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 to 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.