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COST CONTAINMENT IN THE CCU

CCU care is expensive because it is staff and equipment intensive. Its cost-effectiveness is controversial because it has been difficult to show that CCU care is more effective than routine nursing care for most patients. While the negative studies are probably due to the difficulty in carrying out a proper randomized study, they also reflect that the effectiveness of many CCU procedures remains unproved. Since CCU care is very stressful for patients and their families, reducing unnecessary CCU care would save money and improve patent well-being. This makes reducing CCU use a prime target of managed care plans and other third-party payers. Unfortunately, this sometimes results in an arbitrary pressure to reduce CCU use without regard to the needs of individual patients.

As a practical matter, doing too much for a patient poses fewer legal risks than doing too little. It is difficult to show that any specific treatment out of the many performed on a very sick patient made him worse or killed him. It is much easier for a jury to believe that denying a patient entry to the CCU was the cause of his demise. Denial of care will be particularly difficult to defend when the plaintiff can show that it was motivated by financial considerations. This has the potential for dramatically increasing the traditionally low levels of litigation against adult-patient CCU practitioners. Adult CCU care has had little litigation because of the demographics of the patients.

In most cases, patients in the CCU perceive their condition to be serious, and thus they are more understanding of an adverse outcome. Debates over the right to die reinforced the belief that if the intensivist could not save the patient, the patient could not have been saved. Public concern about DRGs (diagnosis-related groups) has now highlighted the hospital's economic interest in a patient's early demise. This will result in intensivists increasingly being sued in the belief that they would have done more had they not bowed to financial pressures.


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