The health care industry has utilized the drgs across

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The health care industry has utilized the DRGs across a wide array of applications. Hospitals have used DRGs as the basis of internal management systems. Medicaid programs and Blue Cross plans have used DRGs as the basis of payment systems. State data commissions have used DRGs as the basis for statewide comparative reporting systems. Most of these applications have utilized the DRGs across the entire patient population. Thus, the failure of the DRG update process to address DRG problems for the non-elderly population became a serious limitation for most applications of the DRGs. Development of the AP-DRGs In 1987, the state of New York passed legislation instituting a DRG-based prospective payment system for all non-Medicare patients. The legislation included a requirement that the New York State Department of Health (NYDH) evaluate the applicability of the DRGs to a non-Medicare population. In particular, the legislation required that the DRGs be evaluated with respect to neo- nates and patients with Human Immunodeficiency Virus (HIV) infections. NYDH entered into an agreement with 3M HIS to assist with the evaluation of the need for DRG modifications as well as to make the necessary changes in the DRG definitions and software. The DRG definitions devel- oped by NYDH and 3M HIS are referred to as the All Patient DRGs (AP-DRGs). Extensive research had been performed by the National Association of Children’s Hospitals and Related Institutions (NACHRI) on alternative approaches to reformulating the DRG categories for neonates and other pediatric patients. The system developed by NACHRI is called the Pediatric Modified Diagnosis Related Groups or PM-DRGs. The PM-DRGs created many additional DRGs specifically for pediatric patients. For neonates, a total of 47 DRGs were created. Neonates were defined as newborns and all other patients of age less than 29 days at admission. As part of its evaluation effort, NYDH and 3M HIS examined the NACHRI neonatal definitions and adopted a modified version of the NACHRI system. The NACHRI system introduced birth weight and duration of mechanical ventilation as two new variables for neonatal patients. The AP-DRGs include birth weight, but in place of the duration of mechanical ventilation use the non-OR procedures for continuous positive airway pressure and mechanical ventilation in the definitions of certain neonatal AP-DRGs. Except for neonates who die or are transferred within the first few days of life, the AP-DRGs define six ranges of birth- weights that represented distinct demands on hospital resources: Less than 750 grams 750-999 grams 1000-1499 grams 1500-1999 grams 2000-2499 grams Greater than 2499 grams
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12 The six birth weight categories are used as the primary variable in forming the neonatal AP-DRGs. Within each birth weight range, the neonates are first subdivided based on the pres- ence of a significant OR procedure, and then further subdivided by the presence of multiple major problems, major problems, minor problems, or other problems. In addition, there are normal new-
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  • Fall '18
  • Diagnosis-related group, DRGs

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