Medicare expenditures on unsuccessful out-of-hospital resuscitations

Numerous studies have shown the futility of continued emergency department (ED) resuscitative efforts for victims of out-of hospital cardiac arrest wh en prehospital resuscitation has failed. Nevertheless, these patients conti nue to arrive in the ED, where they create a strain on resources, To assess the economic cost of this, Medicare expenditures were determined for resus citative efforts on victims of atraumatic, out-of-hospital cardiac arrest s ubsequently pronounced dead in the ED. Charts of patients pronounced dead i n the ED of a 65,000-visit urban teaching hospital during 1995 were reviewe d. Selected patients met the following criteria: 1) Medicare recipient age 65 or over; 2) atraumatic, out-of-hospital arrest; 3) transported to the ED by an EMS crew authorized to perform advanced cardiac life support interve ntions. A total of 105 cases were identified that met inclusion criteria an d for which Medicare had claims on file corresponding to the date of death. Ambulance service payments ranged from $105-$391; mean = $263, Physician s ervice payments ranged from $8-$106; mean = $65, Payments for Medicare Part A (hospital facility) ranged from $59-$1,025; mean = $436, The total Medic are reimbursement was $80,197, mean = $764, This annualizes to a national e xpenditure projection of $58 million. Failed out-of-hospital resuscitation for Medicare patients is associated with poor outcome and high cost. Termin ation of these efforts in the prehospital arena is unlikely to affect outco me, and would result in considerable cost savings on physician and hospital facility charges. Compassionate protocols that recognize these principles should be developed and Implemented. (C) 1999 Elsevier Science Inc.