Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix, and costs.
OBJECTIVE
To analyze the evolving role, patterns of use, and costs of critical care medicine in the United States from 2000 to 2005.


METHODS
Retrospective study of data from the Hospital Cost Report Information System (Centers for Medicare and Medicaid Services, Baltimore, Maryland).


METHODS
Nonfederal, acute care hospitals with critical care medicine beds in the United States.


METHODS
None.


METHODS
None.


RESULTS
We analyzed hospital and critical care medicine beds, bed types, days, occupancy rates, payer mix (Medicare and Medicaid), and costs. Critical care medicine costs were compared with national cost indexes. Between 2000 and 2005, the total number of U.S. hospitals with critical care medicine beds decreased by 12.2% (from 3,586 to 3,150). Although the number of hospital beds decreased by 4.2% (from 655,785 to 628,409), both hospital days and occupancy rates increased by 5.1% (from 145.1 to 152.5 million) and 13.7% (from 59% to 67%), respectively. Critical care medicine beds increased by 6.5% (from 88,252 to 93,955), days by 10.6% (from 21.0 to 23.2 million), and occupancy rates by 4.5% (from 65% to 68%). The majority (90%) of critical care medicine beds were classified as intensive care, premature/neonatal, and coronary care unit beds. The percentage of critical care medicine days used by Medicare decreased by 3.8% (from 37.9% to 36.5%) compared with an increase of 15.5% (from 14.5% to 16.8%) by Medicaid. From 2000 to 2005, critical care medicine costs per day increased by 30.4% (from $2698 to $3518). Although annual critical care medicine costs increased by 44.2% (from $56.6 to $81.7 billion), the proportion of hospital costs and national health expenditures allocated to critical care medicine decreased by 1.6% and 1.8%, respectively. However, the proportion of the gross domestic product used by critical care medicine increased by 13.7%. In 2005, critical care medicine costs represented 13.4% of hospital costs, 4.1% of national health expenditures, and 0.66% of the gross domestic product.


CONCLUSIONS
Critical care medicine continues to grow in a shrinking U.S. hospital system. The critical care medicine payer mix is evolving, with Medicaid increasing in its percentage of critical care medicine use. Critical care medicine is more cost controlled than other healthcare indexes, but is still using an increasing percentage of the gross domestic product. Our updated and comprehensive critical care medicine use and cost analysis provides a contemporary benchmark for the strategic planning of critical care medicine services within the U.S. healthcare system.
Halpern
Neil A
NA
Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA. halpernn@mskcc.org
Pastores
Stephen M
SM
D000046:Academic Medical Centers; D001509:Bed Occupancy / Q000706:statistics & numerical data* / Q000639:trends; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends*; D004635:Emergency Medicine / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D019538:Health Care Surveys; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data*; D017721:Hospital Costs; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D009519:New York City; D010343:Patient Admission / Q000706:statistics & numerical data / Q000639:trends; D011787:Quality of Health Care; D012189:Retrospective Studies; D014481:United States