Critical Care Medicine Beds, Use, Occupancy, and Costs in the United States

Halpern, Neil A.; Pastores, Stephen M.

doi:10.1097/ccm.0000000000001227

Cited by 150 publications

(99 citation statements)

References 40 publications

(45 reference statements)

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“…Care in the ICU accounted for 13.2% of hospital costs and 4.1% of the National Health Expenditures in 2010. 13 We document a 2-fold increase in the use of mechanical ventilation among nursing home residents with advance dementia admitted to the hospital without a substantial improvement in survival. In 2013, Medicare expended nearly $100 million in this high-intensity, low-value care.…”

Section: Discussionmentioning

confidence: 91%

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Association of Increasing Use of Mechanical Ventilation Among Nursing Home Residents With Advanced Dementia and Intensive Care Unit Beds

et al. 2016

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IMPORTANCE Mechanical ventilation may be lifesaving, but in certain persons, such as those with advanced dementia, it may prolong patient suffering without a clear survival benefit. OBJECTIVE To describe the use and outcomes of mechanical ventilation and its association with the increasing numbers of intensive care unit (ICU) beds in the United States for patients with advanced dementia residing in a nursing home 120 days before that hospital admission. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study evaluated Medicare beneficiaries with advanced dementia hospitalized from January 1, 2000, to December 31, 2013, using the Minimum Data Set assessments linked with Medicare part A claims. A hospital fixed-effect, multivariable logistic regression model examined the effect of changes in ICU beds within individual hospitals and the likelihood of receiving mechanical ventilation, controlling for patients' demographic characteristics, function, and comorbidities. MAIN OUTCOMES AND MEASURES Mechanical ventilation.RESULTS From 2000 to 2013, a total of 635 008 hospitalizations of 380 060 eligible patients occurred (30.5% male and 69.5% female; mean [SD] age, 84.4 [7.4] years). Use of mechanical ventilation increased from 39 per 1000 hospitalizations in 2000 to 78 per 1000 hospitalizations in 2013 (P < .001, test of linear trend). As the number of ICU beds in a hospital increased over time, patients with advanced dementia were more likely to receive mechanical ventilation (ie, adjusted odds ratio per 10 ICU bed increase, 1.06; 95% CI, 1.05-1.07). In 2013, hospitals in the top decile in the number of ICU beds were reimbursed $9611.89 per hospitalization compared with $8050.24 per hospitalization in the lower decile (P < .001) without an improvement in 1-year mortality (65.2% vs 64.6%; P = 54).CONCLUSIONS AND RELEVANCE Among hospitalized nursing home residents with advanced dementia, we found an increase in the use of mechanical ventilation over time without substantial improvement in survival. This increase in the use of mechanical ventilation was associated with an increase in the number of ICU beds within a hospital.

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Section: Discussionmentioning

confidence: 91%

“…Unlike using hospital cost reports to determine the number of ICU beds, only the AHA data are able to examine the use of ICU step-down beds. 13 …”

Section: Methodsmentioning

confidence: 99%

Association of Increasing Use of Mechanical Ventilation Among Nursing Home Residents With Advanced Dementia and Intensive Care Unit Beds

et al. 2016

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“…First, the Russell equation, using CCM days as a proxy of CCM use, did not include CCM type days incurred in non-CCM hospital areas. Second, CCM physician billings were not included in the AHA “adjusted inpatient cost per day” (21). It is unlikely that CCM will be cost contained unless national health expectations for critically ill patients are reevaluated (40).…”

Section: Discussionmentioning

confidence: 99%

“…As in previous studies (1;2;17), we determined comprehensive CCM costs per day estimates using the modified Russell equation, a “top-down” approach that examines broad costing without patient-level details (18–21). The cost basis was the “Adjusted expenses per inpatient day” as calculated annually by the American Hospital Association (AHA) for its “nonfederal short-term and other special hospital category” (22).…”

Section: Methodsmentioning

confidence: 99%

Trends in Critical Care Beds and Use Among Population Groups and Medicare and Medicaid Beneficiaries in the United States: 2000–2010

Halpern

Goldman

Tan

et al. 2016

Critical Care Medicine

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184

120

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Objectives To analyze patterns of critical care medicine (CCM) beds, use, and costs in acute care hospitals in the United States (US), and relate CCM beds and use to population shifts, age groups, and Medicare and Medicaid beneficiaries from 2000 to 2010. Design Retrospective study of data from the federal Healthcare Cost Report Information System, American Hospital Association and US Census Bureau. Setting Acute care US hospitals with intensive care beds. Measurements and Main Results From 2000 to 2010, US hospitals with CCM beds decreased by 17% (3,586 to 2,977), while the US population increased by 9.6% (282.2M to 309.3M). Although hospital beds decreased by 2.2% (655,785 to 641,395), CCM beds increased by 17.8% (88,235 to 103,900), a 20.4% increase in the CCM/hospital bed ratio (13.5% to 16.2%). There was a greater percentage increase in premature/neonatal (29%, 14,391 to 18,567) than in adult (15.9%, 71,978 to 83,417) or pediatric (2.7%, 1,866 to 1,916) CCM beds. Hospital occupancy rates increased by 10% (59% to 65%), while CCM occupancy rates were stable (range 65%–68%). CCM beds per 100,000 total population increased by 7.4% (31.3 to 33.6). The proportional use of CCM services by Medicare beneficiaries decreased by 17% (37.9% to 31.4%) whereas that by Medicaid rose by 18% (14.5% to 17.2%). Between 2000 and 2010, annual CCM costs nearly doubled (92.9%, $56 to $108 billion). In the same period, the proportion of CCM cost to the Gross Domestic Product (GDP) increased by 32.1% (0.54% to 0.72%, $10,285 to $14,964 trillion). Conclusions Critical care medicine use and costs in the US continue to rise. The increasing use of CCM by the premature/neonatal and Medicaid populations should be considered by healthcare policy makers, state agencies, and hospitals as they wrestle with critical care bed growth and the associated costs.

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“…In the US alone, annual critical care medicine costs nearly doubled from 2000 to 2010 (from $56.6 to an estimated amount of $108 billion). Although the proportion of hospital cost allocated to critical care medicine (13.2%) decreased by 1.5% and the proportion of national health expenditures (4.14%) remained stable, the proportion of the gross domestic product used by critical care medicine increased from 0.66% in 2005 to 0.74% in 2010 [6, 7]. In highly developed European health-care systems, the average cost per ICU patient is around €1200 per day and €17,000 per admission [8, 9].…”

Section: Introductionmentioning

confidence: 99%

The impact of changes in intensive care organization on patient outcome and cost-effectiveness—a narrative review

et al. 2017

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The mortality rate of critically ill patients is high and the cost of the intensive (ICU) department is among the highest within the health-care industry. The cost will continue to increase because of the aging population in the western world. In the present review, we will discuss the impact of changes in ICU department organization on patient outcome and cost-effectiveness. The general perception that drug and treatment discoveries are the main drivers behind improved patient outcome within the health-care industry is in general not true. This is especially the case for the ICU department, in which the past decades’ organizational changes were the main drivers behind the reduction of ICU mortality. These interventions were at the same time able to reduce cost, something which is rare for drug and treatment discoveries. The organization of the intensive care department has been changed over the past decades, resulting in better patient outcome and reduction of cost. Major changes are the implementation of the “closed format” and electronic patient record. Furthermore, we will present possible future options to improve the organization of the ICU department to further reduce mortality and cost such as pooling of dedicated ICU into mixed ICU and embedding business strategies such as lean and total quality management. Challenges are ahead as the ICU is taking up the largest share of national health-care expenditure, and with the aging of the population, this will continue to increase. Besides future improvements of organizational structures within the ICU, the focus should also be on the implementation of and compliance with proven beneficial organizational structures.

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Critical Care Medicine Beds, Use, Occupancy, and Costs in the United States

Cited by 150 publications

References 40 publications

Association of Increasing Use of Mechanical Ventilation Among Nursing Home Residents With Advanced Dementia and Intensive Care Unit Beds

Association of Increasing Use of Mechanical Ventilation Among Nursing Home Residents With Advanced Dementia and Intensive Care Unit Beds

Trends in Critical Care Beds and Use Among Population Groups and Medicare and Medicaid Beneficiaries in the United States: 2000–2010

The impact of changes in intensive care organization on patient outcome and cost-effectiveness—a narrative review

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