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The Frail, the Old, and Diagnosis Related Groups

Gary Yarbrough, MD
JAMA. 1987;257(15):2030-2031. doi:10.1001/jama.1987.03390150046011.
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To the Editor.—  I read with interest the article by Jencks and Kay1 regarding patient characteristics as modifiers of hospital charges under the diagnosis related group system. The authors looked at the poor, the old, the very old, the younger disabled, younger patients with end-stage renal disease, and the older disabled. The authors themselves acknowledge that "devices used to identify characteristics of beneficiaries are imprecise," yet proceed to assert that there is no evidence that the most vulnerable Medicare patients cost more to treat than the Medicare population as a whole.That this conclusion flies in the face of logic and experience is obvious. The reasons for the authors' errors may not be as clear. Certainly, failure to identify those who are truly more vulnerable has contributed to error, as acknowledged by the authors themselves. Achieving 80 years of life does not necessarily guarantee frailty, and failure to measure

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