Inadequacy of diagnosis related group (DRG) reimbursements for limb salvage lower extremity arterial reconstructions

Abstract

Prospective cost and reimbursement data were collected from 10 centers in various parts of the United States on 566 patients undergoing lower extremity arterial reconstructions for limb salvage and nonlimb salvage indications. Information for each patient was available on indication and type of procedure, length of stay, the type of hospital insurance, and hospital costs/charges. Diagnosis related group payments from each center were used to determine net gain or loss for each patient. Patients were classified as having claudication or critical ischemia (limb salvage). Reimbursements matched costs/charges for the claudication group; overall mean loss in this group was only $915 per patient. However, all centers had important losses in the limb salvage group. Reimbursements averaged 60% of costs/charges, with a mean loss of $8158 per patient and an overall loss for all 10 centers of $3,653,918. An effort to remedy this inequity is progressing via a dialogue between representatives of the Society for Vascular Surgery, the North American Chapter of the International Society for Cardiovascular Surgery, and the federal government.

Is Thrombolysis of Lower Extremity Acute Arterial Occlusion Cost-Effective?

“…This value was derived from a study by Jansen and colleagues [11] where the costs associated with 467 major bypass procedures, which included aortobifemoral, iliofemoral, femorofemoral, femoropopliteal, femoroinfrapopliteal, and popliteoinfrapopliteal bypasses, were evaluated. This cost is comparable to that reported by others for major lower extremity reconstructions [12,13]. In the TOPAS trial, the number of major surgical procedures performed was 116 in the thrombolysis group and 193 in the surgery group.…”

System to decrease length of stay for vascular surgery

“…9 However, it is well known that LOS for vascular patients in teaching hospitals that serve an elderly population with multiple comorbid conditions is protracted. [9][10][11]14,15 This trend may be increased by two factors: poor family support that is more common with patients from inner-city populations, and decreased family financial resources available to pay for home care that might facilitate earlier discharge.…”

Cost-identification analysis of revascularization procedures on patients with peripheral arterial occlusive disease

“…[1][2][3][4][5][6][7] Restricted health care budgets have led to an increasing awareness of the financial costs of revascularization procedures, and costs currently play an important role in decision making. [8][9][10][11][12] Whereas many cost-identification analyses of revascularization procedures for peripheral arterial occlusive disease have focused on the intervention itself, 5,7 the total in-hospital costs of intervention are determined by more factors. Additional costs may be incurred for the management of procedure-related complications, adjuvant therapy for ischemic ulcers or gangrene, and management of comorbidity related to age, sex, and cardiovascular risk factors.…”