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Table 2. Contrast patients with greatest and least costs
Row
number
3-DIGIT ICD-9-
CM CONDITION
CODE
3-DIGIT ICD-9-
CM CONDITION
CODE
3-DIGIT ICD-9-
CM CONDITION
CODE
3-DIGIT ICD-9-
CM CONDITION
CODE
Standardized
totalreimbursement: mean =
0 standard deviation = 1
1
-1
-1
-1
-1
-1.78629
2
-8
-1
-1
-1
-1.41160
3
429
-1
-1
-1
-1.31158
4
414
-1
-1
-1
-1.28103
5
-1
-1
-1
-1
-1.19145
6
414
410
-1
-1
-1.13326
7
414
410
-1
-1
-1.08304
8
-1
-1
-1
-1
-1.04587
9
444
429
786
786
-1.03820
10
410
-1
-1
-1
-1.02175
139
794
-1
-1
-1
1.53877
140
-1
-1
-1
-1
1.63953
141
410
-1
-1
-1
1.74980
142
429
786
-1
-1
1.88893
143
-8
-1
-1
-1
1.90818
144
-1
-1
-1
-1
1.99283
145
-1
-1
-1
-1
2.02380
146
-8
-1
-1
-1
2.45501
147
429
-1
-1
-1
2.55625
148
-1
-1
-1
-1
4.68343
Only one patient has three diagnosis codes; the diagnosis codes do not seem to be different. Therefore,
the patient's severity does not appear to explain the difference in costs and resource utilization; that is,
there is no apparent relationship between the reported diagnosis codes and the total costs for treating each
patient. Patient 148 with a standardized reimbursement of 4.68 has no diagnosis codes listed. Therefore,
we need to look at the patient conditions dataset (which is a separate data file in the MEPS collection)
that contains all diagnoses given to each patient in the course of the year. We can look at these most
crucial patients. Table 3 gives the reimbursements for the patients with procedure '36' for the year 2005.
As there are just nine patients, we can look at each individually.
The total reimbursement ranges from a low of $2750 to a high of $41,000. Because the '36' is incom-
plete, it is not known if these patients have similar procedures, or if the difference is enough to account
for the difference in payments. We can first look to see if they have different secondary procedures.
Table 4 gives the patient conditions for these nine patients as identified in the conditions dataset. In
contrast to the inpatients file, which lists just a handful of diagnoses, there are a total of 72 diagnoses
for these nine patients.
There is no obvious reason that patient #37357013 should cost more compared to patient #55776017
just by comparing the patient conditions.
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