Financial implications of hospital response to bioterrorism based on diagnosis-related group analysis.

INTRODUCTION: During an infectious disease outbreak, the ability of a hospital to continue routine operations depends upon its ability to absorb expected losses in revenue when the routine charge base is replaced by infectious disease-related charges.

OBJECTIVE: The purpose of this study was to determine the probable financial impact of a bioterrorism event or an infectious disease outbreak on an academic and a community hospital.

METHODS: During the fiscal year 01 July 2002-30 June 2003, the average number of inpatient charges identified by the diagnosis-related-groups (DRGs) of an academic, tertiary care, Level-1 trauma center (PUH) and a community hospital (StM) were obtained retrospectively. Per diem charges were determined for patients with: (1) gastroenteritis; (2) sepsis; (3) meningitis; (4) tuberculosis (TB); and (5) pneumonia. These charges were used to simulate the financial coding of patients exposed to biological agents.

RESULTS: The total average PUH per diem charges per patient for all 31,530 discharges was (US)$10,516. Specifically, the average changes were $20,499 for patients with transplants, $14,406 for receiving critical care services, $12,650 for the provision of cardiac care, $11,576 for trauma/orthopedic care, and $8,259 for services for patients who suffered a stroke. For patients with infectious diseases, the average per diem charges per patient were: (1) $6,184 for patients with gastroenteritis; (2) $7,842 for patients with sepsis; (3) $10,831 for patients with meningitis; (4) $6,118 for patients with TB; and (5) $4,586 for patients with pneumonia. Per patient per day, PUH would generate a potential net on average loss of: (1) $4,332 for gastroenteritis; (2) $2,674 for sepsis; (3) $4,398 for TB; and (4) $5,930 for pneumonia replaced an admission. Patients with meningitis on average generated a net gain ($315) compared to the average, but would not compensate for the denial of transplant, cardiac, trauma/orthopedic, and some critical care services during the event. Total average StM per diem charges per patient for all 10,470 discharges equaled $3,008. Specifically, $4,965 for critical care, $3,022 for cardiac care, $4,397 for trauma/orthopedic care, and $3,037 for stroke services. For infectious diseases, the average per diem charge per patient was: (1) $2,273 (+$735) for gastroenteritis; (2) $3,047 (+$39) for sepsis; (3) $2,504 (-$504) for meningitis; (4) $2,887 ($120) for TB; and (5) $2,652 (-$356) for pneumonia (net loss/gain in parenthesis).

CONCLUSIONS: Through DRG analysis, the probable financial impact of a bioterrorist attack on a Health Care Delivery System is largely detrimental. Preparedness for a biological event must include an assessment of hospital capability and capacity to handle these types of patients, but also must consider the financial ability to absorb expected losses in charges or ways in which to recover the losses.