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This commodity provides an overview of neonatal accelerated affliction assemblage (NICU) analysis costs. It discusses abstracts sources as able-bodied as the methods for barometer costs, allegory the strengths and weaknesses of alternating approaches. In addition, abundant advice on NICU analysis costs is presented from a nationally adumbrative sample of 25 hospitals with NICUs. The sample consists of 3288 absolute low bearing weight breed (≤1500 g at birth) with acceptance dates amid January 1, 1993, and September 30, 1994. Advice on boilerplate analysis amount per infant, accessory costs, adaptation costs, breadth of stay, and amount per day are presented. In addition, accessory costs are disaggregated added into those for respiratory therapy, laboratory, radiology, pharmacy, and all added accessory services.

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Athough advances in neonatal technology in the accomplished decades accept bigger adaptation affairs decidedly for breed built-in prematurely, these accept arise at a aerial cost. Neonatal accelerated affliction stays are amid the best big-ticket types of hospitalizations.1 Affection advance efforts will affect analysis costs because they will alter, in some way, the assets acclimated in accommodating care. Because of the aerial amount associated with anniversary day spent in the neonatal accelerated affliction assemblage (NICU), affection advance efforts that aftereffect in bigger accommodating outcomes and abate the time spent in the NICU can potentially aftermath cogent amount savings. However, analysis costs additionally may rise, because not all affection advance efforts will necessarily abate the assets acclimated in accommodating care.

In this article, we aboriginal altercate how NICU analysis costs are measured. We again about-face to a altercation of how analysis costs can be compared beyond institutions and, finally, present contempo affirmation of what is accepted about the costs of neonatal accelerated affliction based on abstracts acquired from the Amount and Resource Utilization action in the Vermont Oxford Network.

Treatment costs about are abstinent by accuse in the literature. Yet, accuse for hospital stays are not authentic measures of cost, because they abash the absolute costs of analysis with the appraisement behavior of hospitals. This is decidedly ambiguous for comparisons beyond hospitals, for which appraisement behavior can alter widely. In a abstraction of absolute low bearing weight (VLBW) breed in the California Medicaid population, Rogowski and Harrison2 begin that the boilerplate allegation for the antecedent analysis abstract analysis costs by 53%.

However, alike for comparisons of patients aural a accustomed hospital, the absolute allegation for a patient’s affliction is not an authentic admeasurement of the amount of treatment. This is because the aforementioned mark-up is not activated to all casework provided by a hospital. In fact, advanced aberration about exits in the mark-up ante for alone casework aural hospitals. As an example, altered mark-ups are acceptable to be activated to respiratory affliction food than to antibiotics. The absolute allegation for a accustomed accommodating reflects the agreement of casework acclimated in analysis and the admeasurement of the mark-ups activated to those services. Thus, the absolute allegation represents a altered mark-up over costs for anniversary patient, depending on the types and amounts of casework acclimated in their treatment.

To admeasurement analysis costs, therefore, it is all-important to disentangle the appraisement behavior of hospitals from abstracts on charges. Figure 1 delineates the conception of hospital amount measures from abstracts on hospital charges. These chase methods accustomed in the literature.3,,4

Measuring hospital costs.

The base for all abstracts of hospital costs is abstracts on hospital charges. Abstracts on hospital accuse can be acquired from several sources, including abundant bills, UB-92 forms, and state-mandated hospital allegation abstracts. Anniversary of these abstracts sources varies in the akin of detail on accuse provided. The best abundant abstracts are line-item bills. These annual anniversary annual provided during the patient’s break with the associated charge. Such data, for a archetypal neonatal accelerated affliction stay, are voluminous. For a archetypal hospital, there may be 10 000 allegation codes acclimated to actualize abundant accommodating bills. Alternately, added aggregated abstracts abide on UB-92 forms. The UB-92 anatomy is the accepted Medicare bill and contains advice on accuse that is added aggregated than a abundant bill. Although few neonatal accelerated affliction stays are billed to Medicare, best hospitals accomplish these forms for added types of patients as well, and this blazon of abstracts additionally can be acclimated for barometer analysis costs for neonates. Abstracts on these forms are aggregated to the UB cipher level. The UB codes are a annual of accepted codes for the types of casework provided by hospitals. In adverse to abundant allegation codes, there are about 100 UB-92 codes (and several hundred subcodes). As an example, the UB cipher for pharmacy is authentic as “charges for medication produced, manufactured, packaged, controlled, assayed, dispensed and broadcast beneath the administration of a accountant pharmacist.” Additional subcategories may be acclimated by hospitals for such items as all-encompassing drugs, nongeneric drugs, and intravenous solutions. Hospitals alter in their use of subcodes. Nonetheless, these types of abstracts are aggregated and appreciably beneath circuitous to use than are abundant line-item bills. Finally, abstracts additionally abide as allotment of state-mandated hospital acquittal abstracts. For example, the accompaniment of California mandates that abstracts on all hospital discharges be provided to the Office of Statewide Health Planning and Development. These acquittal abstracts accommodate advice on the absolute allegation for anniversary stay. For the affidavit acclaimed above, a distinct absolute allegation may not accommodate a acceptable base for the altitude of costs. However, abundant line-item bills, as able-bodied as UB-92 forms, accommodate acceptable bases for the altitude of analysis costs.

As apparent in Fig 1, abstracts on an alone allegation from a accommodating bill allegation be adapted to a admeasurement of cost. Then, the costs associated with anniversary alone allegation annual are summed to access at the absolute amount associated with the stay. The key to the amount about-face alignment is the about-face factor, accepted as a cost-to-charge ratio, which is acclimated to accumulate anniversary alone allegation to actualize a admeasurement of cost. These ratios are acquired from hospital amount reports. A hospital amount abode is a accepted banking advertisement anatomy generated anniversary year by hospitals as allotment of advertisement requirements imposed by such ample insurers as the Health Affliction Financing Administration (HCFA) for the Medicare affairs (form HCFA2552) and, in some states, by authoritative agencies. For example, in the accompaniment of California, all hospitals are appropriate to book a amount abode to the Office of Statewide Health Planning and Development anniversary year. Letters for HCFA and for alone accompaniment authoritative agencies are different. For example, the California amount letters accommodate added revenue-generating centers than do the HCFA amount letters and appropriately are added disaggregated (both of these types of letters are accessible publicly).

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The aspect of amount letters that makes them admired for amount altitude purposes is that for anniversary revenue-generating centermost in the hospital, the amount abode provides advice from which a cost-to-charge arrangement can be constructed. This arrangement represents the boilerplate mark-up activated to casework aural that revenue-generating centermost during the advertisement year. An archetype of a revenue-generating centermost is the laboratory; patients are billed for casework provided by the laboratory. An archetype of a nonrevenue-generating action are the casework provided by hospital’s administrators, which cannot be anon billed to patients. The accuse on a patient’s bill are generated alone by revenue-generating centers aural the hospital. Thus, the amount abode provides about-face factors for all the accuse that arise on the accommodating bill. Of course, alone accuse accept to be mapped to revenue-generating centers. This can be a nontrivial exercise. Amount letters about accommodate 25 to 50 revenue-generating centers. UB-92 forms may accommodate hundreds of UB codes (with subcategories), admitting abundant band items accommodate bags of codes.

The limitation of this amount about-face acclimation is that a compatible agency is activated to all casework aural a accustomed administration in the hospital. Thus, the acclimation will be best authentic back there is low about-face in mark-up ante aural departments. In addition, the measures of amount will be best authentic for a accustomed accommodating citizenry to be advised (in this case, neonates) back the casework acclimated by that accommodating citizenry in a accustomed administration accept a agnate administration of mark-ups as the casework acclimated by the accepted accommodating citizenry in the hospital.

Ideally, one would accept a cost-to-charge arrangement for anniversary abundant band item. In practice, however, this is not possible, and authoritative cost-to-charge ratios are the best types of abstracts available. However, software from bartering vendors about actualize measures of amount based on added disaggregated abstracts than those about accessible on amount reports. However, unless all hospitals use absolutely the aforementioned bartering software, measures of analysis amount will not be commensurable beyond hospitals because of differences in aberrant amount allocations. The allocation of aberrant costs is a key affair in the compatible altitude of analysis costs beyond institutions.

Indirect costs are those that cannot be billed anon to patients. These include, for example, items such as ambassador salaries.Figure 2 illustrates how hospital amount letters admeasure aberrant costs to revenue-generating centers. The amount abode contains advice on the absolute costs associated with anniversary revenue-generating centermost during the advertisement aeon covered by the amount report. In addition, all aberrant costs from the nonrevenue-generating centers are allocated to these revenue-generating centers. Aberrant amount allocations are fabricated application accounting rules that are sometimes arbitrary, such as those based on the aboveboard footage active by the department. From the angle of amount measurement, however, the use of a distinct cost-reporting apparatus for all hospitals ensures that these allocations are fabricated in a compatible abode beyond all hospitals. Because aberrant costs can be substantial, the use of compatible cost-reporting instruments is all-important to actualize measures of analysis amount that are commensurable beyond institutions.

Hospital amount reports.

The HCFA cost-reporting apparatus is the alone acclimation readily accessible that provides for the conception of compatible amount measures beyond hospitals amid in geographically assorted areas in the United States. The HCFA amount report, however, incorporates advice for all patients advised in the hospital, not aloof for the citizenry of absorption here, neonates. In particular, neonatal accelerated affliction and developed accelerated affliction are accumulated into a distinct department. (Coronary accelerated affliction and appropriate affliction are afar into their own departments.) Thus, from a altitude perspective, the catechism arises as to how altered the developed and neonatal accelerated affliction cost-to-charge ratios are. The nursing acuteness of the NICU is college than that for developed accelerated care. On the added hand, aberrant allocations are fabricated based on attic space. In a abstraction of the costing of pediatric services, Miller5 begin that the NICU had disproportionately low allocations of aberrant costs because of the baby attic amplitude active by these units. These two factors assignment in adverse directions, suggesting that the use of the HCFA cost-reporting apparatus for the altitude of adaptation costs will not be accountable to ample altitude errors. There are no studies that abode this affair directly. However, as a fractional analysis of this hypothesis, in the abstraction of VLBW breed in California, Rogowski and Harrison6 compared ratios complete for NICUs alone with those that were complete pooling developed and neonatal accelerated affliction units and begin the differences to be quantitatively small.

Similarly, the catechism arises as to how agnate the amount of accessory casework acclimated by neonates are to those incurred by adults. The Pediatric Costing Study5 provided some affirmation on this point as well. The abstraction assured that amid the aloft accessory casework (such as laboratory, radiology, pharmacy, and medical supplies), the amount of those acclimated by accouchement did not alter decidedly from those acclimated by adults. Thus, in general, the HCFA cost-reporting form, although not advised accurately to admeasurement neonatal accelerated affliction costs, is a acceptable antecedent of amount about-face abstracts for NICU patients. Its primary advantage is its universality, which should be advised adjoin any abeyant limitations in measurement.

Many hospitals accept software from bartering vendors to admeasurement analysis costs. In interpreting amount measures from bartering vendors, it is important to agenda that these will not necessarily be identical to those created application added methods, such as application the HCFA amount abode because aberrant amount allocations are fabricated in altered ways. Similarly, comparisons beyond hospitals of analysis costs generated by altered bartering software bales will be noncomparable.

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Finally, it should be acclaimed that hospital costs, as abstinent from the hospital bill, accommodate alone the institutional allocation of the stay. Physician costs additionally are an important basic of the all-embracing amount of the hospital stay. However, advice on physician accuse is difficult to access in a abode that captures all physician affliction provided. Best physicians or physician groups bill anon for their services, and accumulating of absolute announcement abstracts accordingly are difficult. It is possible, however, to beam physician costs in studies that are conducted on assertive groups of insured patients because all claims can be observed. For example, in a abstraction of VLBW breed in the California Medicaid population, Rogowski and Harrison2 begin that physician costs represented 16.7% of the amount of the antecedent hospitalization.

From the area aloft on amount measurement, a cardinal of important credibility appear with annual to comparing analysis costs beyond hospitals. The aboriginal is that accuse for the patients are not authentic measures of analysis costs, neither for comparisons of analysis costs beyond patients aural a accustomed hospital nor for comparisons beyond hospitals. Accuse are decidedly ambiguous for multiinstitutional comparisons, because they abash advice on costs with the appraisement behavior of alone hospitals. The additional is that it is accessible to actualize measures of analysis amount from allegation data. The important point to agenda in multiinstitutional comparisons is that absolutely the aforementioned acclimation for barometer costs allegation be activated beyond all institutions so that aberrant amount allocations are fabricated uniformly. Otherwise, the amount measures will be noncomparable. Amount altitude based on the HCFA amount letters is the alone alignment accessible currently for the conception of compatible costs beyond hospitals at the civic level.

In addition, in comparing costs beyond hospitals, several added factors charge to be taken into consideration. First, the amount of hospital inputs, both activity and capital, varies broadly beyond altered regions of the United States. For example, hospitals in New York City will accept college ascribe costs than those amid in rural Iowa. The ambition of comparing costs beyond institutions is to analyze the adeptness of accouterment accommodating care. Thus, the ideal admeasurement of costs would be one that controlled for differences in the costs activity and basic beyond hospitals. Fortunately, it is accessible to do this, because measures of the amount of hospital inputs accept been created by HCFA for use in adjusting DRG payments to hospitals for differences in these costs beneath Medicare’s -to-be acquittal system. These acclimation factors are appear annually in the Federal Register as allotment of the updates to the Medicare affairs regulations. Use of geographic acclimation factors permits the ciphering of costs as if anniversary hospital faced the boilerplate amount of activity and basic in the United States. This blazon of amount admeasurement about is not provided by bartering vendors. Finally, because of inflation, costs allegation be adjusted, if all-important to reflect differences in the year in which they were incurred. The accepted aggrandizement acclimation is based on the medical basic of the customer amount index, which is generated annually by the US Bureau of Activity Statistics (for example, see BLS7).

In benchmarking costs beyond institutions, it additionally is important to acclimatize for the severity of affliction of patients beyond hospitals. Because costs are accompanying to affliction severity, abortion to acclimatize for differences in case mix will amerce hospitals with added acutely ill patients. However, few sources of abstracts abide to actualize adjusters for the NICU accommodating mix. For example, few hospitals aggregate advice on bearing weight in their abstracts systems. To some extent, the added aesthetic versions of the DRG grouper, which accommodate breakdowns by bearing weight groups, accommodate a agency to acclimatize for differences beyond hospitals in case mix.8 Abstracts systems such as the Vermont Oxford Network are decidedly admired for this purpose, because the Network collects abstracts on clinically important accommodating characteristics that can be affiliated to amount abstracts to be able to acclimatize analysis costs empiric for differences beyond hospitals in accommodating mix.

Finally, in benchmarking costs, it about is adorable to analyze costs with a associate accumulation of institutions. Back accommodating mix is not observable, selecting hospitals that amusement agnate types of patients is one way to proxy for the mix of patients. In addition, hospital costs are accepted to alter with hospital characteristics. For instance, teaching hospitals accept college costs than do nonteaching hospitals.9 Thus, the adeptness to analyze costs beyond a associate accumulation of institutions about is adorable by hospital administrators. Bartering abstracts systems about are bound in this regard. Bartering advertisement casework can alone criterion abstracts beyond the hospitals that subscribe to their services. The cardinal of hospitals with NICUs about is small. In addition, the allegory units may be absolutely different, alignment from tertiary centers to hospitals with baby level-two units. Some hospitals accept organized into associate groups for such allegory purposes, such as a cardinal of children’s hospitals. Abstracts systems with ample numbers of NICUs such as the Vermont Oxford Network accommodate a ample set of hospitals for award a associate accumulation of institutions. Finally, back comparing amount abstracts beyond hospitals, it is important to accede differences in alteration policies. The breadth of break and, therefore, amount of an baby at an alone hospital may alter appreciably depending on their alteration status.

In this section, we accommodate advice on analysis costs for VLBW breed that were created as allotment of the Amount and Resource Utilization Abstraction of the Vermont Oxford Network (with allotment from the Centermost for the Future of Accouchement of the David and Lucile Packard Foundation). The abstraction calm advice on analysis costs in 25 hospitals in the Vermont Oxford Network.10 Abstracts on analysis costs are provided in Tables 1and 2 for breed accepted to those hospitals amid January 1, 1993, and September 30, 1994 (N = 3288). The sample of breed in the abstraction are those enrolled in the Vermont Oxford database, excluding commitment allowance deaths. Breed enrolled in the database accept bearing weights amid 501 g and 1500 g, and were accepted to the hospital’s NICU aural 28 canicule of birth.

Median Analysis Costs and Breadth of Break for Absolute Low Bearing Weight Infants

Median Accessory Costs for Absolute Low Bearing Weight Infants

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The characteristics of the sample of hospitals is presented in Table 3. Comparisons are fabricated to the cosmos of hospitals in the United States as authentic in the 1992 Annual Survey of Hospitals by the American Hospital Association (AHA). In that year, 796 hospitals appear accepting some neonatal accelerated affliction beds. An accelerated affliction assemblage was authentic as one that is “separate from the bairn nursery accouterment accelerated affliction to all ailing breed including those with the absolute everyman birthweights (less than 1500 g). NICU has the abeyant for accouterment automated ventilation, neonatal anaplasty and appropriate affliction for the sickest breed built-in in the hospital or transferred from addition institution. A full-time neonatologist serves as administrator of the NICU.” In 1992, 984 hospitals appear accepting any neonatal accelerated or boilerplate affliction beds. A neonatal boilerplate affliction assemblage is authentic as one that is “separate from the accustomed bairn nursery and that provides boilerplate and/or accretion affliction and some specialized casework including actual resuscitation, intravenous therapy, and adaptation for abiding oxygen analysis and monitoring.” As apparent in Table 3, the sample of hospitals in the Amount and Resource Utilization Abstraction about are beyond hospitals than the cosmos of hospitals with NICU beds (a absolute bed admeasurement of 454 compared with 398), and additionally accept added NICU beds (24.5 vs 17.1) and added neonatal boilerplate affliction beds (6.2 vs 4.0). They additionally are added heavily abounding against teaching and children’s hospitals. The geographic administration is adequately agnate to the cosmos of hospitals with NICUs, but with beneath hospitals in the South and added in the Central regions of the United States. The abstraction hospitals additionally are added acceptable to be amid in cities of citizenry amid 250 000 and 2.5 million, but are beneath acceptable to be amid in the better city areas (>2.5 actor in population). They additionally are added acceptable to be private, nonprofit organizations and beneath acceptable to be for-profit or accessible hospitals.

Characteristics of Hospital Sample (Percentage Distribution)

Table 1 presents advice on analysis costs for these infants, in 1994 connected dollars. The boilerplate analysis amount beyond all breed was $49 457, with an boilerplate breadth of break of 49 days. Analysis costs accept a continued appropriate tail, however, with some patients actuality absolute big-ticket to treat. The 90th percentile of analysis costs in the sample of breed in the abstraction was $130 377, with a best of $889 136. Breadth of break is analogously skewed, with the 90th percentile actuality 99 canicule and the longest breadth of break 632 days.

Treatment amount varies inversely with bearing weight, with a boilerplate analysis amount of $89 546 for breed with bearing weights amid 501 g and 750 g and $31 531 for breed in the 1251 g to 1500 g range. This reflects differences in both the boilerplate breadth of stay, which decreases with bearing weight, and in the acuteness of analysis during anniversary day of the stay. Boilerplate amount per day additionally is inversely accompanying to bearing weight.

As apparent in breakdowns by acquittal status, breed who died in the NICU, whether on day 1 or afterwards day 1, had boilerplate costs per day that were at atomic alert as aerial those for breed who went home or were transferred to addition hospital. Breed who were outborn had college costs than those who were inborn. Both breadth of break and boilerplate costs per day were college for outborn infants.

Treatment costs additionally alter with gestational age, actuality accomplished for breed with gestational ages amid 24 and 26 weeks. These breed accept the longest boilerplate lengths of stay, at 82 days. However, although amount per day decreases with gestational age afterwards 24 weeks, the accomplished costs per day are for breed with gestational ages <24 weeks, averaging $2346, which is 70% college than the amount per day of breed in the aing accomplished gestational age range. This is acceptable to attributable to the college ante of afterlife amid these infants.

Accommodation costs annual for the majority of all-embracing analysis costs. The boilerplate adaptation amount is $35 521, compared with a boilerplate accessory amount of $13 872. However, some breed accept absolute aerial adaptation and accessory costs. The 90th percentile of adaptation costs amid breed in the abstraction was $85 568, with best of $454 899. Accessory costs are analogously skewed. The 90th percentile of accessory costs is $46 175, with a best of $434 236.

Table 2 provides advice on the breakdowns of accessory costs by the aloft types of accessory services: respiratory therapy, laboratory, radiology, pharmacy, and all added accessory services. Overall, boilerplate accessory annual costs are accompanying inversely to bearing weight, with aciculate drops in accessory costs at 1000 g of bearing weight. For instance, breed with bearing weights that are 1001 to 1250 g accept boilerplate accessory costs that are about bisected of those for breed with lower bearing weights. Accessory costs per day in the hospital additionally are inversely accompanying to bearing weight.

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Infants who are absolved home from the hospital accept the accomplished absolute accessory cost, with a boilerplate of $15 992 compared with $11 667 for breed who died afterwards day 1, and lower amounts for added breed (who were either transferred or died on day 1). However, breed who died afterwards the aboriginal day in the hospital had a boilerplate breadth of break of 8 canicule compared with 59 for breed who went home, absorption a aerial use of accessory casework amid breed who eventually die during their hospital stay. This is reflected in the aerial accessory costs per day for accouchement who died (∼$1500), compared with those who went home ($272) or were transferred ($387).

Median accessory costs are accomplished for breed with gestational ages of 24 to 26 weeks. However, accessory costs per day are abundant college for breed with gestational ages <24 weeks than for all added groups ($1414 compared with $493 for the aing accomplished gestational age group). This assuredly is accompanying to their college bloodshed rates. Accessory costs are about commensurable for congenital and outborn infants, although costs per day in the hospital are somewhat college for outborn breed ($389 vs $309).

Respiratory affliction costs had a boilerplate amount of $3112, with the accomplished costs incurred by breed with bearing weights <750 g and with gestational ages of 24 to 26 weeks. Respiratory affliction costs were about alert as aerial for breed who went home than for those who were transferred or died (after day 1), $4100 compared with $2100. Respiratory affliction costs additionally are awful skewed, with the 90th percentile in the sample actuality $16 125 and the best $237 032.

Laboratory affliction costs had a boilerplate amount of $3308 for breed in the study. These costs are accompanying inversely to bearing weight and are accomplished for breed with gestational ages amid 24 and 26 weeks, with a boilerplate amount of $10 212. Class costs are accomplished for breed who die afterwards day 1, carefully followed by breed who go home. Again the above accumulation has a abundant beneath breadth of stay, accouterment affirmation of adequately accelerated use of class casework for breed who die. Class casework additionally are skewed, with the 90th percentile in the sample actuality $11 480 and the best $50 405.

The boilerplate radiology amount is $942. Radiology costs chase the aforementioned accepted arrangement as do class costs. They additionally are skewed, with the 90th percentile actuality $3613 and the best $23 713.

Median pharmacy costs are $2258. They are commensurable amid breed who died (after day 1) and breed who were transferred, with somewhat college costs for breed activity home. Again, pharmacy costs are skewed, with some patients accepting aerial costs. The 90th percentile of pharmacy costs is $7806, with a best of $144 993.

Finally, all added accessory costs, including such items as medical supplies, annual for $2474 in boilerplate costs. Because this is a balance category, it is difficult to adapt the empiric patterns.

Neonatal accelerated affliction costs are high. Affection advance efforts will acceptable change the assets acclimated in accommodating affliction and appropriately analysis costs. With absolute abstracts from hospital announcement systems, it is accessible to actualize measures of analysis costs in a way that provides allegory beyond institutions. Use of commensurable abstracts are important to be able to appropriately appraise the furnishings of affection advance efforts on analysis costs. Affection advance efforts may access or abatement costs depending on how they affect assets acclimated in accommodating care. However, accustomed the aerial amount of these stays, improvements in accommodating outcomes that abate the time spent in the NICU accept the abeyant to actualize cogent amount savings, which may, in some cases, account institutional investments into affection advance efforts.

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This analysis was adjourned by the Centermost for the Future of Accouchement of the David and Lucile Packard Foundation.

I acknowledge Barbara Thurston for secretarial abetment and Chi San for computer programming.

Note. The afterward hospitals alternate in the Amount and Resource Utilization Study: Arnot-Ogden Memorial Hospital, Elmira, NY; Children’s Health Care—Minneapolis, Minneapolis, MN; Children’s Hospital Medical Centermost of Akron, Akron, OH; Cook Children’s Medical Center, Fort Worth, TX; Dartmouth-Hitchcock Medical Center, Lebanon, NH; Fletcher Allen Health Care, Burlington, VT; Greenville Memorial Medical Center, Greenville, SC; Harris Methodist Hospital, Fort Worth, TX; Legacy Emanuel Hospital and Health Center, Portland, OR; McKay Dee Hospital and Medical Center, Ogden, UT; Mercy Hospital and Medical Center, Chicago, IL; Miami Valley Hospital, Dayton, OH; Milton S. Hershey Medical Center, Hershey, PA; Parkview Memorial Hospital, Fort Wayne, IN; Presbyterian Hospital, Alburquerque, NM; Riverside Hospital, Toledo, OH; Sinai Hospital of Baltimore, Baltimore, MD; Sparrow Hospital, Lansing, MI; St. Agnes Hospital, Baltimore, MD; St. Francis Medical Center, Peoria, IL; St. John’s Mercy Medical Center, St. Louis, MO; St. Luke’s Regional Medical Center, Boise, ID; The Methodist Hospitals, Gary, IN; University of California Davis, Medical Center, Sacramento, CA; and Wesley Medical Center, Wichita, KS.

Office of Technology Assessment. Neonatal accelerated affliction for low birthweight infants: costs and effectiveness. Washington, DC: Congress of the US; 1987

Rogowski J, Harrison E. Analysis costs for absolute low birthweight infants. Santa Monica, CA: RAND; 1995; MR-451–AHCPR

Miller H. Final report: pediatric costing study. Columbia, MD: Centermost for Health Policy Studies; 1993

Rogowski R, Harrison E. Unpublished. See adduce #2 for a description of the study

US Bureau of Activity Statistics. Monthly Activity Review. Washington, DC; 1998

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Muldoon J. Structure and achievement of altered DRG allocation systems for neonatal medicine. In: Horbar JD, Gould JB, eds. Evidence-based Affection Advance in Neonatal and Perinatal Medicine. 1998

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