title: Rising Billing for Intermediate Intensive Care among Hospitalized Medicare Beneficiaries between 1996 and 2010.
abstract: BACKGROUND
  Intermediate care (i.e., step-down or progressive care) is an alternative to the intensive care unit (ICU) for patients with moderate severity of illness. The adoption and current use of intermediate care is unknown.
  
  
  OBJECTIVE
  To characterize trends in intermediate care use among U.S. hospitals.
  
  
  METHODS
  We examined 135 million acute care hospitalizations among elderly individuals (≥65 yr) enrolled in fee-for-service Medicare (U.S. federal health insurance program) from 1996 to 2010. We identified patients receiving intermediate care as those with intensive care or coronary care room and board charges labeled intermediate ICU.
  
  
  RESULTS
  In 1996, a total of 960 of the 3,425 hospitals providing critical care billed for intermediate care (28%), and this increased to 1,643 of 2,783 hospitals (59%) in 2010 (P < 0.01). Only 8.2% of Medicare hospitalizations in 1996 were billed for intermediate care, but billing steadily increased to 22.8% by 2010 (P < 0.01), whereas the percentage billed for ICU care and ward-only care declined. Patients billed for intermediate care had more acute organ failures diagnoses codes compared with general ward patients (22.4% vs. 15.8%). When compared with patients billed for ICU care, those billed for intermediate care had fewer organ failures (22.4% vs. 43.4%), less mechanical ventilation (0.9% vs. 16.7%), lower mean Medicare spending ($8,514 vs. $18,150), and lower 30-day mortality (5.6% vs. 16.5%) (P < 0.01 for all comparisons).
  
  
  CONCLUSIONS
  Intermediate care billing increased markedly between 1996 and 2010. These findings highlight the need to better define the value, specific practices, and effective use of intermediate care for patients and hospitals.
authors.affiliation: 1 The Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, and.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Sjoding
authors.affiliation: 1 The Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, and.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Valley
authors.affiliation: 1 The Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, and.|3 Institute for Healthcare Innovation and Policy, University of Michigan, Ann Arbor, Michigan.|2 VA Center for Clinical Management Research, Ann Arbor, Michigan.
authors.forename: Hallie C
authors.initials: HC
authors.lastname: Prescott
authors.affiliation: 4 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.|5 Department of Anesthesia and Interdisciplinary Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Hannah
authors.initials: H
authors.lastname: Wunsch
authors.affiliation: 1 The Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, and.|2 VA Center for Clinical Management Research, Ann Arbor, Michigan.|6 Institute for Social Research, Ann Arbor, Michigan; and.|7 Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Iwashyna
authors.affiliation: 1 The Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, and.|3 Institute for Healthcare Innovation and Policy, University of Michigan, Ann Arbor, Michigan.
authors.forename: Colin R
authors.initials: CR
authors.lastname: Cooke
mesh_terms: D000067:Accounts Payable and Receivable; D000368:Aged; D000369:Aged, 80 and over; D018588:Fee-for-Service Plans / Q000191:economics* / Q000639:trends; D005260:Female; D005377:Financial Management, Hospital / Q000706:statistics & numerical data* / Q000639:trends; D006761:Hospitals / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007345:Insurance Claim Review; D007362:Intensive Care Units / Q000191:economics* / Q000639:trends; D007902:Length of Stay / Q000191:economics / Q000639:trends; D008297:Male; D006278:Medicare / Q000191:economics* / Q000639:trends; D012189:Retrospective Studies; D014481:United States
keywords: hospital costs; intensive care unit; intermediate care facilities; longitudinal studies; organization and administration