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ICU admission rates among Medicare beneficiaries declined in past decade

Among Medicare fee-for-service beneficiaries, admission rates to the ICU have been on a downward trend from 2006 to 2015, according to findings published in Annals of Internal Medicine.

“Admission to the ICU is costly and strains health system resources,” Gary E. Weissman, MD, MSHP, fellow in pulmonary and critical care medicine from the Perelman School of Medicine at the University of Pennsylvania, and colleagues wrote. “Accurate estimates of population-level ICU admission rates could aid in disaster planning, training a suitable critical care workforce, and targeting policy interventions to reduce admissions that are low value or discordant with patient preferences.”

Weissman and colleagues assessed nationally representative data of all acute and ICU hospitalizations between 2006 and 2015 among Medicare beneficiaries aged 65 years or older to determine accurate estimates of ICU use and geographic differences in admission incidence.

The researchers identified 88,402,008 hospitalizations, of which 16.7% were associated with an ICU.

The ICU admission rate declined from 6,117 per 100,000 person-years (95% CI, 5,965-6,272) in 2006 to 4,247 per 100,000 person-years (95% CI, 4,120-4,377) in 2015. The proportion of hospitalizations that included ICU care decreased from 17% in 2006 to 16.3% in 2015.

State-level ICU admission rates varied greatly, ranging from 2,117 per 100,000 person-years (95% CI, 2,027-2,209) in Hawaii to 6,312 per 100,000 person-years (95% CI, 6,157-6,470) in Mississippi in 2015. There was a decrease in ICU admission rates among all states except Nebraska.

The researchers observed a positive association between the state-level ICU admission rate and number of total beds in 2006 and an even stronger association in 2015 that indicated a monotonically increasing relationship with many beds and few admissions (except in Washington, D.C., and North Dakota).

Between 2006 and 2015, the national ICU bed count increased by 11.4%; however, state-level changes varied from –38.1% in Rhode Island to 54.4% in Washington. Across states, there was no association between the percentage of change in ICU beds and admissions.

“Policy and population health strategies to promote high-value care for Medicare fee-for-service beneficiaries requiring ICU services probably vary among states,” Weissman and colleagues concluded. “The United States has more ICU beds per capita than many peer nations; however, bed availability is not the sole driver of ICU admissions and its effects also vary across states. Institution of federal policies governing critical care workforce training, reimbursements or critical care services, and state-level approvals of certificates of need will thus require more local and granular data.” – by Alaina Tedesco

Disclosures: The authors report no relevant financial disclosures.