- Healthcare providers may be able to decrease hospital costs by avoiding ICU admissions for some patients with chronic obstructive pulmonary disease (COPD), exacerbation of heart failure (HF), and acute myocardial infarction (AMI), a recent American Thoracic Society study indicated.
The examination of Medicare claims data from 2010 to 2012 revealed that chances of survival did not improve with an ICU admission for COPD, HF, and AMI patients who were 65 years or older. However, hospital costs were significantly higher among patients that spent time in the ICU.
Hospital costs for an AMI patient with an ICU admission were $4,923 more than an AMI patient without an ICU admission.
Similarly, hospital costs for an HF patient who was admitted to the ICU were $2,608 more compared to an HF patient did not have an ICU stay.
COPD was the only condition studied that did not show greater hospital costs if a patient received an ICU admission or not.
“These findings suggest that the ICU may be overused for some COPD, HF, or AMI patients with an uncertain indication for intensive care, and opportunities exist to decrease healthcare costs by reducing ICU admissions for certain patients,” wrote researchers.
Providers frequently used an ICU admission to treat COPD, HF, and AMI patients, the study showed. Among the patients studied, 20 percent with COPD, 24.7 percent with HR, and 64.9 percent with AMI were admitted to the ICU to treat their condition.
In total, about 30.5 percent of patients with the three conditions experienced an ICU admission.
Despite common ICU utilization, researchers found that 30-day mortality rates were not significantly different among patients who went to the ICU versus those who did not. The study showed the following 30-day mortality rates for both patient groups:
• 8.3 percent for COPD patients admitted to the ICU versus 8.6 percent for COPD patients admitted to the general ward
• 12.1 percent for HF patients staying in the ICU compared to 11 percent for HF patients treated at the general ward
• 15.9 percent for AMI patients with an ICU admission versus 16.3 percent for AMI patients with a general ward admission
With limited patient outcome improvements, researchers concluded that providers could increase care efficiency while decreasing hospital costs by reconsidering ICU admissions for certain patients.
“Our results highlight that there is a large group of patients who doctors have trouble figuring out whether or not the ICU will help them or not,” Thomas Valley, MD, MSc, the study’s lead author and a pulmonary and critical care researcher at the University of Michigan Medical School, stated in a press release. “We found that the ICU may not always be the answer. Now, we need to help doctors decide who needs the ICU and who doesn’t.”
The study’s findings may also have implications for providers participating in some bundled payment models. Medicare’s Bundled Payment for Care Improvement initiative addresses COPD, AMI, and congestive heart failure.
Through the initiative, Medicare reimburses providers involved in a patient’s COPD, AMI, or heart failure episode a set price for the initial inpatient hospital stay and 90 days after discharge. If actual care episode costs go over the target price, then providers lose money and may have to repay CMS for some of the financial losses.
To realize maximum savings, providers need to ensure that care delivery is efficient, meaning high-cost healthcare events, such as an ICU admission, should be avoided.
Bundled payment models for conditions are also becoming a key way to shift to value-based care. CMS recently introduced three bundled payment models that cover acute myocardial infarctions, coronary artery bypass grafts, and surgical hip and femur fraction treatments.
The models will qualify for the maximum incentive payment offered under the Quality Payment Program’s Advanced Alternative Payment Model track.
“These results may have important implications for health system leaders and policymakers,” concluded study authors. “Improving the efficiency of intensive care is vital to any restructuring of the American healthcare system, given the substantial resources associated with its use.”
“Attempts to constrain national ICU capacity, however, must be preceded by evidence that withholding ICU care will actually reduce costs without worsening outcomes for vulnerable patients.”