Rising use of intensive care unit services in Medicare

Introduction

In recent years, rising cost, new technology, demographic shifts, and demands for higher quality have placed pressure on Medicare, the largest part of US healthcare. The consequence for the use of ICU services is unknown.

Hypothesis

Use of ICU services is growing in the Medicare population.

Methods

We selected all Medicare Prospective Payment System (PPS) hospitalizations from 1994 to 2001 and generated rates using corresponding beneficiary files. We calculated total ICU admission rates, rates per 1000 beneficiaries, and rates stratified by age and medical versus surgical admission.

Results

In 1994, there were 10.7 million Medicare PPS hospitalizations, 2.2 million (20.5%) of which incurred ICU care. By 2001, hospitalizations increased 5.3% to 11.3 million, while ICU admissions increased 14.5% to 2.5 million. After adjusting for changes in the number of beneficiaries, hospitalizations fell 2.1%, while ICU admissions increased 6.4%. Those ≥ 80 years saw the greatest increase in ICU admission rates (41%), accounting for 33.4% of ICU admissions in 2001. Growth in ICU use was due to increased medical admissions, which rose 18.9% while surgical ICU admissions fell 4.7%.

Conclusions

ICU use has been rising dramatically in Medicare, especially in the elderly. This rise is occurring despite a reduction in the number of hospitalizations per beneficiary.

Figure 1