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In 2006 it was estimated the annual number of cases of community acquired pneumonia in the U.S. was between 5,000,000 and 6,000,000 with a total

In 2006 it was estimated the annual number of cases of community acquired pneumonia in the U.S. was between 5,000,000 and 6,000,000 with a total cost of more than $8 billion. While the cost per case is low, the cost per case for patients requiring hospitalization is not low. A group of physicians and support staff decided to analyze DRG 89, Pneumonia, to determine if there were cost saving opportunities and to prioritize any opportunities identified. Using the table below, A) calculate the potential cost savings based on the current treatment profile and the best practice identified, B) divide the potential savings based on whether the physician must change their practice style or managers should reduce the cost of delivering services, and C) prioritize the top four opportunities, i.e., which areas should be targeted for improvement first.

DRG 89 - Community Acquired Pneumonia

Current Practice

Best Practice

Service

Quantity

Cost

Total cost

Quantity

Cost

Admission

1

$39

$39

1

$30

Med/Surg

6

$1,200

$7,200

4.9

$1,050

Respiratory therapy

6

$200

$1,200

6

$150

Rehab therapy

4

$150

$600

3

$150

Dietary

18

$23

$414

14.7

$15

Clinical Lab

18

$75

$1,350

15

$75

Radiology

6

$100

$600

4

$95

Pharmacy

36

$110

$3,960

30

$85

Social services

3

$75

$225

3

$60

Cardiology

1.5

$100

$150

1.5

$100

Total Cost

$15,738

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