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World Journal of Surgery
Published in: World Journal of Surgery 4/2021

01-04-2021 | Cholecystitis | Original Scientific Report

Diagnosis-Related Group (DRG)-Based Prospective Hospital Payment System can be well adopted for Acute Care Surgery: Taiwanese Experience with Acute Cholecystitis

Authors: Yu-Tung Wu, Yu-Ning Lin, Chi-Tung Cheng, Chih-Yuan Fu, Chien-Hung Liao, Chi-Hsun Hsieh

Published in: World Journal of Surgery | Issue 4/2021

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Abstract

Background

Laparoscopic cholecystectomy (LC) is a common procedure for cholelithiasis paid by diagnostic-related groups (DRGs) systems. However, acute cholecystitis (AC) patients usually have heterogeneous conditions that compromise the successful implementation of DRGs. We evaluated the quality/efficiency of treating AC patients under the DRG system in Taiwan.

Methods

All AC patients who underwent LC between October 2015 and December 2016 were included. Patient demographics, treatment outcomes, and financial results were analyzed. Patients were reimbursed by one of the two DRG schemes based on their comorbidities/complications (CC): DRG-1, LC without CC; and DRG-2, LC with CC. Hospitals were reimbursed the costs incurred if they were below the lower threshold (balanced sector); with the outlier threshold if costs were between the lower and outlier thresholds (profitable sector); and with the outlier threshold plus 80% of the exceeding cost if costs were higher than the outlier threshold (profit-losing sector).

Results

Among 246 patients, 114 were paid by DRG-1, and 132 were by DRG-2. In total, 195 of 246 patients underwent LC within 1 day after admission, and patients with mild AC had shorter hospital stays than those with moderate or severe AC. The complication rate was 7.3% with only one mortality. In total, 92.1% of patients in DRG-1 and 90.9% of patients in DRG-2 were profitable. The average margin per patient was 11,032 TWD for DRG-1 and 24,993 TWD for DRG-2.

Conclusions

DRGs can be well adopted for acute care surgery, and hospitals can still provide satisfactory services without losing profit.
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Metadata
Title
Diagnosis-Related Group (DRG)-Based Prospective Hospital Payment System can be well adopted for Acute Care Surgery: Taiwanese Experience with Acute Cholecystitis
Authors
Yu-Tung Wu
Yu-Ning Lin
Chi-Tung Cheng
Chih-Yuan Fu
Chien-Hung Liao
Chi-Hsun Hsieh
Publication date
01-04-2021
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 4/2021
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-020-05904-5

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