A new concept for DRG-based reimbursement of services in German intensive care units: results of a pilot study

Objective. To evaluate LOS in developing a concept of borderline ICU LOS for a realistic reimbursement of intensive care. Design. Retrospective analysis of LOS and cost data extracted from patients' electronic records. Setting. Surgical ICU of the University Hospital Gottingen, Germany. Patients and participants. All adult ICU admissions with LOS >24 h over a 24-month period (1 January 2000 to 31 December 2001; n=1631.) Interventions. None. Measurements and results. Cluster analysis partitioned the ICU population into three homogenous groups based on ICU LOS and total direct costs: cluster 1 (n=1405; mean LOS=2.8; mean cost=e2399); cluster 2 (n=190; mean LOS=13.4; mean cost=e12,754); cluster 3 (n=36; mean LOS=34.9; mean cost=e34,173). Cost distribution between cluster 1 and clusters 2 and 3 combined was 48 vs 52%. Upper 95 percentile LOS of 6.7 allowed cluster 1 to be replaced by an LOS profile population of less than or equal to 7 days population (n=1355; 96% population and 91% total ICU cost overlap with cluster 1) representing 83% of total ICU population and 44% of total ICU costs. Stratification of >7 day population into LOS less than or >20 days (n=220; n=56) were further differentiated by mortality (11 vs 23%) and sepsis incidence (33 vs 79%). Conclusions. It may be feasible to formulate a LOS-based reimbursement scheme for ICU services in Germany based on the selection of (appropriate) patients' ICU LOS profiles.