Certified Nurse Manager and Leader (CNML) Practice Test

What do Diagnostic-Related Groups (DRGs) primarily influence?

1. Rate of hospital stay

2. Payment rate based on specific diagnoses

3. Patient satisfaction scores

4. Quality of care metrics

The correct answer is: Payment rate based on specific diagnoses

Diagnostic-Related Groups (DRGs) primarily influence payment rates based on specific diagnoses. This system categorizes hospital cases into groups that are expected to have similar hospital resource use, helping to determine how much hospitals will be reimbursed for patient care based on the diagnoses assigned at the time of admission. The rationale behind DRGs is to create a more standardized and predictable model of reimbursement that helps control healthcare costs while still managing to capture the variations in treatment required for different diagnoses. By linking payment to the specific diagnosis rather than the actual cost incurred during a patient's stay, DRGs ensure that healthcare facilities receive a predetermined amount for treating patients within those categories, thereby influencing the financial aspects of hospital management and operations. This framework is not directly focused on the rate of hospital stay, patient satisfaction scores, or quality of care metrics, although those outcomes can be indirectly affected by the financial incentives created by how payments are structured.