The family of an elderly client demonstrates understanding of diagnosi

QUESTION

The family of an elderly client demonstrates understanding of diagnosis-related groups (DRGs) when which statement is made?

1. “Since he has the same diagnosis as others who were able to be discharged early, he has to be discharged.”
2. “Since the average length of stay for his diagnosis is exceeded, he must be
discharged from the hospital. ”
3. “Medicare will continue to pay for his care for as long as he
requires hospital care.”
4. “Since he has does not have several related medical issues and diagnoses, Medicare requires him to be discharged.”

ANSWER:

Answer: 2
Rationale: DRGs are a prospective system of payment to providers and organizations for a set amount for a specific condition stipulated in advance. The medical diagnosis is the basis for the earned payment, not the particular clients’ specific needs for the illness or disease the diagnosis represents. The payment is then based on the average care required for that diagnosis. Fee-for-service plans pay for each individual hospitalization based on the particular length of stay after services are rendered. A DRG applies to all clients with those related diagnoses, not just one client.