I am trying to find the dollar amount Medicare currently reimburses
for hip fracture hospitalizations (ideally 2002 or 2003 data, 2001
ok). Reimbursement is done through DRGs (Diagnosis-Related Groups)and
I believe the DRG for hip fractures is 236. Reimbursement may vary by
region.. if so I would like data for a few regions and hopefully a
list / explanation of other regions so I can follow up on those. For
reference, hip fracture hospitalizations were estimated to cost
$11,500 in 1994.  I am also interested in reimbursement for vertebral
fractures and forearm fractures and will post separate questions with
separate fees, if someone is able to answer this one.

Thanks,
Brendan

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Clarification of Question by bkelly2001-ga on 16 May 2003 08:50 PDT

This seems difficult to get without a provider ID.  It is important
for me to understand this information though, so if someone does have
provider access, I may be willing to pay up to $100 for reimbursement
and average cost levels for hip, vertebral and forearm fractures.
Please contact me / comment if you may be able to find this and we can
discuss what price may be appropriate for the information you can
find.

Thanks,
Brendan

Hi Brendan,

I can give you a few leads on your question and hopefully another
researcher can pick up the remainder.  On first glance, it looks as if
the Medicare site now requires a provider ID# to view information.

I did find this information at another coding site and you are correct
on the DRG 236.

DRG Info and Setup:    
GMLOS: 3.9     AMLOS: 4.9     Rel Wt: 0.735     Ave Nat Pmt: $3253.85
 
ICD-9 Codes:  808.0 - 808.9  
http://tinyurl.com/boyv

If you are a contracted provider, you should be able access the
information here:
http://cms.hhs.gov/paymentsystems
http://cms.hhs.gov/providers/pricer/pricdnld.asp

Per the National Osteoporosis Foundation:
http://tinyurl.com/bozy

"The average cost for hospitalization from a hip fracture is $26,000,
not including physician fees."

Best of luck and I'll check back on the progress of your question.  
V