A new concept for DRG-based reimbursement of services in German intensive care units: results of a pilot study.
OBJECTIVE
To evaluate LOS in developing a concept of borderline ICU LOS for a realistic reimbursement of intensive care.


METHODS
Retrospective analysis of LOS and cost data extracted from patients' electronic records.


METHODS
Surgical ICU of the University Hospital Göttingen, Germany.


METHODS
All adult ICU admissions with LOS >24 h over a 24-month period (1 January 2000 to 31 December 2001; n=1631.)


METHODS
None.


RESULTS
Cluster analysis partitioned the ICU population into three homogeneous groups based on ICU LOS and total direct costs: cluster 1 (n=1405; mean LOS=2.8; mean cost= Euro 2399); cluster 2 (n=190; mean LOS=13.4; mean cost=Euro 12,754); cluster 3 (n=36; mean LOS=34.9; mean cost= Euro 34,173). Cost distribution between cluster 1 and clusters 2 and 3 combined was 48 vs 52%. Upper 95 percentile LOS of 6.7 allowed cluster 1 to be replaced by an LOS profile population of < or = 7 days population (n=1355; 96% population and 91% total ICU cost overlap with cluster 1) representing 83% of total ICU population and 44% of total ICU costs. Stratification of >7 day population into LOS less than or >20 days (n=220; n=56) were further differentiated by mortality (11 vs 23%) and sepsis incidence (33 vs 79%).


CONCLUSIONS
It may be feasible to formulate a LOS-based reimbursement scheme for ICU services in Germany based on the selection of (appropriate) patients' ICU LOS profiles.
Neilson
Aileen R
AR
HealthEcon AG, Steinentorstrasse 19, Posfach 1510, 4001Basel, Switzerland. aneilson@healthecon.com
Moerer
Onnen
O
Burchardi
Hilmar
H
Schneider
Heinz
H
D016000:Cluster Analysis; D003953:Diagnosis-Related Groups; D004180:Direct Service Costs; D005260:Female; D005858:Germany; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011445:Prospective Payment System; D012189:Retrospective Studies