title: Cost and survival results of critical care regionalization for Medicare patients.
abstract: A ground-based mobile ICU, two medical evacuation helicopters, and a specially equipped fixed wing aircraft were utilized by a critical care transport team, staffed by a critical care physician, ICU nurse, critical care technologist, and respiratory therapist to facilitate regionalization of critical care services from small community hospitals to a central tertiary care facility. Survival, length of stay, age, actual hospital cost, and reimbursement were evaluated retrospectively for 81 Medicare patients transported by the team to a tertiary care facility during a 33-month period. All patients had acute, nontraumatic, medical/surgical illnesses, primarily cardiac. Forty-four (54%) patients were discharged home alive. Average hospital cost per patient was $36,059.00, average Medicare reimbursement was $13,802.00, and average hospital loss was $22,256.00. We show that regionalization to tertiary care facilities can facilitate access to critical care technology, but the Medicare reimbursement system of diagnosis-related groups makes this concept financially prohibitive for the tertiary care hospital.
authors.affiliation: Medical/Surgical ICU, St. Francis Medical Center, Pittsburgh, PA 15201.
authors.forename: D W
authors.initials: DW
authors.lastname: Crippen
authors.forename: M M
authors.initials: MM
authors.lastname: Bonetti
authors.forename: J W
authors.initials: JW
authors.lastname: Hoyt
authors.forename: B R
authors.initials: BR
authors.lastname: Martin
mesh_terms: D000368:Aged; D003422:Critical Care / Q000191:economics* / Q000458:organization & administration; D003953:Diagnosis-Related Groups; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D007902:Length of Stay; D006278:Medicare / Q000191:economics*; D009026:Mortality; D011379:Prognosis; D012041:Regional Medical Programs / Q000191:economics* / Q000458:organization & administration; D014481:United States