Extracorporeal Membrane Oxygenation (ECMO) and Hospital Economics

Background: Extracorporeal membrane oxygenation (ECMO) is a powerful, life-prolonging technology but is resource-intensive. Methods: This retrospective analysis utilized Medicare Fee-for-Service (FFS) inpatient data (October 2019-December 2022) to identify ECMO hospitalizations with continuous FFS coverage. We assessed total payment, costs, length of stay (LOS), and predominant medical severity diagnosis-related group (MS-DRG) and International Classification of Diseases (ICD-10) codes. Outcomes were stratified by DRG code, ICD-10 procedure codes, and ECMO type. Hospital costs were estimated using cost-to-charge ratios from the Centers for Medicare and Medicaid Services with a 3-year lag. Results: Continuous ECMO within MS-DRG 003 discharged between January 1, 2020, and December 31, 2022 were a subset of hospitalizations analyzed. For continuous central (CC) ECMO, mean costs were $287,334, median costs were $223,766, and the standard deviation (SD) was $224,261. Mean payment was $264,021, median was $218,642, and SD was $157,882. For continuous venoarterial (VA) ECMO, mean costs were $245,448, median was $191,363, and SD was $212,822. Mean payment was $241,617, median was $202,199, and SD was $145,456. For continuous venovenous (VV) ECMO, mean costs were $329,111, median was $256,706, and SD was $285,745. Mean payment was $298,141, median was $237,679, and SD was $198,160. The majority of patients (64%) received VA, which was the only ECMO type with a median payment that surpassed median costs. Rural facilities and teaching hospitals had consistently higher mean frequencies among all ECMO claims (CC, VA, VV) from October 2019-December 2022 compared to their counterparts (Rural: CC=2.4, VA=9.3, VV=4.9; Urban: CC=1.4, VA=6.1, VV=2.2; Teaching: CC=2.1, VA=8.6, VV=3.4; Non-teaching: CC=0.5, VA=1.9, VV=0.7). Conclusion: VV ECMO had the highest median costs and payment among the ECMO types. Median payment was less than median hospitalization costs for all types of ECMO apart from continuous VA ECMO.