Critical Care Plus
Benchmark ICUs Demonstrate Better Care, More Profit
Superiority Demonstrated in All Sizes, Kinds of Hospitals
By Julie Crawshaw
If all intensive care units (ICUs) adhered to the practice benchmarks of the best ICUs, more than 30,000 lives and $1.5 billion would be saved annually in the United States, according to a study released early this year.
The Solucient Leadership Institute, which provides health care and benchmark information, says its study— "100 Top Hospitals: Intensive Care Unit Benchmarks for Success"—is the first of its kind encompassing hospitals across the country. Solucient’s executive director, Jean Chenoweth, says that ICUs have not pursued cost-cutting measures as aggressively as other departments because the wide range of potentially fatal illnesses ICUs handle makes it difficult to measure quality of care. (For lists of the top teaching and community ICUs arranged by Medicare ID number, see Tables 1 and 2 at the bottom of this article.)
Overall, the benchmark hospitals paid higher wages but employed fewer staff than peer hospitals. And despite the biggest drop in profits since 1993—and financial stress brought on by the Balanced Budget Act of 1997—the 100 benchmark hospitals showed more profits, treated more difficult cases, and achieved better overall outcomes than did their peers. They also had a median total profit margin of 8.71% and a median cash flow margin of 16.44%, vs. 1.88% and 9.69%, respectively, for peer hospitals.
Sixty-three percent of this year’s benchmark hospitals have made the Top 100 list more than once. More than half of those have performed at benchmark levels for at least four years. Boston’s Brigham & Women’s Hospital is the only facility selected as a benchmark hospital in each of the eight years since the study began. Thirty-seven hospitals in the South made the list. Only 15 in the Northeast did, but that region had the highest percentage increase in top hospitals. Study results indicate that competition, managed care, and regulation caused variability in the levels of hospital performance.
Hospitals in All Categories Show Superiority
"The research shows that regardless of whether we are comparing teaching hospitals, teaching hospitals with residencies in intensive care, or community hospitals, some institutions in all three categories exhibit superior intensive care management, resulting in much better outcomes and significantly lower costs," Chenoweth says.
Researchers used seven equally-weighted measures in assessing hospital performance:
- risk-adjusted mortality index
- risk-adjusted complications index
- severity-adjusted average length of stay
- expense per adjusted discharge
- profitability
- proportion of outpatient revenue
- productivity (total asset turnover ratio)
They included mortality factors separate from ICU care in their performance measurements and studied three different kinds of patient populations in 1200 hospitals:
- patients with one or more of 10 medical diagnoses, such as stroke, that frequently require ICU care
- postoperative patients following surgeries that call for ICU care;
- life support patients who require a mechanical ventilator for four or more days.
Solucient calculated that by performing at the benchmark level, ICUs would lower mortality rates more than 20% for postsurgical patients, 15% for medical patients, and complication rates for postsurgical patients by 19%.
Researchers noted that because they derived their estimates using only an ICU patient subset, their findings might understate the improvement that could be made if all ICUs performed at the level of the 100 Top Hospitals. They also found that if all ICUs operated at benchmark level:
- the cost of ancillary services alone would be nearly $66 million less annually;
- the most critically ill ICU patients would have substantially better outcomes; and
- deaths for patients on mechanical ventilation for at least four days would lower by more than 8%.
The number of ICU patients is expected to double from its current 5 million level by about 2015. The approximately 75,000 ICU beds in the United States have an average daily occupancy of 45,000-50,000. ICU patients comprise 10% of hospital population but account for 25% of hospital expenditures, which is hardly surprising since ICU patients are usually much more ill than those in the general hospital population.
The study reviewed 15 major teaching hospitals, 25 teaching hospitals with fewer than 400 beds, 20 large community hospitals with more than 250 beds, 20 medium-sized community hospitals with 100-250 beds, and 20 small community hospitals with 25-99 beds.
| Table 1: Top ICU Community Hospitals |
| Northwest Medical Center, Tucson, AZ Summit Medical Center, Oakland, CA MidState Medical Center, Meriden, CT Lee Memorial Health System, Fort Myers, FL St. Anthony’s Hospital, Saint Petersburg, FL JFK Medical Center, Atlantis, FL Aventura Hospital and Medical Center, Aventura, FL Winter Park Memorial Hospital, Winter Park, FL Palm Beach Gardens Medical Center, Palm Beach Gardens, FL Florida Medical Center, Ft. Lauderdale, FL Blake Medical Center, Bradenton, FL Southwest Florida Regional Medical Center, Fort Myers, FL Orange Park Medical Center, Orange Park, FL Putnam Medical Center, Palatka, FL Brandon Regional Hospital, Brandon, FL Largo Medical Center, Largo, FL Oak Hill Hospital, Spring Hill, FL Mease Countryside Hospital, Safety Harbor, FL Hardin Memorial Hospital, Elizabethtown, KY North Arundel Hospital, Glen Burnie, MD Albany Memorial Hospital, Albany, NY Ellis Hospital, Schenectady, NY Seton Health System, Troy, NY Parma Community General Hospital, Parma, OH Trumbull Memorial Hospital-Forum Health, Warren, OH Southwest General Health Center, Middleburg Heights, OH Community Health Partners, Lorain, OH Grand View Hospital, Sellersville, PA Westmoreland Regional Hospital, Greensburg, PA Nazareth Hospital, Philadelphia, PA Riddle Memorial Hospital, Media, PA St. Clair Memorial Hospital, Pittsburgh, PA Jefferson Hospital, Pittsburgh, PA Baptist Hospital of East Tennessee, Knoxville, TN Parkridge Medical Center, Chattanooga, TN Good Shepherd Medical Center, Longview, TX All Saints Health System, Fort Worth, TX Wadley Regional Medical Center, Texarkana, TX Memorial Hermann Baptist Beaumont Hospital, Beaumont, TX Southwest Texas Methodist Hospital, San Antonio, TX Shannon Medical Center, San Angelo, TX Metropolitan Methodist Hospital, San Antonio, TX Doctors Hospital of Dallas, Dallas, TX Augusta Medical Center, Fishersville, WA Central Washington Hospital, Wenatchee, WA |
| Table 2: Top ICU Teaching Hospitals |
| Loma Linda University Medical Center, Loma Linda, CA Exempla Saint Joseph Hospital, Denver, CO Hospital of St. Raphael, New Haven, CT Middlesex Hospital, Middletown, CT St. Francis Hospital, Wilmington, DE Cedars Medical Center, Miami, FL Community Hospital East, Indianapolis, IN St. Vincent Hospital & Health Services, Indianapolis, IN Franklin Square Hospital Center, Baltimore, MD Union Memorial Hospital, Baltimore, MD Greater Baltimore Medical Center, Baltimore, MD HealthAlliance Hospital, Leominster, MA Mount Auburn Hospital, Cambridge, MA UMASS Memorial Medical Center, Worcester, MA Providence Hospital and Medical Center, Southfield, MI Spectrum Health Downtown Campus, Grand Rapids, MI Bon Secours Cottage Health Services, Grosse Pointe, MI Sinai-Grace Hospital, Detroit, MI St. Joseph’s Health Center, Syracuse, NY Park Ridge Hospital, Rochester, NY Mercy Hospital of Buffalo, Buffalo, NY Mission Saint Joseph's Health System, Asheville, NC Summa Health System, Akron, OH Fairview Hospital, Cleveland, OH St. John West Shore Hospital, Westlake, OH UPMC McKeesport Hospital, McKeesport, PA Chestnut Hill Hospital, Philadelphia, PA York Hospital, York, PA St. Luke’s Hospital & Health Network, Bethlehem, PA Hamot Medical Center, Erie, PA Western Pennsylvania Hospital, Pittsburgh, PA Lancaster General Hospital, Lancaster, PA Montgomery Hospital Medical Center, Norristown, PA Mercy Fitzgerald Hospital, Darby, PA Easton Hospital, Easton, PA Crozer-Chester Medical Center, Upland, PA Lankenau Hospital, Wynnewood, PA Sacred Heart Hospital, Allentown, PA Bristol Regional Medical Center, Bristol, TN Baptist Hospital, Nashville, TN |
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