Charge and reimbursement analysis for intensive care unit patients in a large tertiary teaching hospital

Abstract

Hospital charge and reimbursement data were analyzed for 115 patients admitted to the surgical intensive care and burn-trauma units at Brigham and Women's Hospital over a two-month study period. A skewed distribution of hospital charges resulted in mean and median charges of $43,068 and $29,081, respectively. Major differences were observed in total charges among major diagnostic groups. The median charge was highest in orthopedic trauma and neurosurgery patients. The median charge across major diagnostic groups correlated with the length of stay in the unit and in the hospital, and the number of drugs used. The median percent reimbursement from private providers, Medicaid, Medicare, and health maintenance organizations was 93, 55, 40, and 30 percent, respectively, and 55 percent overall. Reimbursement was high from private providers regardless of major diagnostic group. Medicare reimbursement through the diagnostic reference group system was considerably higher in cardiothoracic patients (77 percent) than in other major diagnostic groups. The discrepancy between charge and Medicare reimbursement in these patients was consistent with that reported for intensive care units in other hospitals, thereby underscoring the need for cost containment and more realistic reimbursement methods.