IS ACADEMIC MANAGED CARE AN OXYMORON

BACKGROUND: A review of 1993 data on length of stay (LOS) and charges for diagnosis-related group (DRG) 195 (complicated cholecystectomies) showed that Maricopa Medical Center charged more and had longer LOS th an all other area hospitals. METHODS: Twenty DRG 195 charts were analy zed for the causes of the inefficiencies. The remaining cholecystectom y DRGs were similarly analyzed. RESULTS: Analysis of the charts for DR G 195 showed that 55% of the patients had laparoscopic conversions. Ch arges and LOS varied significantly because of the conversions, increas ed preoperative hospital days and increased operative times. Moreover, 30% of patients were more than 70 years old. Comparisons of other cho lecystectomy DRGs showed similar inefficiencies, indicating a hospital system's problem. CONCLUSIONS: Diagnosis-related group delta analysis is a powerful performance improvement tool. Once problem areas are id entified and corrected, monitoring prospective data produces rapid ana lysis of quality of care and cost improvements. The models can serve a s a means for teaching hospitals to become more competitive and satisf y the joint Commission on Accreditation of Healthcare Organizations re quirements for patient-care improvements.