerable controversy in selected several operations/diseases including appendectomy in Korea. Recently, Yoo et al [ 3 ] reported their results about effectiveness of the current Korean DRG system in laparoscopic appendectomy and tried to determine the factors that influence the amount of the DRG reimbursement and total in-patient cost. However, a few studies have been conducted about Korean DRG system for appendectomy for now.…”

A Simple Diagnosis-Related Groups-Based Reimbursement System Is Cost Ineffective for Elderly Patients With Displaced Femoral Neck Fracture Undergoing Hemiarthroplasty in Beijing

“…According to clinical data (such as diagnoses and procedures), demographic data (such as age and gender), and resource consumption data (such as hospitalizations), cases are categorized (including costs, duration of hospitalization). DRGS was originally designed as a management tool for clinicians to monitor service quality and utilization, but it is now used as a prospective payment system in many countries ( 5 ). In 2011, Beijing, China implemented a DRG-based reimbursement system for the treatment of FNFs.…”