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Financial Consequence of COVID-19 on United States PICUs: A 2017 to 2023 Study Using the Pediatric Health Information
Vanessa Toomey1,2, Steven Howard3, Margaret J Klein2
1Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Insights
The COVID-19 pandemic increased pediatric intensive care unit (PICU) costs more than charges, despite fewer bed days. Reduced bed days for common respiratory illnesses during COVID-19 significantly decreased overall PICU charges.
Area of Science:
- Pediatric critical care medicine
- Health economics
- Epidemiology
Background:
- The COVID-19 pandemic significantly impacted healthcare systems globally.
- Understanding the financial implications for pediatric intensive care units (PICUs) is crucial for resource allocation and operational planning.
Purpose of the Study:
- To evaluate the financial consequences of pediatric intensive care unit admissions in the United States during the COVID-19 pandemic.
Main Methods:
- A retrospective cohort study analyzed data from the Pediatric Health Information System (PHIS) and Virtual Pediatric System (VPS) databases.
- Included were PICU admissions for children under 18 from January 2017 to March 2023.
- Costs were calculated using hospital-specific cost-to-charge ratios, with multivariable mixed modeling controlling for length of stay and severity of illness.
Main Results:
- Encounter-level costs per PICU day increased by 8.9% during the COVID-19 years compared to pre-pandemic years, outpacing the 4.1% increase in charges.
- Bed days for conditions like bronchiolitis, asthma, pneumonia, and respiratory failure decreased significantly (28-94%).
- Overall PICU charges decreased by $1.2 billion in the first year of the pandemic due to a 33% reduction in bed days.
Conclusions:
- The COVID-19 pandemic highlighted the financial vulnerabilities of PICUs contributing to the PHIS/VPS.
- A decrease in bed days, particularly for common pediatric respiratory illnesses, significantly impacted overall PICU charges.
Objective:
To evaluate the financial consequence of admission to PICU during the COVID-19 pandemic in the United States.
Design:
Retrospective cohort study.
Setting:
PICUs in the Pediatric Health Information System (PHIS) and Virtual Pediatric System (VPS) databases.
Patients:
PICU admissions in children younger than 18 years from January 2017 to March 2023.
Interventions:
None.
Measurements And Main Results:
We queried 29 diagnostic categories using two unlinked national databases, PHIS and VPS. Costs were calculated from PHIS charges using the hospital's specific cost to charge ratio. From PHIS, median charges and costs per PICU day were determined for each diagnosis, year, region, and hospital status. The median charges and costs per PICU days were matched to VPS PICU days. Multivariable mixed modeling was used, controlling for center, length of stay (LOS), and severity of illness which included use of mechanical ventilation, extracorporeal membrane oxygenation support, and Pediatric Risk of Mortality score. The primary outcomes were PICU charges and costs per day. The secondary outcomes were bed days, cumulative charges and costs. There were 484,328 PHIS and 331,740 VPS encounters. Percent change (95% CI) in encounter-level costs per PICU day increased (8.9% [95% CI, 8.8-9.1], p < 0.001) at a greater rate than encounter-level charges (4.1% [95% CI, 1.2-7.2], p = 0.006)) when comparing pre-COVID-19 to COVID-19 years, after controlling for LOS, severity of illness and diagnosis. Bed days for bronchiolitis, asthma, pneumonia, and respiratory failure decreased by 28-94% compared with the average pre-COVID-19 years. After combining all diagnoses, bed days decreased by 70,100 (33%), and PICU charges decreased by $1.2 billion during COVID year 1, when compared with the average pre-COVID-19 years.
Conclusions:
The COVID-19 pandemic exposed the financial vulnerability of PHIS/VPS contributing PICUs in the United States. Bed days are a key driver to maintaining financial margins.
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