Costs of Critical Care Medicine
Section snippets
National Hospital Databases and CCM Data
There are two national US databases that track hospital use and cost data (Table 1). The first is the commercially available Hospital Statistics report that is annually published by the American Hospital Association (AHA).9 This dataset contains information obtained from the yearly AHA surveys that are voluntarily completed by almost all US hospitals. The second is the Healthcare Cost Report Information System (HCRIS), a dataset composed of the Hospital Cost Reports that are annually submitted
Critical Care Cost Calculations in the United States
The main tenets for understanding CCM utilization and cost in the United States were outlined in 1984 by Berenson12 in a report commissioned by the US government. Recognizing the limitations of the national hospital databases, Berenson suggested that the Russell equation, first described in 1979, be used to “indirectly” calculate national CCM costs.12, 13
The primary goal of the Russell equation is to establish an all-inclusive average ICU cost per day (Fig. 1, step 1). This value is then
Summary of US ICU Cost Studies
Berenson12 estimated that $13 to $15 billion was spent for the care of adult critically ill and coronary care patients in 1982. This CCM cost represented 14% to 17% of total inpatient community hospital costs and 0.7% of the GDP. Using the Russell equation, Jacobs and Noseworthy, estimated 1986 ICU costs in the United States at $33.9 billion, approximating 20% of all inpatient hospital costs, and 0.7% of the GDP (Table 5).14 Halpern and coworkers15 estimated US CCM costs to be $29.5 billion in
Alternative Uses and Approaches to Solving the Russell Equation
Beyond determining national CCM costs, the Russell equation methodology has also been applied to defined hospital networks15 and populations.19, 20 In these analyses, all data to solve the Russell equation was obtained from network or population-specific datasets rather than the AHA or HCRIS. Halpern and colleagues15 determined ICU cost per day for Department of Veterans Affairs (DVA) medical centers (1986 to 1992) either directly from the DVA Cost Distribution Report (CDR) or through the
Limitations of Global ICU Cost Approaches
The CCM costing approaches discussed here focus on average daily and aggregate yearly CCM costs of care. Costs attributable to components of CCM care (staffing, technology, medications, and patient care) are not identified. The Russell equation approach also may give the impression that all ICU days are similar in cost. This, however, is not true, as the first day of ICU care is far more resource intensive than subsequent days.25, 26 Additionally, the average ICU daily cost may vary based on
Cost Control Strategies
Given the high costs associated with CCM, cost control strategies have been proposed or implemented by clinicians, hospital administrators, and policy makers.27 These strategies include rationing care,28 reducing unnecessary variation in care by regionalization of critical care services,29, 30 caring for critically ill patients in non-ICU settings (telemetry, step-down units, postanesthesia care units, and ventilator units), fast-tracking surgical patients,31 providing telemedicine coverage to
Summary
Critical care medicine is expensive and continues to grow in a shrinking US hospital system. The main drivers of CCM costs are the numbers and use of ICU beds. Existing hospital databases do not contain all the requisite elements to directly measure CCM costs. Therefore, the Russell equation, an indirect costing methodology, is most commonly used to estimate national CCM costs. Calculating national CCM costs in a standardized manner remains challenging because there is no universal approach to
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The authors have nothing to disclose.