Diagnostic Related Groups (DRGs) are primarily used to determine reimbursement for inpatient stays. Every inpatient visit is placed into one DRG category based on the patient’s primary diagnosis, procedures performed, and discharge status.
Each DRG is given a weighted value relative to the time and resources required to effectively administer care for the average patient. This value is multiplied by a preset dollar amount unique to each hospital that reflects its individual status (teaching hospitals have higher reimbursements, for example) and service area demographics (such as average local wage levels) to find the total reimbursement amount.
The most common diagnosis by hospital admissions volume is septicemia, followed by heart failure and shock in second, and then psychoses in third. In 2018, diagnoses for septicemia reached an approximate 31.6 million, 30 million of which were secondary diagnoses.
Definitive Healthcare’s claims data shows that total diagnoses of heart failure and shock increased substantially since 2016, where it previously ranked as the fourth highest diagnosis by volume — 11.6 million in 2016 vs. 18.2 million in 2018.
Psychoses saw 12.5 million total diagnoses in 2018, on par with previous years. Part of the reason for the consistently high psychoses volumes is the definition of the DRG itself. Its subcategories include multiple types of severe mental illnesses that can require inpatient treatment, such as schizophrenia, bipolar disorder with manic episodes, and severe depression.