Medicare intensive care unit use: Analysis of incidence, cost, and payment
Medicare intensive care unit use: Analysis of incidence, cost, and payment
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DOI：
10.1097/01.ccm.0000146301.47334.bd
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发表时间：
2004-11-01
影响因子：
8.8
通讯作者：
Linde-Zwirble, WT
中科院分区：
文献类型：
--
作者：
Cooper, LM;Linde-Zwirble, WT
目的：确定联邦医疗保险受益人中重症监护病房服务的发生率、费用和支付情况。设计：回顾性观察性数据库队列研究。设置：所有拥有重症监护病房床位的非联邦医院（n = 5003）通过住院前瞻性支付系统（IPPS）支付。我们使用了所有2000财政年度Medicare IPPS住院治疗，并使用了一致的付款信息（n = 10，657，587）.干预措施：无.测量和主要结果：我们检查了费用和支付的总体分布，按医院类型和诊断相关组。2，353，208例病例（21.1%）接受了重症监护。老年人（65岁以上）的总发病率为每千名受益人59.8例，随着年龄的增长，从36.2例（65-69岁）增加到91.6例（85岁以上）。重症监护病房患者的费用几乎是楼层患者的三倍（14,135美元对5,571美元），其中三分之二的费用与重症监护病房部分的住院费用有关，重症监护病房每天2,278美元。然而，重症监护室病例的支付率仅为最低标准病例的两倍（11 704美元对5 835美元）。只有83%的费用是为重症监护室的病人支付的，而底层病人的费用是105%，当需要重症监护室护理时，医院损失了58亿美元。诊断相关组的重症监护室百分比与支付百分比之间存在线性关系，仅在诊断相关组中支付>90%的费用，重症监护室病例数大于或等于60%。我们发现，教学医院比非教学医院支付（87%对78%的成本，分别），但这只是由于间接的医疗教育payment.Conclusions：重症监护是常见的，昂贵的，支付低的医疗保险人群。很少有诊断相关的群体有足够大的重症监护室人口，以确保足够的支付。针对重症监护室常见疾病的额外诊断相关组将改善支付并激励效率。
Objective: To determine the incidence, cost, and payment for intensive care unit services among Medicare beneficiaries.Design: Retrospective observational database cohort study.Setting: All nonfederal hospitals with intensive care unit beds (n = 5003) paid through the inpatient prospective payment system (IPPS).Patients: We used all fiscal year 2000 Medicare IPPS hospitalizations with consistent payment information (n = 10,657,587).Interventions: None.Measurements and Main Results: We examined the distribution of cost and payments overall, by hospital type, and by diagnosis related group. Intensive care was used in 2,353,208 cases (21.1%). The overall incidence was 59.8 cases per thousand beneficiaries in the aged (65+) population, increasing with age from 36.2 (65-69) to 91.6 (85+). Intensive care unit patients cost nearly three times floor patients ($14,135 vs. $5,571), with two thirds of costs associated with the intensive care unit portion of the stay, $2,278 per intensive care unit day. However, intensive care unit cases were paid at a rate only twice floor cases ($11,704 vs. $5,835). Only 83% of costs were paid for intensive care unit patients, compared with 105% for floor patients, generating a $5.8 billion loss to hospitals when intensive care unit care is required. There was a linear association between the percent intensive care unit in a diagnosis related group and the percent paid, with payment >90% of cost only in diagnosis related groups with greater than or equal to60% intensive care unit cases. We found that teaching hospitals were better paid than nonteaching hospitals (87% vs. 78% of costs, respectively), but this was only due to indirect medical education payments.Conclusions: Intensive care is common, expensive, and poorly paid in the Medicare population. Few diagnosis related groups have a large enough intensive care unit population to ensure adequate payment. Additional diagnosis related groups for conditions common to the intensive care unit would improve payment and enable incentives for efficiency.