DRG Creep

A method of coding diagnosis-related groups (DRGs) under Medicare’s prospective payment plan, in a fashion that does not conform to the ‘optimisation’ rules governing coding DRGs; DRG creep often errs in favour of the hospital by paying more than it should receive
Causes Misspecification, miscoding, and resequencing
Mentioned in ?
References in periodicals archive ?
(11), foi o da atribuicao, aos pacientes internados, de DRG que nao correspondiam exatamente ao seu perfil, e sim a grupos de mais alta pontuacao, no fenomeno denominado de DRG creep. Finalmente, de acordo com Guterman e Dobson (12), pode-se supor que o metodo de pagamento prospectivo por procedimento leve a uma mudanca das prioridades dos prestadores, na qual se subordine a preocupacao com a qualidade a objetivos meramente financeiros.
Researchers found that at least part of the increase in case mix among hospitals after the Diagnosis Related Groups (DRG) system was introduced was attributed to differences in documentation or "DRG creep" (Steinwald and Dummit 1989; Carter, Newhouse, and Relles 1990; Hsia et al.
changes in hospital record keeping practices to increase case mix and reimbursement." Code creep is also often referred to as upcoding and, in hospital billing, diagnosis-related group (DRG creep).
Only 60-65 percent of that increase is real, with the remainder reflecting "upcoding" or DRG creep. At the same time, a case mix index understates intensity increases by failing to capture the average intensity increase produced by shortened lengths of stay.
This increase may be a sign of new pressures placed on doctors by hospitals, an indication of "DRG creep."
This phenomenon has come to be known as "DRG creep" in the United States (Hsia et al.
Although some quality evaluations revealed little DRG creep, it is not entirely clear that the payers have in place the necessary evaluative mechanisms to determine DRG creep.
1987) and preventing so-called DRG creep (upcoding to maximize hospital benefits: Ginsburg and Carter 1986; Hsia, Krushat, Fagan et al.
Brooks, P.E., and Fagan, A.B.: DRG creep and miscoding under the prospective payment system.
Simborg, D.W.: DRG creep. A new hospital-acquired disease.
Simborg, D.W.: DRG creep: A new hospital acquired disease.
If the procedure is susceptible to manipulation but is nevertheless adopted as an adjustment factor for DRGs, it may subsequently be performed more frequently and in less severely ill patients--a form of "procedure creep" analogous to "DRG creep" (Simborg, 1981).