I costi della comorbilità: Gli APR-DRG in geriatria

The patient classification system based on DRG actually running in Italy has many limits in geriatrics. A possible example of this matter is Senile Dementia where the same clinical problem has different classification and reimbursement. A new patient classification system APR-DRG seems to evaluate properly the geriatric patient even when compared to the comprehensive geriatric assessment (CGA) and to identify the frail elderly at risk of resource consumption. The Yale Costing Model is a step-down method for evaluating costs that we are now applying in our Hospital to compare costs to hospital charges for each APR-DRG ranked by severity level in geriatric patients. Opportunity exists to carry out a revision of the Italian Prospective Payment System to promote the implementation of a severity refined classification system like APR to obtain a better risk adjustment and to avoid that an unfair payment would adversely affect the hospital treating the frail elderly.