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March 21, 1986

Diagnosis-Related Groups and Severity of Illness

Author Affiliations

Elmhurst, Ill

JAMA. 1986;255(11):1435. doi:10.1001/jama.1986.03370110057008

To the Editor.—  The "insensitivity of the DRGs [diagnosis-related groups] to severity of illness" mentioned by Dr Mullin1 is a major problem for two reasons. First, ignoring the importance of "severity of illness" may sound the death knell for DRGs as the preferred basis of prospective payment. This problem is likely to be resolved by adoption of a capitation system for paying both physicians and hospitals.In the long run, the greater problem with the clinical "insensitivity" of the DRG system is its failure to satisfy the "severity of illness" factor in the development of physician performance profiles, useful in evaluating efficiency and effectiveness of clinical practice habits.To help a physician decide to practice efficiently, three sets of data are needed: (1) Cost data, to confirm that "you're spending more than your peers." (2) Severity of illness data, to satisfy the response, "Of course I am. I treat