student
Russian Federation
The study examines cost management in a case-based payment group (DRG) system as an operational discipline of a hospital. Based on discrete event modeling of a “digital twin” of a multidisciplinary hospital (600 beds; calibration on 9,800 episodes, validation on 2,600), three scenarios are compared: baseline, process (length of stay percentile goals and diagnostic turnaround times, pre-discharge planning, ERAS/day hospital), and full (plus improved clinical documentation and formulary policy). Process measures reduced tails, median stay, and episode cost; adding CDI and standardization of materials increased the Case Mix Index and revenue without worsening outcomes. The sustainability threshold is reached at a day hospital share ≥ 20% and coding discipline; without TAT improvements and CDI, a significant portion of the gain is lost. The work demonstrates how the combination of protocols and process speed levels out the cost of treatment in the CCG.
DRG, DRG, length of stay (LOS), turnaround time (TAT), ERAS, day hospital, CDI, Case Mix Index (CMI), episode cost, digital twin, standardization, pre-discharge planning.
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