Top 10 ICU Diagnoses Driving Up Healthcare Costs, Care Variations

December 20, 2017 - Cardiac procedures and sepsis dominated the list of top ten intensive care unit (ICU) diagnoses that represented the greatest opportunity for hospitals to reduce healthcare costs and care variations for ICU length of stay, a recent Premier Inc. analysis revealed.

“Spending too much time in the ICU can negatively impact patients and the bottom line, particularly in this era of value-based care payment models,” stated Robin Czajka, RN, Premier’s Service Line Vice President of Cost Management at Premier.

Care variations for ICU patients, particularly for lengths of stay, can significantly impact hospital costs. Medicare only reimburses hospitals for 83 percent of total care costs for intensive care services, University of Texas researchers found in 2016.  Hospitals lose money for every unnecessary day a patient spends in the ICU.

Longer ICU stays are also usually reimbursed at the same rate as shorter stays. Unnecessary days in the ICU create additional cost burdens for hospitals, the report stated.

In addition, longer ICU stays could jeopardize value-based reimbursement and incentive payments under alternative payment models. Organizations are responsible for total costs of care under alternative payment models, such as bundled payments and capitated payment arrangements. Unnecessary costs generated by a longer-than-necessary ICU stay may result in hospitals going over budget and losing incentive payments.

Additionally, patient safety issues also increase the longer patients stay in the ICU. About 10 percent of ICU patients acquire a healthcare-associated infection because of increased invasive device use, a BMJ Quality & Safety study stated.

Despite healthcare cost and patient safety risks, the Premier analysis of data from 786 facilities and over 20 million discharges between 2011 and 2016 uncovered significant care variations for common ICU diagnoses.

The following diagnoses had the highest care variation for ICU length of stay over the five-year period:

• Sepsis patients with major complications or comorbidities, accounting for 19 percent of ICU reduction opportunity

• Infectious and parasitic diseases associated with operating room procedure and major complications or comorbidities, representing 15 percent of the ICU reduction opportunity

• Cardiac valve and other major cardiothoracic procedures without cardiac catheterization, but with major complications or comorbidities, representing 12 percent of the ICU reduction opportunity

• Coronary bypass without cardiac catheterization, but with major complications or comorbidities, accounting for 9.8 percent of the ICU reduction opportunity

• Respiratory system diagnosis with ventilator support for up to 96 hours, accounting for 9.5 percent of the ICU reduction opportunity

• Craniotomy and endovascular intracranial procedures with major complications or comorbidities, representing 8.9 percent of the ICU reduction opportunity

• Sepsis patients using a mechanical ventilator for 96 hours or more, representing 6.8 percent of the ICU reduction opportunity

• Cardiac valve and other major cardiothoracic procedure with cardiac catheterization and major complications or comorbidities, accounting for 6.8 percent of the ICU reduction opportunity

• Cardiac valve and other major cardiothoracic procedure without a cardiac catheterization, but with complications or comorbidities, representing 6.1 percent of the ICU reduction opportunity

• Heart failure and shock with major complications or comorbidities, accounting for 6 percent of the ICU reduction opportunity

Hospitals should launch ICU optimization projects that target the top ICU diagnoses contributing to care variations and excessive healthcare costs. Premier suggested that hospitals implement the following best practices for ICU optimization:

• Implement evidence-based practices to reduce healthcare-associated infections and delirium

• Develop intermediate care settings as a transition for patients who no longer need ICU-level care

• Create checklists to monitor patient progress and goals

• Use multidisciplinary teams of physicians, nurses, pharmacists, residents, and other ICU staff to care for patients

Data analytics are also key to identifying the patients who can benefit from ICU optimization, Premier’s Czajka added.

“While ICU optimization is no easy task, robust data and analytics can help unveil opportunities to improve care delivery and quality within this setting – ranging from identifying diagnoses with the greatest variation in outcomes to monitoring patients who no longer need ICU-level care within newly-created intermediate care settings,” she said.

Healthcare organizations in the analysis that used the best practices reported a 13 percent decrease in patient ICU days across the top ten diagnoses from 2011 to 2016.

ICU optimization best practices also resulted in significant cost savings for hospitals. Mercy Health, a health system of 22 acute care facilities in Ohio and Kentucky, saved over $6.7 million in a two-year period by using data trends to identify patients who were in a higher level of care than necessary.