A facility is looking into the possibility of adding or deleting

procedures to their surgery product line in the cardiothoracic area.

The following table lists the types of procedures they are reviewing

MS-DRG Description Relative Wt. National LOS

Heart Transplant or Implant of Health

22 15.6820 15.7
Assist System w/o MCC

Cardiac Valve & Other Maj

2216 9.2380 13.0
Cardiothoracic Proc w Card Cath w MCC

Coronary Artery Bypass w PTCA w/o

2232 5.5976 7.9
MCC

2237 Major Cardiovas proc w MCC 5.0843 6.7

Number of Patients
Your hospital's Actual (estimate) Your hosp
DRG
LOS charges
 

2 20.9 3 $89,500

216 12.1 107 $49,500

232 7.1 240 $32,000

237 11.6 156 $25,000

Complete the information below to determine the case mix of these

surgery patients in your facility.

1. Determine the case mix for this group of procedures

MS-DRG Number of Patients Total Weights

2 3  3X15.6820=47.046

216 107  107X9.2380=988.466

232 240  240X5.5976=1343.424

237 156  156X5.0843=793.1503

Totals  506  3172.0863

Case mix    3172.0863\506=6.26

2. Complete the estimated per patient payment from third parties for
these MS-DRGs. Round to the whole number.

Estimated per patient revenue

Number of Your hospital's
from third parties (based on a
MS-DRG Patients Actual average
hospital payment rate of
(estimate) charge
$5,500)

2 3  15.6820X5500=86,251 $89,500

216 107  9.2380X5500=50,809 $49,500

232 240  5.5976X5500=30,786.80 $32,000

237 156  5.0843X5500=27,963.65 $25,000

3. Compute the difference in LOS

 Your hospital's National Average
MS-DRG Difference
Actual LOS LOS

2 20.9 15.7  5.2

216 12.1 13.0  -0.9

232 7.1 7.9  -0.8

237 11.6 6.7  4.9

4. Compute the difference in reimbursement or charges

Estimated revenue from third

MS-DRG parties (based on a hospital Your hospital's average charges Difference
payment rate of $5500)

22  86,251 $89,500  -3249

2216  50,809 $49,500  1309

2232  30,786.80 $32,000  -1213.20

2237  27,963.65 $25,000  2963.65

5. For this group of patients only, what would the estimated income

be?

Estimated revenue from third

No. of patients Estimated
MS-DRG parties (based on a hospital
(estimate) reimbursement
payment rate of $5500)
22  86,251 3  $258,753

2216  50,809 107  $5,436,563

2232  30,786.80 240  $7,388,880

2237  27,963.65 156  $4,362,384

6. Based on this information, if you had to choose one procedure to

add to your surgical product line, which one would it be and why? 

Coronary Artery Bypass w PTCA w/o MCC I would choose this one
because it has the biggest return . Even though this procedure will
take a loss on the charges the reimbursement will even it out.