Growth of Intensive Care Unit Use and Costs

Abstract & Commentary

By Ruth Kleinpell, PhD, RN, Director, Center for Clinical Research and Scholarship, Rush University Medical Center; Professor, Rush University College of Nursing, Chicago, IL, is Associate Editor for Critical Care Alert.

Dr. Kleinpell reports no financial relationship to this field of study.

Synopsis: Through a retrospective analysis, this study examined ICU resource use and costs for 121,747,260 inpatient hospitalizations and found a rapid rise in Medicare ICU use with stable adjusted daily critical care costs, but increasing costs for care outside the ICU.

Source: Milbrandt, EB, et al. Growth of intensive care unit resource use and its estimated cost of Medicare. Crit Care Med 2008;36:2504-2510.

Tracking the utilization of intensive care unit (ICU) resources is important in informing clinicians of patterns of use and costs of care, especially as the proportion of patients aged 65 and older increases and ICU resources remain limited. Milbrandt and colleagues examined resource use and costs for ICU and floor costs for inpatient Medicare prospective payment system hospitalizations during a 10-year period from 1994 to 2004. The findings of their retrospective review demonstrated that 33% of Medicare hospitalizations involved an ICU stay. Annual adjusted Medicare ICU costs increased 36% due to increased utilization. While adjusted ICU cost per day remained stable ($2616 vs $2575; 1994 vs 2004); adjusted floor cost per day rose due to decreased floor length of stay ($1027 vs $1488).

Commentary

Similar to other studies assessing ICU utilization,1-3 the results of this study highlight that ICU use is on the rise and leading to large increases in annual ICU costs for Medicare. While the daily cost of ICU care remained relatively stable, average adjusted cost per floor day rose substantially due to reductions in floor length of stay, with the remaining days becoming more costly.

This study demonstrated that efforts to reduce length of stay do not seem to have an appreciable effect in the ICU. The authors cite that interventions to decrease ICU length of stay such as the use of sedation and analgesia protocols, ventilator weaning, and intensivist staffing have the potential to reduce costs if widely applied in the ICU setting. ICU clinicians should be cognizant of the importance of targeted interventions aimed at improving care in the ICU with the goal of decreasing unnecessary ICU length of stay. Efforts to promote best care in the ICU, including the use of a daily goal sheet,4 infection prevention measures, palliative care, and family care conferences5 to discuss realistic treatment goals for critically ill patients, may help in decreasing ICU length of stay as well as ICU costs of care.

References

  1. Halpern NA, et al. Critical care medicine in the United States 1985-2000: An analysis of bed numbers, use, and costs. Crit Care Med 2004;32:1254-1259.
  2. Halpern NA, et al. Critical care medicine use and cost among Medicare beneficiaries 1995-2000: Major discrepancies between two United States federal Medicare databases. Crit Care Med 2007;35:692-699.
  3. Milbrandt EB, et al. Rising use of intensive care unit services in Medicare. Crit Care 2005;9(Suppl 1):S112.
  4. Pronovost P, et al. Improving communication in the ICU using daily goals. J Crit Care 2003;18:71-75.
  5. Curtis JR, et al. Intensive care unit quality improvement: A "how-to" guide for the interdisciplinary team. Crit Care Med 2006;34:211-218.