Abstract Details

Title Does CMS GMLOS In the Neurological ICU Represent Reality in Academic Medical Centers?

Topic Practice, Policy, and Ethics

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-073

Objective To investigate geometric mean length of stay (GMLOS) in commonly encountered diagnosis related groups in the neurological intensive care unit (ICU) using the Nationwide Inpatient Sample (NIS) data.

Background The Medicare Severity Diagnosis Related Group (MS-DRG) classification system was implemented in 2008 by the Centers for Medicare & Medicaid Services (CMS) to establish a risk-stratified prospective payment system for hospitals. The three variables that compose the MS-DRG are the patient’s principle diagnosis, co-morbidities, and received procedures. The GMLOS standard is the major cost determinant for hospitals as prolonged lengths of stay can cause hospitals to operate at a financial loss.

Design/Methods Cases with MS-DRG-020 (intracranial vascular procedures with principal diagnosis of hemorrhage with major complications/comorbidities) were obtained from the NIS for the period from January 1, 2008 through December 31, 2012. The primary outcome was GMLOS. GMLOS was calculated for all hospitals, teaching and non-teaching hospitals, in comparison to the corresponding CMS GMLOS used in reimbursement for each year. Demographic and sample characteristics of teaching and non-teaching hospitals were compared using Chi-square tests.

Results For MS-DRG-020 we observed consistently higher GMLOS than CMS reimbursement standard over time. This trend was more prevalent in teaching hospitals with -0.1, 1.2, 0.6, 1.4, and 2 days more than CMS reimbursement standard in years 2008, 2009, 2010, 2011, and 2012, respectively. Comparing to non-teaching hospitals, teaching hospitals tend to have higher case-mix-index since teaching hospitals generally admit more severely ill patients.

Conclusions Our results suggested CMS may need to focus further on the equity of payment for cases in the neurological ICU with greater severity of illness and thus longer GMLOS that were cared at teaching hospitals.

Authors/Disclosures
Mohammad Hajighasemi-Ossareh, MD PRESENTER	No disclosure on file
Ling Zheng, MBBS, PhD (University of Southern California)	No disclosure on file
May A. Kim-Tenser, MD, MHA, FAHA (Keck Medical Center of USC)	Dr. Kim-Tenser has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Chiesi.
Benjamin Emanuel, DO	Dr. Emanuel has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Reback McAndrews Blessey.
	No disclosure on file
	No disclosure on file
Sebina Bulic, MD (USC)	Dr. Bulic has nothing to disclose.

��ɫ��

��ɫ��