Critical care medicine continues to grow in a shrinking U.S. hospital system. The critical care medicine payer mix is evolving, with Medicaid increasing in its percentage of critical care medicine use. Critical care medicine is more cost controlled than other healthcare indexes, but is still using an increasing percentage of the gross domestic product. Our updated and comprehensive critical care medicine use and cost analysis provides a contemporary benchmark for the strategic planning of critical care medicine services within the U.S. healthcare system.

CCM is increasingly used and prominent in a shrinking U.S. hospital system. CCM occupancy is lower than expected. Despite its increasing use and cost, CCM is using proportionally less of national health expenses and the gross domestic product than previously estimated.

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.

This article is a methodological review to help the intensivist gain insights into the classic and sometimes arcane maze of national databases and methodologies used to determine and analyze the intensive care unit (ICU) bed supply, occupancy rates, and costs in the United States (US). Data for total ICU beds, use and occupancy can be derived from two large national healthcare databases: the Healthcare Cost Report Information System (HCRIS) maintained by the federal Centers for Medicare and Medicaid Services (CMS) and the proprietary Hospital Statistics of the American Hospital Association (AHA). Two costing methodologies can be used to calculate ICU costs: the Russell equation and national projections. Both methods are based on cost and use data from the national hospital datasets or from defined groups of hospitals or patients. At the national level, an understanding of US ICU beds, use and cost helps provide clarity to the width and scope of the critical care medicine (CCM) enterprise within the US healthcare system. This review will also help the intensivist better understand published studies on administrative topics related to CCM and be better prepared to participate in their own local hospital organizations or regional CCM programs.