Use of severity stratified cost accounting in critical care medicine

Introduction: The cost of critical care medicine has been estimated to represent 33% of a hospital's operating budget. In an era of increasing demand for scarce ICU resources and mandatory cost containment strategies, accurate assessment of costs and outcomes are necessary. The knowledge of all true costs (not charges) against a background of severity stratified disease diagnosis is crucial for efficient utilization of resources, administrative and clinical patient care decision making. Methods: Ten consecutive patients with a diagnosis of sepsis were evaluated in a pilot study that utilized the APACHE III System to define severity and outcome predictions for mortality and length of stay. Cost data (specific for the ICU) for nursing, respiratory therapy, radiology, laboratory and pharmacy were derived from the hospital cost accounting system. All referable physician billing (MD cost) was provided by the Medical Foundation. Results: The average APACHE III score was 71.0, ICU LOS 11.9 days, average ICU cost/day $1,941, average MD cost/day $575, combined average ICU + MD cost/day $2,517 and average cost/case $30,512. 56% of the hospital cost was in the ICU. The components of total cost were nursing 33%, MD 22%, pharmacy 14%, laboratory 13%, respiratory 6%, radiology 6%, supplies 2% and other 4%. Conclusions: The characterization of all true ICU costs referable to a severity stratified diagnosis is feasible and provides the opportunity to evaluate specific costs and outcomes as cost containment strategies develop.