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April 17, 1987

The Frail, the Old, and Diagnosis Related Groups-Reply

Author Affiliations

Health Care Financing Administration Baltimore

Health Care Financing Administration Baltimore

JAMA. 1987;257(15):2031. doi:10.1001/jama.1987.03390150046012

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In Reply.—  A common theme in the letters from Drs Yarbrough and Fulop is that elderly patients are more expensive to treat than younger patients. Dr Yarbrough points out the difference between an 80-year-old jogger and an 80-year-old patient with emphysema and hemiparesis, and his point is well taken. Since our article was submitted for publication, unpublished work by the Prospective Payment Assessment Commission (ProPAC) staff (Kurt Price, PhD, personal communication, February 1987) indicates that age predicts almost nothing about the cost of a patient's care once diagnosis related group and comorbid conditions are taken into account. Their findings suggest that including age in the diagnosis related group algorithm actually reduces its precision. The Medicare Prospective Payment System has strongly encouraged hospitals to code comorbid diagnoses fully, and we believe the resulting improvement in data quality may explain the modest difference between the ProPAC results and ours. In any case,