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. 2020 Sep;160(3):e153-e154.
doi: 10.1016/j.jtcvs.2020.03.147. Epub 2020 Apr 13.

Administrators: Do you know how your pediatric cardiac surgeries are reimbursed?

Joyce L Woo  1 , Brett R Anderson  2
Affiliations

Administrators: Do you know how your pediatric cardiac surgeries are reimbursed?

Joyce L Woo et al. J Thorac Cardiovasc Surg. 2020 Sep.
No abstract available

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Conflict of interest statement

Disclosures:

The authors have no conflicts of interest relevant to this article to disclose.

Figures

Figure 1:
Figure 1:
Profitability ratios as functions of hospital base rates. A) DRG 630 (Severity 3 & 4): Neonates ≥2.5 kg undergoing a major cardiac procedure, by RACHS-1 score; B) DRGs 588 and 609 (Severity 3 & 4): Neonates <2.5 kg undergoing major procedure—cardiac or not, by presence of cardiac surgery DRG = Diagnostic Related Group Profitability Ratio = (Estimated reimbursement for a given hospital base-rate) / (Estimated expenses). Expenses are estimated using cost-to-charge ratio based costs, standardized across hospitals and payers. It is a measure of relative profit-generating ability (not synonymous with profit) RACHS-1 = Risk Adjustment for Cardiac Surgery; a measure of surgical case complexity, where RACHS 5 & 6 represent the highest case complexity.
Central Figure:
Central Figure:
Profitability ratios for neonates ≥2.5kg by hospital base rates & surgical case complexity Central Message: Under the All Patients Refined Diagnosis-Related Group payment system, high complexity neonatal cardiac surgeries may not be as profitable as lower complexity neonatal cardiac surgeries.
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Comment in

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