Medicare Transfer DRGs effective October 1, 2005
INVESTOR-OWNED CHAIN #1
| HOSP |
FY05 MEDICARE REV. |
EST FY06 MEDICARE REVENUE |
FY06 NTDRG REDUCT |
TOTAL TDRG REDUCT |
| 1 |
$14,285,642 |
$14,097,510 |
$188,132 |
$392,117 |
| 2 |
$136,845,275 |
$134,139,573 |
$2,705,703 |
$3,534,619 |
| 3 |
$33,456,520 |
$33,000,324 |
$456,196 |
$724,096 |
| 4 |
$5,681,868 |
$5,611,628 |
$70,240 |
$133,847 |
| 5 |
$8,365,379 |
$8,207,992 |
$157,387 |
$249,990 |
| 6 |
$5,077,920 |
$4,987,955 |
$89,965 |
$122,372 |
| 7 |
$8,320,953 |
$8,300,782 |
$20,171 |
$66,519 |
| 8 |
$22,492,579 |
$22,055,963 |
$436,615 |
$872,555 |
| 9 |
$8,735,314 |
$8,637,577 |
$97,737 |
$168,325 |
| 10 |
$4,209,734 |
$4,131,086 |
$78,649 |
$166,585 |
| 11 |
$10,137,179 |
$9,982,223 |
$154,956 |
$273,400 |
| Total |
$257,608,363 |
$253,152,612 |
$4,455,751 |
$6,704,425 |
INVESTOR-OWNED CHAIN #2
| HOSP |
FY05 MEDICARE REV. |
EST FY06 MEDICARE REVENUE |
FY06 NTDRG REDUCT |
TOTAL TDRG REDUCT |
| 1 |
$54,915,614 |
$54,551,548 |
$364,066 |
$932,220 |
| 2 |
$10,619,638 |
$10,607,224 |
$12,414 |
$82,763 |
| 3 |
$13,085,388 |
$13,045,694 |
$39,694 |
$56,139 |
| 4 |
$22,617,364 |
$22,532,619 |
$84,745 |
$252,791 |
| 5 |
$25,891,920 |
$25,688,822 |
$203,099 |
$378,076 |
| 6 |
$7,422,139 |
$7,415,638 |
$6,501 |
$173,301 |
| 7 |
$21,183,625 |
$20,947,959 |
$235,666 |
$335,310 |
| 8 |
$22,883,509 |
$22,720,986 |
$162,523 |
$274,635 |
| 9 |
$15,778,496 |
$15,718,312 |
$60,184 |
$133,592 |
| 10 |
$24,674,582 |
$24,527,066 |
$147,516 |
$196,741 |
| 11 |
$10,052,531 |
$9,986,493 |
$66,038 |
$113,060 |
| 12 |
$20,029,958 |
$19,815,591 |
$214,367 |
$428,904 |
| 13 |
$16,678,213 |
$16,500,577 |
$177,636 |
$314,779 |
| 14 |
$9,002,106 |
$8,778,947 |
$223,159 |
$314,424 |
| 15 |
$113,107,585 |
$112,281,565 |
$826,020 |
$1,130,269 |
| 16 |
$29,772,643 |
$29,372,255 |
$400,388 |
$664,260 |
| 17 |
$75,133,006 |
$74,325,608 |
$807,398 |
$1,598,028 |
| 18 |
$39,761,065 |
$39,347,412 |
$413,653 |
$598,512 |
| 19 |
$11,102,567 |
$11,060,621 |
$41,946 |
$78,469 |
| 20 |
$24,471,881 |
$24,337,571 |
$134,310 |
$301,059 |
| 21 |
$16,256,118 |
$16,106,760 |
$149,358 |
$179,609 |
| Total |
$584,439,949 |
$579,669,268 |
$4,770,681 |
$8,536,939 |
BACKGROUND INFORMATION ON TDRG/TDVI REPORTS TRANSFER DRGS/MARKETING/REPORT OVERVIEW - 11/11/05
- All reports are based on FY2004 MedPAR data.
- We assume that the mix of patients does not change.
- We take into consideration how hospitals' responded to "old" TDRGs = OTDRGs = DRGs for which transfer rules existed in FY04. We assume hospitals' responses in FY04 are valuable predictors of hospitals' response to "new" TDRGs = NTDRGs.
- The TDVI takes into account:
- Pct of cases in NTDRGs.
- Pct of cases transferred to rehab, nursing home, home health.
- Pct of early discharges.
- Response to OTDRGs.
- The TDVI represents the "relative risk," based on the relative reduction for a particular group, compared to the overall estimated reduction. A "particular group" might be a hospital, an MDC, or a DRG. For example, a hospital CFO might wish to estimate the particular risk overall for his facility. A hedge fund manager may want a single TDVI for an entire publicly traded organization. Mid-level managers may wish to study the TDVI for a Major Diagnostic Category.
- The total risk is the estimated percent reduction in Medicare revenue from the new TDRGs, which became effective on 10/1/2005.
- We need to double-check which TDRGs became applicable in FY05. Those are OTDRGs, but we don't know how hospitals responded to these, since we only have FY04 data. We call these OTDRG5.
HOSPITALS
- Their main question is: How much can we expect to lose, if we don't change our transfer patterns?
- Where should we take action, (using Pareto's Principle), to cut our losses?
- What MDCs should we focus on?
- Are the reductions in Medicare revenue from the TDRGs greater for surgical or medical cases?
HEDGE FUNDS
- How much money is taken away for a group of for-profit hospitals?
- Is one investor-owned company at greater risk than another?
- Is the problem worse for hospitals with a higher mix of high-tech = surgical caseload than medical?
- They may like to know the distribution, for FY06, of patients by
- XTDRGs = DRGs for which transfer rules do not apply
- OTDRGs = DRGs that involved transfer rules before FY06
- NTDRGs = DRGs for which the new transfer rules began on 10/1/05
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