Critical care medicine use and cost among Medicare beneficiaries 1995-2000: Major discrepancies between two United States federal Medicare databases

Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Critical Care Medicine (Impact Factor: 6.15). 04/2007; 35(3):692-9. DOI: 10.1097/01.CCM.0000257255.57899.5D
Source: PubMed

ABSTRACT A comparison of federal Medicare databases to identify critical care medicine (CCM) use, cost discrepancies, and their possible causes.
A 6-yr (1995-2000) retrospective analysis of Medicare hospital and CCM use and cost, comparing the Hospital Cost Report Information System (HCRIS) with Medicare Provider Analysis and Review File (MedPAR) supplemented when necessary by Health Care Information System (HCIS) (identified herein as MedPAR/HCIS).
All nonfederal U.S. hospitals.
Data are presented as days (M = million) and costs ($; B = Billion) for both hospitals and CCM. Between 1995 and 2000, the number of hospital days decreased in both databases: HCRIS (-13.2%; 78M to 67.7M) and MedPAR/HCIS (-14.1%; 82.8M to 71.1M). CCM days decreased in HCRIS (-4.6%; 8.3M to 7.9M). In contrast, CCM days increased in MedPAR/HCIS (7.2%; 13.9M to 14.9M). The discrepancy in CCM days between HCRIS and MedPAR/HCIS increased from 40% (5.6M days) in 1995 to 47% (7M days) in 2000. Two CCM billing codes (intensive care unit and coronary care unit "post/intermediate") used in MedPAR/HCIS were responsible for 73% on average per year, over the study period, for this CCM discrepancy. The use of these two codes progressively increased (44%; 3.9M to 5.6M days) by the end of the study. The cumulative 6-yr discrepancy in CCM days between HCRIS and MedPAR/HCIS (37.3M days) had a calculated cost of $92.3B.
We have identified major, and progressively increasing, discrepancies between two U.S. federal databases tabulating hospital and CCM use and cost for Medicare beneficiaries. Two CCM "post/intermediate" billing codes in MedPAR/HCIS were predominantly responsible for the CCM discrepancy. To accurately assess Medicare CCM use and cost, either HCRIS, or MedPAR/HCIS without the "post/intermediate" codes, should be used.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine the extent to which hospitals vary in the use of intensive care, and the proportion of variation attributable to differences in hospital practice that is independent of known patient and hospital factors. Hospital discharge data in the State Inpatient Database for Maryland and Washington States in 2006. Cross-sectional analysis of 90 short-term, acute care hospitals with critical care capabilities. DATA COLLECTION/METHODS: We quantified the proportion of variation in intensive care use attributable to hospitals using intraclass correlation coefficients derived from mixed-effects logistic regression models after successive adjustment for known patient and hospital factors. The proportion of hospitalized patients admitted to an intensive care unit (ICU) across hospitals ranged from 3 to 55 percent (median 12 percent; IQR: 9, 17 percent). After adjustment for patient factors, 19.7 percent (95 percent CI: 15.1, 24.4) of total variation in ICU use across hospitals was attributable to hospitals. When observed hospital characteristics were added, the proportion of total variation in intensive care use attributable to unmeasured hospital factors decreased by 26-14.6 percent (95 percent CI: 11, 18.3 percent). Wide variability exists in the use of intensive care across hospitals, not attributable to known patient or hospital factors, and may be a target to improve efficiency and quality of critical care.
    Health Services Research 10/2012; 47(5):2060-80. DOI:10.1111/j.1475-6773.2012.01402.x · 2.49 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Rationale: Although the number of intensive care unit (ICU) beds in the United States is increasing, it is unknown whether this trend is consistent across all regions. Objective: We sought to better characterize regional variation in ICU bed changes over time and identify regional characteristics associated with these changes. Methods: We used data from the Centers for Medicare and Medicaid Services and the United States Census to summarize the numbers of hospitals, hospital beds, ICU beds and ICU occupancy at the level of Dartmouth Atlas hospital referral region from 2000 to 2009. We categorized regions into quartiles of bed change over the study interval, and examined the relationship between change categories, regional characteristics and population characteristics over time. Measurements and Main Results: From 2000 to 2009 the national number of ICU beds increased 15%, from 67,579 to 77,809, mirroring population. However, there was substantial regional variation in absolute changes (median: +16 ICU beds; interquartile range: -3 to +51) and population-adjusted changes (median: +0.9 ICU beds per 100,000; interquartile range: -3.8 to +5.9), with 25.0% of regions accounting for 74.8% of overall growth. At baseline, regions with increasing numbers of ICU beds had larger populations, lower ICU beds per 100,000 capita, higher average ICU occupancy and greater market competition as measured by the Herfindahl-Hirschman Index (p<0.001 for all comparisons). Conclusions: National trends in ICU bed growth are not uniformly reflected at the regional level, with the majority of growth occurring in a small number of highly populated regions.
    American Journal of Respiratory and Critical Care Medicine 12/2014; 191(4). DOI:10.1164/rccm.201409-1746OC · 11.99 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The past 50 years have witnessed the emergence and evolution of the modern pediatric ICU and the specialty of pediatric critical care medicine. ICUs have become key in the delivery of health care services. The patient population within pediatric ICUs is diverse. An assortment of providers, including intensivists, trainees, physician assistants, nurse practitioners, and hospitalists, perform a variety of roles. The evolution of critical care medicine also has seen the rise of critical care nursing and other critical care staff collaborating in multidisciplinary teams. Delivery of optimal critical care requires standardized, reliable, and evidence-based processes, such as bundles, checklists, and formalized communication processes.
    Pediatric Clinics of North America 06/2013; 60(3):545-62. DOI:10.1016/j.pcl.2013.02.001 · 2.20 Impact Factor