Descriptive Analysis of Medicare Hospital Episodes with Critical Care Billings: Implications for Bundling Services for Pricing

摘要

The purpose of the project was (1) to analyze billing and utilization patterns for physician critical care services provided to Medicare beneficiaries and (2) to assess the implications of these findings for bundling these services for pricing. The study used the 1987 Part A/Part B Merged File, representing a five percent sample of all beneficiaries. These findings indicate that coding practices and billings for critical care physician services in 1987 exhibited substantial variability. On a hospital episode basis, payments for physician critical care services were quite small (and more variable), as compared to the total episode cost. The total physician bill for the entire episode was a more stable and much larger proportion of the total cost. The number of critical care codes billed was consistently and significantly less than the number of ICU/CCU days reported for the 25 DRGs involving substantial critical care use. All of this suggests that: (1) some clarification is needed regarding the coding of critical care services and (2) there may be limited utility in bundling these services alone on a DRG-basis or per diem basis (in the ICU).