Medical-based classification, representing 23 major diagnostic categories, that aggregates patients into case types based on diagnosis. A DRG is a subset of a major diagnostic category.
A hospital patient classification system developed under federal grants at Yale University. The current payment system for Medicare is based on the federal government’s setting a predetermined price for the “package of care” in the hospital (exclusive of physician’s fees) required for each DRG. If the hospital can provide the care for less than the DRG price, it can keep the difference; if the care costs the hospital more than the price, the hospital has to absorb the difference. Originally each DRG was intended to contain patients who were roughly the same kind of patients in a medical sense and who spent about the same amount of time in the hospital. The groupings were subsequently redefined so that, in addition to medical similarity, resource consumption (ancillary services, see service, as well as inpatient service days) was approximately the same within a given group. There are now 468 DRGs identified on the basis of the following criteria: the principal diagnosis (the final diagnosis which, after study in the hospital, was determined to be chiefly responsible for the hospitalization); whether an operating room procedure was performed; the patients age; comorbidity; and complications.
An indexing or classification system designed to standardize prospective payment for medical care. Diseases and conditions are assigned to a single DRG when they are felt to share similar clinical and health care utilization features. The reimbursement for treating all individuals within the same DRG is the same, regardless of actual cost to the health care facility.