DIAGNOSIS-RELATED GROUP REFINEMENT WITH DIAGNOSIS-SPECIFIC AND PROCEDURE-SPECIFIC COMORBIDITIES AND COMPLICATIONS

Diagnosis-related groups have been revised through more refined uses o f secondary diagnoses. Under the refined diagnosis-related groups, pat ients are distinguished with respect to classes of secondary diagnoses that are disease- and procedure-specific. Each class represents a dif ferent level of utilization for a given principal diagnosis or surgica l procedure. The refined system was evaluated with national data from the Medicare program. Estimates of hospital costs and utilization base d on refined diagnosis-related groups were more precise than those bas ed on unrefined diagnosis-related groups. This approach to diagnosis-r elated group refinement does not represent a radical departure from th e current diagnosis-related group framework and does not require new d ata collection efforts. Moreover, a payment system based on the refine d model is less affected by the ordering of the diagnoses than under t he existing diagnosis-related group system. How the refined diagnosis- related group framework can accommodate future refinements at all leve ls of the classification scheme is also discussed.