DRGs and specialized nutrition support. Prospective payment and nutritional support: the need for reform.

The Medicare Prospective Payment System does not recognize the use of parenteral and enteral nutrition services as an explicit factor to be used in determination of DRG payment rates. When the DRGs were originally created, the use of parenteral and enteral nutrition services (PENS) was not coded in discharge data sets. As a result, it was impossible to determine whether patients who received PENS were more expensive to treat. Data we have collected indicate that patients who receive PENS tend to have high hospital costs--costs that often exceed the DRG payments established by the Health Care Financing Administration (HCFA). The potential for a hospital to incur a financial loss as a result of treating patients who require PENS could make such patients less attractive to hospitals and thus could adversely affect patients requiring these services. In order to minimize this possibility, we suggest several alternative modifications to the DRG payment system. The modifications would provide higher payments for patients who require PENS, thereby reducing the possibility of discrimination against these patients. By readjusting the DRG prices for patients who do not require PENS, the entire payment modification can be made budget-neutral.