Medicare intensive care unit use: Analysis of incidence, cost, and payment*

Cooper, Liesl M.; Linde-Zwirble, Walter T.

doi:10.1097/01.ccm.0000146301.47334.bd

Cited by 118 publications

(71 citation statements)

References 10 publications

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“…Briefly, we identified ICU admission through billing codes that indicate time spent in an ICU setting (including intermediate and coronary care units). 19,20 As a secondary step, we verified the use of ICU care based on specific ICU charges and variables indicating ICU day counts greater than 0 during the index hospital admission. 20,21 We defined LOS as the duration between the admission date and final discharge date for the index hospitalization (which included transfers to another acute care hospital).…”

Section: Primary Outcomesmentioning

confidence: 99%

Population‐level comparative effectiveness of laparoscopic versus open radical nephrectomy for patients with kidney cancer

Tan

Wolf

et al. 2011

Cancer

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BACKGROUND:Because there is limited population-based evidence supporting the comparative effectiveness of laparoscopic radical nephrectomy (LRN) after its widespread adoption, we compared trends in hospital-based outcomes among patients with kidney cancer treated with LRN or open radical nephrectomy (ORN). METHODS: Using linked SEER-Medicare data, the authors identified patients with kidney cancer who were treated with LRN or ORN from 2000 through 2005. The authors measured 4 primary outcomes: intensive care unit (ICU) admission, prolonged length of stay, 30-day hospital readmission, and in-hospital mortality. The authors then estimated the association between surgical approach and each outcome, adjusting for patient demographics, tumor characteristics, and year of surgery. RESULTS: The authors identified 2108 (26%) and 5895 (74%) patients treated with LRN and ORN, respectively. Patients treated with LRN were more likely to be white, female, of higher socioeconomic position, and to have tumor sizes of 4 cm (all P < .05). The adjusted probability of ICU admission and prolonged length of stay was 41% and 46% lower, respectively, for patients undergoing LRN (P < .001). Although uncommon for both groups, the adjusted probability of in-hospital mortality was 51% higher (2.3% vs 1.5%, P ¼ .04) for patients treated with a laparoscopic approach. CONCLUSIONS: At a population level, patients treated with LRN have a lower likelihood of ICU admission and prolonged length of stay, supporting the convalescence benefits of laparoscopy. In-hospital mortality, however, was higher among patients treated with LRN. The latter finding suggests a potentially unanticipated consequence of this technique and highlights the need for long-term monitoring during and after the widespread adoption of new surgical technologies. Cancer 2011;117:4184-93.

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Section: Primary Outcomesmentioning

confidence: 99%

Population‐level comparative effectiveness of laparoscopic versus open radical nephrectomy for patients with kidney cancer

Tan

Wolf

et al. 2011

Cancer

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“…However, we used various measures of resource utilization as a proxy for costs. With the estimated costs of an inpatient day at USD 1236, an ICU day at USD 2278 to USD 5973, and a day on mechanical ventilation at USD 10,299 [13,15], the results presented in the current study represent significant differences between subpopulations of DRG 536. An additional limitation of our study is the inability to identify patients with major complications or comorbidities, who might be classified in DRG 535 (fractures of the hip or pelvis with major complications or comorbidities) based on the ICD-9 diagnosis data given in the National Trauma Data Bank.…”

Section: Discussionmentioning

confidence: 76%

Variation in Resource Utilization for Patients With Hip and Pelvic Fractures Despite Equal Medicare Reimbursement

Samuel

Webb

Lukasiewicz

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Medicare currently reimburses hospitals for inpatient admissions with ''bundled'' payments based on patient Diagnosis-related Groups (DRGs) regardless of true hospital costs. At present, DRG 536 (fractures of the hip and pelvis) includes a broad spectrum of patients with orthopaedic trauma, likely with varying inpatient resource utilization. With the growing incidence of fractures in the elderly, inadequate reimbursements from Medicare for certain patients with DRG 536 may lead to growing financial strain on healthcare institutions caring for these patients with higher costs. Questions/purposes The purposes of the study were to determine whether (1) inpatient length of stay; (2) intensive care unit stay; and (3) ventilator time differ among subpopulations with Medicare DRG 536. Methods A total of 56,683 patients, 65 years or older, with fractures of the hip or pelvis were identified in the 2011 and 2012 National Trauma Data Bank. This clinical registry contains data on trauma cases from more than 900 participating trauma centers, allowing analysis of resource One of the authors certifies that he (AMS) or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Orthopaedic Trauma Association (Rosemont, IL). One of the authors certifies that he (JML) or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Bone Therapeutics (Charleroi, Belgium), an amount of less than USD 10,000 from Kuros (Zurich,Switzerland), an amount of less than USD 10,000 from ISTO Technologies (St Louis, MO, USA), an amount of less than USD 10,000 from Emcyte (Fort Myers, FL, USA), an amount of less than USD 10,000 from Royal Marketing Inc (Westmount, Quebec, Canada), an amount of less than USD 10,000 from Graftys (Chicago, IL, USA), an amount of USD 100,000-USD 1,000,000 from Merck (Kenilworth, NJ, USA), and an amount of USD 100,000-USD 1,000,000 from National Institutes of Health (Bethesda, MD, USA). One of the authors certifies that he (JNG) or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 10,000-USD 100,000 from Bioventus (Durham, NC, USA), an amount of USD 10,000-USD 100,000 from Harvard Clinical Research Institute (Boston, MA, USA), an amount of USD 10,000-USD 100,000 from ISTO Technologies (St Louis, MO, USA), an amount of less than USD 10,000 from Medtronic (Minneapolis, MN, USA), an amount of USD 10,000-USD 100,000 from Stryker (Kalamazoo, MI, USA), an amount of less than USD 10,000 from Affinergy (Durham, NC, USA), an amount of USD 10,000-USD 100,000 from Alphatec (Carlsbad, CA), an amount of less than USD 10,000 from DePuy (Raynham, MA, USA), an amount of less than USD 10,000 from Powered Research (Research Triangle Park, NC, USA), an amount of less than USD 10,000 from KCI (San Antonio, TX, USA), an amount of less than USD 10,000...

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“…Regardless of baseline characteristics, hospital mortality was significantly higher in the CTnI-positive group than in the CTnI-negative group: 35% vs 12%, respectively; relative risk (RR), 1 Regardless of baseline characteristics, hospital mortality was significantly higher in the CTnI-positive group than in the CTnI-negative group. (Table 3).…”

Section: Resultsmentioning

confidence: 99%

Prognostic Value of Initial Elevation in Cardiac Troponin I Level in Critically Ill Patients Without Acute Coronary Syndrome

Liu

Shehu

Herrold

et al. 2015

Critical Care Nurse

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Background Cardiac troponin I levels are often obtained to help rule out acute coronary syndrome. Objective To determine if elevation of troponin level within 24 hours for patients without acute coronary syndrome admitted to the intensive care unit provides important prognostic information. METHODS Patients without acute coronary syndrome admitted to the intensive care unit were prospectively divided into 2 groups according to highest serum level of cardiac troponin I within 24 hours of admission (elevated > 0.049 ng/mL; control ≤ 0.049 ng/mL). Hospital mortality, incidence of intubation, and other parameters were compared between the 2 groups. Results Patients with elevated troponin level (n = 40) had higher mortality than did control patients (n = 50) (35% vs 12%; P = .01). Compared with control patients, patients with elevated levels were more likely to be intubated (41% vs 17%; P = .02). Conclusion Critically ill patients without acute coronary syndrome with elevated levels of cardiac troponin I at admission had higher mortality and more intubations than did control patients.

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Medicare intensive care unit use: Analysis of incidence, cost, and payment*

Cited by 118 publications

References 10 publications

Population‐level comparative effectiveness of laparoscopic versus open radical nephrectomy for patients with kidney cancer

Population‐level comparative effectiveness of laparoscopic versus open radical nephrectomy for patients with kidney cancer

Variation in Resource Utilization for Patients With Hip and Pelvic Fractures Despite Equal Medicare Reimbursement

Prognostic Value of Initial Elevation in Cardiac Troponin I Level in Critically Ill Patients Without Acute Coronary Syndrome

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