Gainsharing in the ICU

Abstract

Background. Gainsharing is a pay-for-performance (P4P) program that provides incentives to attending physicians to reduce hospital costs while maintaining quality care. Hypothesis. Overall hospital costs decreased because of the gainsharing program during the past 4 years, while ICU costs increased over the same period because the incentives were given only to the discharging physician of record. Methods. Retrospective analysis was performed on the most frequent hospital and ICU admissions by All Patient Refined–Diagnosis Related Group (APR-DRG). A best practice norm was calculated by taking the mean hospital cost of the top 25 percentile. Savings opportunity (SO) was defined by subtracting the BPN from the actual cost. Gainsharing payments to the discharging physicians required meeting specific quality standards. Results. A total of 9034 patients were admitted to the ICU during the study period under this program. Among all APR-DRGs, total hospital costs decreased by $2.7 million (10%) for these specific admissions, mostly related to a shorter overall hospital stay. However, average ICU costs actually rose during the same period by $0.9 million (32%). The DRG with the greatest ICU SO was “tracheostomy with long-term mechanical ventilation” ($1.7 million). This group averaged $67 000 in ICU costs per patient but accounted for only 0.8% of the total number of admissions. There was also a savings opportunity for “septicemia” ($0.4 million, 2% of patients) and “small- and large-bowel surgery” ($0.4million, 1.5% of patients). Conclusions. The incentive to reduce costs was absent to physicians in the ICU, unlike the overall hospital, which experienced cost savings.