Diagnosis-related groups, costs, and outcome for patients in the intensive care unit.

Our purpose was to analyze hospital cost, resource utilization, and outcome by age for a large group of patients who required intensive care unit (ICU) services. Patients in the ICU (N = 6331) were stratified by age groups. Mean hospital cost per patient generally increased with age. Older patients (65 years of age and older) who were treated in the ICU had longer hospital lengths of stay, higher mortality rates, and a greater percentage of outlier patients, as compared with younger patients (under 65 years of age). Patients in the ICU would have produced a substantial loss for our medical center under a diagnosis-related group (DRG) all payer prospective payment scheme. Although higher mean costs were associated with older patients, every age group of patients in the ICU that we examined demonstrated a loss under DRGs. As a whole for the 3-year period, patients in the ICU would have generated more than +30 million in losses for our medical center. These losses were a result of a variety of factors, including a greater severity of illness and greater hospital resource utilization. The current DRG hospital payment system appears to be inequitable for the patient who receives treatment in the ICU during the hospital stay. As hospital operating margins continue to decline because of federal and state DRG hospital payment systems, additional pressures may be applied for physicians, nurses, and health care professionals to cut expenses for these patients. In this effort to watch the bottom line, physicians and nurses must not sacrifice the quality of or the access to care for patients who require ICU services.