CLINICAL CARE PATHWAYS IN A SURGICAL EPILEPSY PROGRAM - A COMPARISON OF COSTS BY DIAGNOSTIC RELATED GROUPS FOR PROGRAM AND NONPROGRAM ADMISSIONS

Specific diagnostic related groups (DRGs) for patients investigated an d treated in a surgical epilepsy program have not been established. Th is has raised concern that admissions into such a program are categori zed into DRGs that do not accurately reflect resource consumption. Thr ee DRGs commonly pertain to surgical epilepsy program admissions: 001, 024, and 025. We established clinical care pathways to allow for the diversity of clinical presentations and the differences in subsequent investigation with or without surgical treatment and categorized finan cial data for 50 patients completing the surgical epilepsy program fro m June 1993 through December 1994 for the purposes of comparing costs among clinical pathways along with that for 1,401 patients who were no t in the program but who were discharged under the same DRGs during th e same period. Four clinical pathways contained sufficient patient vol ume to allow comparison among the pathways and with nonprogram-related admissions under the same DRGs. A considerable range of cost ($1,576- $86,653) was identified among the four most common clinical care pathw ays. The two pathways involving intracranial electrode implantation fo llowed by prolonged electrographic monitoring were distinguished by th e necessity for a subsequent surgical admission as opposed to resectio n of the epileptogenic area at the time of electrode removal. The cost incurred by an additional admission increased by 14% to $64,305. The mean cost of program patients discharged under each DRG was significan tly higher than that for other patients: DRG 001, $28,439 versus $22,2 89, p < 0.03; DRG 024, $13,479 versus $5,552, p < 0.012; and DRG 025, $9,809 versus $3,033, p < 0.001. The aggregate difference among our 50 patients between total costs incurred for epilepsy surgery cases and the costs that would have been incurred if these patients had the same average costs as patients outside the program was $591,071. Such find ings appear to justify revision of the existing DRG classification to reflect the higher resource consumption by patients with intractable e pilepsy.