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ICU Early Physical Rehabilitation Programs: Financial Modeling of Cost Savings*

Lord, Robert K. AB1; Mayhew, Christopher R. BS1; Korupolu, Radha MBBS, MS2; Mantheiy, Earl C. BA1; Friedman, Michael A. PT, MBA3; Palmer, Jeffrey B. MD4; Needham, Dale M. FCA, MD, PhD1,4

doi: 10.1097/CCM.0b013e3182711de2
Feature Articles

Objective: To evaluate the potential annual net cost savings of implementing an ICU early rehabilitation program.

Design: Using data from existing publications and actual experience with an early rehabilitation program in the Johns Hopkins Hospital Medical ICU, we developed a model of net financial savings/costs and presented results for ICUs with 200, 600, 900, and 2,000 annual admissions, accounting for both conservative- and best-case scenarios. Our example scenario provided a projected financial analysis of the Johns Hopkins Medical ICU early rehabilitation program, with 900 admissions per year, using actual reductions in length of stay achieved by this program.

Setting: U.S.-based adult ICUs.

Interventions: Financial modeling of the introduction of an ICU early rehabilitation program.

Measurements and Main Results: Net cost savings generated in our example scenario, with 900 annual admissions and actual length of stay reductions of 22% and 19% for the ICU and floor, respectively, were $817,836. Sensitivity analyses, which used conservative- and best-case scenarios for length of stay reductions and varied the per-day ICU and floor costs, across ICUs with 200–2,000 annual admissions, yielded financial projections ranging from –$87,611 (net cost) to $3,763,149 (net savings). Of the 24 scenarios included in these sensitivity analyses, 20 (83%) demonstrated net savings, with a relatively small net cost occurring in the remaining four scenarios, mostly when simultaneously combining the most conservative assumptions.

Conclusions: A financial model, based on actual experience and published data, projects that investment in an ICU early rehabilitation program can generate net financial savings for U.S. hospitals. Even under the most conservative assumptions, the projected net cost of implementing such a program is modest relative to the substantial improvements in patient outcomes demonstrated by ICU early rehabilitation programs.

1 Outcomes After Critical Illness and Surgery (OACIS) Group, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.

2 Department of Physical Medicine and Rehabilitation, The University of Kentucky College of Medicine, Lexington, KY.

3 Department of Physical Medicine and Rehabilitation, The Johns Hopkins Hospital, Baltimore, MD.

4 Department of Physical Medicine and Rehabilitation, The Johns Hopkins School of Medicine, Baltimore, MD.

* See also p. 909.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: dale.needham@jhmi.edu

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins