Early discharge of the postmastectomy patient: unbundling of hospital services to improve profitability under DRGs.

Cost containment is necessary for health care facilities to remain profitable and, therefore, operable. Thus, newer strategies of providing quality patient care need be developed to achieve this goal. The purpose of this study was to compare the costs and outcome of patients who had modified radical mastectomies, who were discharged home with an indwelling hemovac drain, and whose follow-up was conducted by visiting nurses in contrast to the traditional hospitalization of these patients until the hemovacs were removed. Two groups were compared in a prospective fashion. Twenty patients who had undergone a modified radical mastectomy for stage I or II breast carcinoma and who were discharged home with an indwelling hemovac drain (HWIH) were compared with 20 modified radical mastectomy patients who remained hospitalized with the drains for continuous wall suction (IHWH). Mean length of stay for the HWIH group (2.65 days) was significantly lower than the IHWH group (9.65 days) (P less than .001). Mean total hospital charges (exclusive of physician fees) were significantly lower for the HWIH group ($ 2106) than for the IHWH group ($ 7672) (P less than .001). Under Diagnosis Related Group (DRG) reimbursement allowances, the IHWH group had a loss of $ 355 per patient, whereas the HWIH group had a profit of $ 5211 per patient. One complication in the HWIH group required rehospitalization (a wound infection that was treated with IV antibiotics). This study suggests that significant improvement in efficiency may be accomplished for selected mastectomy patients who are discharged home with the indwelling hemovac drain to be followed as outpatients by both the surgeon and a nurse specialist.