Stroke hospitalization under prospective payments: analysis of diagnosis related group 14.

Development of a hospital prospective payment system (PPS) for Medicare patients based on diagnosis related groups (DRGs) should generate renewed interest in acute care utilization by stroke patients. Within the PPS, these patients are classified as DRG 14--specific cerebrovascular disorders except transient ischemic attacks. Hospitals are paid a relatively fixed rate for each Medicare patient within this category. In order to investigate patterns of inpatient care for this DRG, hospital utilization patterns in four United States metropolitan areas with a variety of acute and long-term care utilization characteristics were compared. The study involved a total of 4,593 discharges in DRG 14. Hospital discharge and admission rates and mean stays of the four sample populations were evaluated. Data demonstrated that discharge and admission rates of the four areas in this DRG were similar. However, the results also indicated that mean stays for DRG 14 varied by over 100%. These differences could not be explained by differences in age level and payor status of sample populations. Some variations appeared to be related to limitations in the availability of nursing home beds for posthospital care stroke patients. These results suggest that efforts to improve the efficiency of hospital care for stroke patients under DRGs must increasingly focus on long-term care services.