Hospital costs, resource characteristics, and the dynamics of death for patients with a primary diagnosis of congestive heart failure.

Although substantial changes have been recommended in the diagnosis related group (DRG) prospective hospital payment system related to very expensive care for some patients, no major change in payment for these patients has been implemented by the US Congress. Both the Health Care Financing Administration and the Prospective Payment Assessment Commission continue to study issues related to DRG stratification along the lines of severity of illness, outcome (lived or died), or complications and/or comorbidities. We analyzed hospital resource consumption for 599 patients with a primary diagnosis of congestive heart failure (CHF) by outcome (ie, survivors vs mortalities). The 68 mortalities had a much greater intensity of hospital resource utilization, and a substantial financial risk under DRG pricing schemes, compared to the 531 survivors. Only mortalities within one week of admission to the hospital were profitable under DRGs. A long hospital length of stay (LOS) for mortalities was very unprofitable (mortalities with a greater than 60-day LOS generated a +42,028 loss per patient). Emergency patients who died tended to have a shorter hospital LOS and less financial risk under DRGs, compared to patients who died who were not admitted as emergencies. These data suggest significant inequities in the DRG prospective payment system vis-a-vis CHF mortality. Variables predictive of greater hospital resource utilization for mortalities included longer hospital lengths of stay and urgent admission. Health policy leaders should be encouraged to further stratify DRG hospital resource consumption for appropriate variance in hospital costs.