[L

CommunlcGtiom for
Communications
priorities
prlorItiu permit.
] for this
commuDiclliaDl1I .8 8diII,
communications to the editor
this section
The comments
pennit. The
will bebe published
IBCffon will
comment8 should
,hould not
published asu space
exceed 350
not exceed
and
8fHJCB and
wortla in
350 words 'n

To the Editor:
the Editor: immediately examined
immediately examined our our production
production methods
methods and and instructions
instructions furlOr
use. We
use. We discovered
discovered that that fastener hooks used
filstener hooks used inin our
our endotracheal
endotracheal
Dr. Mamdani
Dr. Mamdani would reach different
would reach conclusions ifif he
dift"erent conclusions read our
he read our tube holders
tube holders could,
could, indeed,
indeed, break oil' our
break off product for
our product lOr two reasons:
two reasons:
paper more
paper more carefully
carefully and
and directed his attention
directed his attention toto the
the specific
speciflc because strips
because the hook
strips ofof the book fastener
filstener were
were cut cut during
during manufacturing;
manufacturing;
methodologies we
methodologies we employed.
employed. His
His knowledge
knowledge ofof cost
cost accounting
accounting because users
and because
and users werewere instructed
instructed toto cutcut fastener
fastener strips
strips toto size
size
appears toto bebe limited
appears limited toto the
the article
article hehe cites
cites by
by Finkler,
Finkler, which
which isis aa during product
during product use.
use.
useful commentary
useful commentary but
but not
not related
related toto our
our study.
study. We
We are
are leaders
leaders inin We immediately
We immediately stopped
stopped all all production
production and began cutting
and began cutting fas-
fas-
employing the
employing the most
most sophisticated
sophisticated costingcosting methods
methods available,
available, as as tener hook
tener hook strips
strips with knife that
heated knife
with aa heated seals rows
that seals rows ofofhook as itit cuts,
hook as cuts.
evidenced by
evidenced by the
the fact that over
fact that over 5050 hospitals
hospitals around
around thethe country
country have
have We also
We also began
began providing three pre-cut
providing three prtHmt strips all tube
strips toto fitfit all tube sizes,
sizes, so so
purchased the
purchased the computer software (MCFIS)
computer software (MCFIS) developed
developed by by usus and
and product users
product users wouldnt
wouldn'thavehave totocut
cutstrips
stripstotosize.
size.
used inin the
used the study.
study. During
During the the past
past year,
yeu; we have pursued
we have pursued eveneven more
more We have had
We have bad nono other
other reports
reports ofofhook migration inin our
hook migration our pre-market
pre-market
advanced costing
advanced costing methods
methods which which willwill provide,
provide, we we believe,
believe, eveneven clinical trials oror inin our
clinical trials our marketplace
marketplace experience.
experience. We We very
very muchmuch
stronger evidence
stronger evidence ofof thethe disproportionate
disproportionate impact impact ofof DRG
DRG payments
payments appreciate
appreciate Dr. Dr. Heffner’s
HeBner! helphelp inin identi1,’ing
identifyingaaproblem
problemand andare glad to
areglad to
lOr certain
for certain types
types ofof patients.
patients. able toto continue
be able
be continue providing solution toto the
providing aa solution the long-term
long-term stabilization
stabilization
Dr. Mamdani
Dr. Mamdani also also seems
seems particularly
particularly concerned
concerned because
because the the of oral
of oral endotracheal
endotracheal tubes. tubes.
variable costs
variable costs are
are small
small andand the
the marginal
marginal savings ofwithholding
savings of withholding ICU ICU
treatment are
treatment are insignificant.
insignificant. This This view
view isis erroneous.
erroneous. Economists
Economists Daniel W.
Daniel W. McElaney
McElaney
agree that
agree that many
many costs
costs areare fixed
fixed inin the
the short
short run,
run, but
but allall costs
costs are
are Dale Medical
Dale PrrH:Wcta,lne.
Medical Products, Inc.
variable over time. IfIfaa hospital
variable overtime. hospital chooses
chooses systematically
systematically toto transferor
transfer or Plalnoille, Massachusetts
Plainville, MtllllldChwetts
refuse admission toto those
refuse admission those segments
segments of of the
the patient
patient population
population
requiring intensive
requiring c8re, variable
intensive care, variable nurse
nurse staffing
staffing and
and supply
supply costs,
costs, asas Effect of
Effect of Solvent Drag
Solvent Drag
well asas fixed,
well fixed, equipment
equipment and and administrative
administrative costs,costs, can
can he
be eliminated
eliminated
both within
both within and and outside
outside of of the
the intensive care" unit. If
intensive careunit. Dr. Mamdani
If Dr. Mamdani To the Editor:
the Editor:
questions this
questions this logic,
logic, we
we suggest
suggest he he observe
observe the the Chicago
Chicago market
market andand
explain why
explain why so few hospitals
so few hospitals are are treating
treating chronic
chronic ventilator
ventilator patients
patients The report of
The report of Boland (Cheat 1985;
Boland etet alal (Chest 1985; 87:373-76)
87:373-76) indicating that
indicating that
when
when demand
demand isis high.high. TheThe answer that the
answer isis that the true
true economic
economic costscosts inhalation ofof aa distilled
inhalation distilled water
water fog 109 accelerates
accelerates the the clearance
clearance ofof
natechnetium
Ullmtechnetiumdiethylene triamine penta
diethylene triamine penta acetate (DTPA) from
acetate (DTPA) from the
the
Mamdani refers
Mamdani refers toto are
are high
high and
and Medicare
Medicare DRG
DRG payments,
payments, Medicaid
Medicaid
rates, and,
rates, and, increasingly,
increasingly, other
other third
third party payments do
party payments do not
not support
support lungs
lungs waswas ofof particular
particular interest
interest since
since such
such aerosols
aerosols are
are commonly
commonly
these costs,
these costs. used inin aa variety
used variety ofofbronchopulmonary
bronchopulmonary disorders. The
disorders. The authors have
authors have
Dr. Mamdani
Dt Mamdani cannot
cannot understand
understand how
how we
we could
could project that costs
project that costs concluded that distilled
concluded that distilled water
water may
may increase
increase the
the permeability
permeability ofof the
the
per discharge
per discharge increased
increased asas muchmuch asas 16 16 percent
percent fromfrom 1983 1985. IfIf
1983 toto 1985. alveolar epithelium,
alveolar epithelium, and and they
they urged
urged caution
caution inin thethe use
use ofof distilled
distilled
Dr. Mamdani
Dr. Mamdani had bad evaluated
evaluated existing data, he
existing data, he would
would havehave found that
lOund that water aerosols
water aerosols asas aa vehicle
vehicle forlOr inhaled
inhaled drugs
drugs and and humidification
humidification of ofair,
air.
this estimate
this estimate has bas turned
turned outout toto be
be very
very close actual experience.
close toto actual experience. InIn There isis an
There an alternative
alternative hypothesis
hypothesis whichwhich could could explain
explain why why
the May
the May 1,I, 1985
1985 issue HospUala (pg
ofHospitals
issue of (pg 70),
70), per
per discharge
discharge costscosts during
during inhalation ofofdistilled
inhalation distilled water
water increases
increases thethe rate
rate ofsetechnetium
or-technetium DTPA DTPA
this period
this period ofof time
time increased
increased 17.7 17.7 percent.
percent. clearance. IfIfthe
clearance. the water still present
water isis still present within
within the the alveoli
alveoli atat the
the time
time ofof
Finally, ifif Dr.
Finally, Dr. Mamdani
Mamdani follows IOllows budgetary
budgetary proposals
proposals beforebeIOre the scan,
the scan, thethe radioactive
radioactive indicator
indicator may have been
may have been carried
carried through
through
the epithelium
the epithelium by by the
the water,
water, which
which should
should be be rapidly
rapidly removed
removed from from
Congress, he
Congress, he isis aware that not
aware that not onlyonly are
are hospitals
hospitals facing
facing freezes
freezes inin
DRG rates,
DRG rates, but
but teaching
teaching hospitals
hospitals such
such asas Rush
Rush and and Cook
Cook County
County are are the airspaces
the airspaces inin response
response toto the the osmotic
osmotic differences
dift"erences between
between the the
facing substantial
facing substantial declines
declines inin overall
overall payments
payments as as DRG
DRG ratesrates pro-
pro- inhaled fluid
inhaled 8uid and and the
the pulmonary
pulmonary tissues tissues and and blood.
blood. This This phe-
phe-
gress toto nationwide
gress nationwide rates rates and
and indirect
indirect education
education adjustments
adjustments are are nomenon
nomenon isis referred
referred toto as as “solvent drag" and
"solvent drag” and itit may
may well have played
well have played
aa role
role inin increased
increased ratesrates ofofclearance
clearance following
IOllowing instillation
instillation ofofdistilled
distilled
scaled back.
scaled back. The
The loss
loss per
per discharge
discharge projected
projected inin ourour research
research pales
pales inin
comparison toto losses
comparison losses under
under Administration
Administration MedicareMedicare proposals.
proposals. water
water observed
observed by by Chinard
Chinard etet alal (Trans(7rana Assoc
AIIIIOC Am
Am Phys Phy. 1962;
1962;
75:253-61)
75:253-61) and and more
more recently
recently by by Jones
Jones etet alal (Am
(Am RevRev Respir
Respir Die 1978;
DiaI978;
With all
With all the
the anecdotal
anecdotal reporting
reporting of of dumping
dumping patients
patients on on teaching
teaching
hospitals (particularly
hospitals (particularly publicpublic teaching
teaching hospitals),
hospitals), and and withwith thethe 118:1007-13). The
118:1007-13). The available
available datadata do do not
not permit
permit distinction
distinction between
between aa
aggressive emergence
aggressive emergence of ofthe
the for-profit
lOr-profit healthcare
healthcare corporations
corporations inin the the true increase inin permeability
true increase permeability and and an effect ofofsolvent
an effect solvent drag.
drag. The The use
use ofof
HMO market,
HMO market, one one would
would expect
expect Dr. Dr. Mamdani
Mamdani toto havehave more
more insight
insight large volumes
large volumes ofof saline
saline solution
solution rather than water
rather than water aerosols
aerosols may also
may also
into the
into the message
message ofof ourour study.
study. We We would
would recommend
recommend he he and
and others
others be associated with
be associated with some
some risk,
risk, since this practice
since this practice could
could result
result inin excess
excess
read the
read the recently
recently completed
completed Office
Office ofofTechnology
Technology Assessment
Assessment study
study retention of
retention of salt
salt and
and water
water inin some
some patients.
patients.
on intensive
on intensive care
care units
units which
which provides
provides aa more
more complete
complete narrative
narrative
description ofof the
description the issues
issues we have captured
we have captured inin financial
financial terms.
terms.
R. M.
R. Ef:fros. M.D.;
M. Effros, and G.G. B.R. Mason,
M.D.; and Muon. M.D.,
M.D .•
(Intensive Care
(Intensive Care Units:
Units: Clinical
Clinical Outcome,
Outcome, CostsCosts and
and Decision
Decision Mak-
Mak-
moision ofofRespiratory
Division PhysWlogy and
Respiratory Physiology and Medicine,
Medidne,
Harbor-UCLA Medical
Harbor-UCLA Medical Center,
Center, Torrance,
7bn-aRCe. CA
CA
ing. Congress
ing. Congress ofof the
the United
United States
States Office
Office ofofTechnology
Technology Assessment
Assessment
orA-HCS-28, Washington,
OTA-HCS-28, Washington, D.C.
D.C. November
November 1984.)
1984.) To the Editor:
the Editor:

We
We were
were most
most interested
interested inin the the observations
observations ofof Drs.
Drs. Effros
Eflius and
and
Peter
PeterW W. Butler, M.H.S.A; Roger
Butler, M.H.S.A; C. Bone,
Roger C. M.D., F.C.C.P;
Bone, M.D., EC.C.P';
and Thus
and Field. MS.
TIna Field, M.S. Mason
Mason on on our
our paper
paper onon the clearance ofof DTPA.
the clearance DTPA. WeWe are liuniliar with
are familiar with
Rwh-Pre.byterian-St. Luke’s
Rush-Presbyterian-St. Lukes Medical
Medical Center,
Center, Chicago
Chicago the observations
the observations of
ofJones
Jones etet alal and
and Chirond
Chirond andand suspect
suspect that, while
that, while
distilled water
distilled aerosol may
water aerosol may increase
increase alveolar
alveolar epithelial
epithelial permeability,
permeability,
Dale Endotracheal
Dale Tube Holders
Endotracheallllbe Holders we
we cannot
cannot exclude
exclude thethe possibility
possibility of ofsolvent
solvent drag.
drag. However,
However, when when wewe
 .....

definitive
definitive diagnosis
diagnosis and bleeding may
and bleeding occur during
may occur during the
the procedure.
procedure. Instead,
Instead, the
the authors,
authors, concerned concerned with break-even and/or
with break-even pro&tability
and/or profitability
Only further
Only farther experience
experience will define
will de&ne thethe precise
precise role ofofbiopsy
role biopsy In the
in the of patient care,
of patient care, chose chose to to useuse accounting
accounting cost, aa process
cost, process which which may may
evaluation of
evaluation of suspected
suspected Kaposi's
Kaposi’s sarcoma
sarcoma involving
involving the
the tra-
tra- grossly
grossly distort distort true true economic
economic costs.
costs. In In so doing, they
so doing, they were were able able toto
cheobronchial tree.
cheobronchial tree. avoid
avoid investigating
investigating the true
the true costs costs of of these patients to
these patients to thethe health
health care care
facility.
facility. Had
Had these these been been determined,
determined, the authors could
the authors could have have com- com-
Kam-Yung Lau,
Kam-Yung Lau, M.D.;}anet
M.D.; Av, M.D.;
Janet Av, M.D.; pared
pared them them to to thethe exact
exact cost cost of providing care
of providing care to to these
these patientspatients under under
Alan Rubin,
Alan Rubin, M.D.;
M.D.; Michael UHner,
Michael Littner, M.D.,
M.D., F.C.C.P.;
FC.C.P; an
an alternative
alternative system
system of of care.
care. By
By this this method,
method, the authors
the authors would
would
Marcel KrautIatJmmer,
and Marcel
and Krauthaminer, M.D.,
M.D., F.C.C.P.;
FC.C.P.; have fOund
have fuund the marginal cost
the marginal difference’ l of
cost clifJerence of the patients to
the patients the health
to the health
VetmJns AtlmiraimrJcion
Veterans Administration Medical Center,
Medical Center, care facility,
care facility, therebythereby measuring measuring the the economic
economic efficiency,
efficiency, rather than
rather than
Sepulo«la,
Sepulveda, and the UCLA
and the UCLA School oj'MedidRIJ,
School of Medicine, pro&tability, of
profitability, of not providing intensive
not providing intensive care care fOr fur medicare
medicare patients.
patients.
LoIAngelu
Los Angeles Having chosen
Having chosen to examine
to examine only accounting
only accounting costs, with
costs, with aa resultant
resultant
fOur-million
four-million dollar
dollar loss loss to to the the healthhealth care facility, the
care facility, authors then
the authors then
suggest that
suggest that a a "responsible
“responsible management
management response"
response” to this
to this loss might
loss might
To the EdUor:
To the Editor:
require the
require the reduction
reduction or elimination
or elimination ofhealth
of health care care fOr these patients.
for these patients.
Although the
Although the diagnosis of Kaposi's
diagnosis of Kaposi’s sarcoma ofthe
sarcoma of the tracheobronchial
tracheobronchial Whether
Whether or not
or not thisthis is is a a viable
viable alternative,
alternative, would have
one would
one have to to assume
assume
tree can
tree can sometimes
sometimes be made
be made histologically
histologically by biopsy
by biopsy at
at &beroptic
fiberoptic that
that care care fur fOr these patients would
these patients would be be provided
provided in in non-critical
non-critical care
care

bronchoscopic examination
bronchoscopic eumlnation In in the
the setting
setting of the acquired
of the acquired immune
immune areas.
areas. Would Would the the institution,
institution, in in fact,
fact, realize
realize any
any savings?
savings?
de&ciency
deficiency syndrome, we
syndrome, we feel
feel thatthat biopsy
biopsy of of these
these tracheobronchial
tracheobronchial Resources
Resources consumed
consumed by the
by the patients
patients would
would remain remain almost
almost un- un-
lesions is
lesions is usually unnecessary; the
usually unnecessary; diagnosis of
the diagnosis of widespread
widespread Kaposi! Kaposi’s changed,
changed, merely transferred
merely transferred to aa different
to different cost center where
cost center where a a higher
higher
sarcomais
sarcoma is frequently
frequently already established
already established histologically
histologically (fe, by skin
(ie, by skin oror volume
volume of
of patients
patients would
would be reflected
be reflected inin lower lower accounting
accounting costs. costs. At
At
lymph node
lymph biopsy). The
node biopsy). The tracheal
tracheal and
and bronchial
bronchial lesions
lesions are are highly
highly the same
the same time, time, unless unless new new patientspatients not not subject
subject to to DRG reimburse-
DRG reimburse-

characteristic
characteristic In appearance
in appearance and they
and they may may bleed
bleed when when biopsied.
biopsied. ment structure were
ment structure were to replace these
to replace these patientspatients in in thethe Intensive
Intensive Care
Care
Further, the
Further, the diagnostic
diagnostic yield
yield ofbiopsy
of biopsy samples samples may may be be low.
low. Unit, the
Unit, the &xed fixed costs costs of of the the Intensive
Intensive Care
Care Unit Unit would would remain remain
We have
We have now now perfimned
peribrmed &beroptic
fiberoptic bronchoscopic
bronchoscopic examination
examination on
on unchanged.
unchanged. The hospital
The hospital still
still has has toto pay pay fOr fur thethe space,
space, as well as
as well as
nine patients who
nine patients who bad endobronchial and/or
had endobronchial and/or tracheal
tracheal lesions lesions whichwhich maintenance
maintenance of the
of the highhigh technology.
technology. Labor
Labor costs of
costs of the
the Intensive
Intensive

appeared characteristic
appeared characteristic of
of Kaposi!
Kaposi’s sarcomasarcoma (ie, brightly
(fe, brightly red
red to to Care
Care Unit
Unit would
would not not change.change. Presumably, the
Presumably, the hospital
hospital would
would
violaceous vascular
violaceous vascular lesions). As
lesions). As In in the
the casecase reported
reported by Lau
by Lau and and increase
increase billing to
billing the non-DRG
to the non-DRG patients toto maintain
patients maintain pro&tability.
profitability.
colleagues, all
colleagues, nine patients
all nine patients bad
had Kaposi!
Kaposi’s sarcoma
sarcoma extensively
extensively involv-
involv- Furthermore, the
Furthermore, the authors
authors chose chose to increase all
to increase costs by
all costs by 16 16 percent
percent
ing
ing the
the skin, proven by
skin, proven by biopsy
biopsy prior prior to to the &beroptic bronchoscopic
the fiberoptic bronchoscopic to
to reftect
reflect "estimated
“estimated increases
increases in cost
in cost per per discharge
discharge between
between 1983
1983

examinations (which
examinations (which were were performed
pertOnned to to diagnose
diagnose unexplained
unexplained pul- pul- and 1985':
and 1985’ Once again,
Once again, we we are are not provided with
not provided adequate justifica-
with adequate justi&ca-
monary
monary in&ltrates).
infiltrates). The diagnosis
The diagnosis of
of Kaposi!
Kaposis sarcoma sarcoma ofof the the tra-
tra- tion.
tion. Theoretically,
Theoretically, as we
as become more
we become more familiar familiar with with our our technology,
technology,
cheobronchial
cheobronchial tree was
tree was mademade from bronchial biopsy
from bronchial biopsy samples samples in in only
only the cost
the cost of of technology
technology application application should should drop. drop. This This has has certainly
certainly

one (11
one (11 percent)
percent) of of these
these nine nine patients,
patients, was
but was con&nned
but confirmed at
at autopsy
autopsy been
been true true in In areas
areas such such as as renal dialysis and
renal dialysis cardiac bypass,
and cardiac bypass, where where
in an
in an additional
additional ave patients.
five patients. Three (33
Three (33 percent)
percent) of of the nine patients
the nine patients the
the costcost per per patient
patient has has decreased
decreased signi&cantly since
significantly since their their introduc-
introduc-
bad self-limited
had self-limited 20 to
20 to 5050 mlml mucosal
mucosal bleeds bleeds fOllowing
following the bronchial
the bronchial tion.
tion, Without
Without major
major breakthroughs
breakthroughs In intensive
in intensive care technology, itit isis
care technology,
biopsy
biopsy procedure.
procedure. difficult
difficult to
to comprehend
comprehend an
an increase
increase of
of approximately
approximately $4,000 per
$4,000 per
patient in
patient in two two years.
years. A more detailed
A more detailed analysis
analysis of the inftation
of the inflation factor factor
PUchenilc, M.D.,
Arthur E. Pitchenik,
ArthurE. M.D., F.C.C.P.;
F.C.C.P; would help
would help the Industry In
the industry holding down
in holding down costs. costs.
MargtJret A
Margaret FUchl, M.D.;
A. Fischl, M.D.; and
and Finally, one
Finally, one must must examineexamine the
the ethical
ethical issues
issues involved.
involved. In an
In an
Mario
Mariof J. StJlclana,
Saldana, M.D.,
M.D., accompanying editorial
accompanying editorial (Chut (Chest 1985; 82:141), Weinberg
1985; 82:141), Weinberg implies implies that that
of
Mi4mi, Miami,
Univerlity of Miami,
University Mi4mi, FloriJa
Florida huge amounts
huge amounts of
of money
money are are spent
spent futilely futilely on on the tenninally ill
the terminally ill andand
patients who
patients who cannot cannot get get well.well. Yet, Yet, in practice, clinicians
in practice, clinicians are often
are often
faced with
faced with utilizing
utilizing high technology in
high technology in situations
situations where
where an an elderly
elderly
Costs
Costs In the leu
in the ICU patient's outcome
patient’s outcome remains remains uncertain. uncertain. Despite Despite extensive extensive work
work duringduring
the past
the past ten ten years,
years, early early predictive
predictive indices
indices of patient outcome
of patient outcome remain
remain
To EdUor:
the Editor:
To the
unreliable. An
unreliable. An error error factor of
factor of even
even 5 5 percent,
percent, when
when applied applied to to 446446
patients, would
patients, would result
result In an
in an erroneous
erroneous prediction in
prediction in 25 patients, or
25 patients, or
In
In the
the recent
recent study, Butler et
study, Butler et al
al (Chut
(Chest 1985;
1985; 82:229-33)
82:229-33) evaluated
evaluated more
more than than one one patient
patient every every two two weeks.
weeks. Since
Since there
there is aa significant
is signi&cant
the relative
the relative profitability
pro&tability of of providing critical care
providing critical care to to seriously
seriously ilII
ill potential
potential fOr
for negative
negative outcome,
outcome, fe, preventable
ie, preventable morbidity
morbidity or mo~
or mor-
elderly patients
elderly patients in
in relation
relation to
to cost
cost andand reimbursement
reimbursement under the
under the tality, are
tality, are we justi&ed in
we justified In restricting
restricting care on
care on thethe basisbasis of of uncertain
uncertain
present DRG
present DRG payment
payment system system adopted
adopted by Medicare. Based
by Medicare. Based on their
on their &nancial
financial considerations?
considerations?
&nding
finding of of aa 4.7 million dollar
4.7 million dollar revenue
revenue loss loss treating
treating 446 patients, the
446 patients, the We
We agreeagree with with The Presidents Commission
The Presidents Commission on Life
on Life Support
Support that
that it it
authors concluded that
authors concluded that "this should send
“this should send a a clear
clear message
message to to hospitals
hospitals would be
would be more more desirabledesirable to
to cut cut costs
costs in In areas
areas where where outcome outcome is is
concerning the
concerning care given
the care given to to these patients." We
these patients.” We are
are concerned
concerned about
about unlikely
unlikely to
to be be aft'ected,
affected, rather
rather than
than discontinue
discontinue intensive
intensive care
care
the potential negative
the potential negative impact impact on on health
health carecare fOr
for the
the elderly
elderly resultiog
resulting services
services fOr for the elderly and
the elderly severely ill
and severely ill patients.2
patients. I
from
from aa study
study suchsuch as as this. With this
this. With this inin mind,
mind, we would
we would like like to
to note
note thethe
B. Mtamtlanl,
B. Mamdani, M.D.; C.
M.D., C. FrankUn,
Franklin, M.D.;
M.D.; K.
K. WIriu,
Weiss, M.D.;
M.D.;
fOllowing significant
following significant omissions
omissions from their
from their analysis
analysis of data.
cost data.
of cost
The methods
The methods used used inin this
this study
study to to detennine
determine costs were
costs were not not well-
well- and C. Burke,
and C. Burke, M.D., Cook
M.D., County Hospital,
Cook County H08pitIIl,
planned. The
planned. The cost
cost generated
generated by these 446
by these patients was
446 patients was $11.1
$11.1 million,
million, Chicago
Chicago

or $1,200
or $1,200 per day, $50
per day, $50 perper hour
hour fOr every hour
for every hour the patients were
the patients were in In
the hospital,
the hospital, ICU ICU and and non-ICU.
non-ICU. The The authors stated that
authors stated that costs were
costs were REFERENCES
REFERENCES
calculated by
calculated by multiplying
multiplying patient billed
patient billed charges
charges by
by cost-to-charge
cost-to-charge
1 Finkler
Finlder SA.
SA. The
The distinction
1 distinction between cost
between cost and charges. Ann
and charges. Intern
Ann Intern
ratios. This
ratios. method of
This method of determining
determining costscosts represents
represents the
the accounting
accounting
Med 1982;
Med 1982; 96:102-09
96:102-09
cost fOr
cost fur the patient and
the patient not the
and not true economic
the true economic cost cost of
of providing
providing care
care
22 Deciding
Deciding to life sustaining
fOrego life
to furego sustaining lPeatment: aa report
treatment: report onon thethe
to
to these patients. I If
these patients.’ the authors'
If the authors’ purpose
purpose was
was to to determine
determine how
how ethical,
ethical, medical
medical and legal
and legal issues
issues in treatment decisions.
in treatment decisions. Publica-
Publica-
many
many more more dollars
dollars were
were spent
spent on on the use of
the use Intensive care
of intensive care over
over tion
tion No. 0402-884. Washington,
No. 0-402-884. Washington, DC: Government Printing
DC: Government Printing Office
Office
routine care,
routine economic costs
care, economic costs would have been
would have been moremore appropriate.
appropriate.’ I 1983;
1983; 95-100
95-100

CHEST
CHEST /I 88
89 I/ 1
1 I/ JANUARY,
JANUARY. 1888
1986 151
159