Critical Care Medicine Beds, Use, Occupancy, and Costs in the United States: A Methodological Review

Abstract

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 ICU bed supply, use, occupancy, and costs in the United States. Data for total ICU beds, use, and occupancy can be derived from two large national healthcare databases: the Healthcare Cost Report Information System maintained by the federal Centers for Medicare and Medicaid Services and the proprietary Hospital Statistics of the American Hospital Association. Two costing methodologies can be used to calculate U.S. 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 U.S. ICU bed supply, use, occupancy, and costs helps provide clarity to the width and scope of the critical care medicine enterprise within the U.S. healthcare system. This review will also help the intensivist better understand published studies on administrative topics related to critical care medicine and be better prepared to participate in their own local hospital organizations or regional critical care medicine programs.

Figure 1

Both CCM cost estimate methods, the Russell equation (Left panel) and the national projections (Right panel), involve four steps. The first step identifies the hospitals to be studied. The second step obtains the data to solve the Russell equation by identifying the ICU and non-ICU days and obtaining the average inpatient cost per day (Left panel, Step 2) or identifying ICU days and the associated ICU costs (Right panel, Step 2). The third step either solves for the ICU cost per inpatient day [(ICU cost per inpatient day = (ICU: non-ICU bed cost ratio) × (non-ICU cost per inpatient day)] in the Russell equation (Left panel, Step 3) or the total costs of ICU care in the selected hospitals (Right panel, Step 3). The fourth step translates the ICU cost per inpatient day to national costs (Left panel, Step 4) or “projects or estimates” the ICU days and costs from the patients of the selected hospitals to the national level using the hospitals’ projection “weights” as well as formulas for projection or estimation (Right panel, Step 4). The figure is reprinted with permission from Intensive Care Medicine (34).