What hospital inpatient services contributed the most to the 2001-2006 growth in the cost per case?

Abstract

Objective: To demonstrate a refined cost-estimation method that converts detailed charges for inpatient stays into costs at the department level to enable analyses that can unravel the sources of rapid growth in inpatient costs.

Data sources: Healthcare Cost and Utilization Project State Inpatient Databases and Medicare Cost Reports for all community, nonrehabilitation hospitals in nine states that reported detailed charges in 2001 and 2006 (n = 10,280,416 discharges).

Study design: We examined the cost per discharge across all discharges and five subgroups (medical, surgical, congestive heart failure, septicemia, and osteoarthritis).

Data collection/extraction methods: We created cost-to-charge ratios (CCRs) for 13 cost-center or department-level buckets using the Medicare Cost Reports. We mapped service-code-level charges to a CCR with an internally developed crosswalk to estimate costs at the service-code level.

Principal findings: Supplies and devices were leading contributors (24.2 percent) to the increase in mean cost per discharge across all discharges. Intensive care unit and room and board (semiprivate) charges also substantially contributed (17.6 percent and 11.3 percent, respectively). Imaging and other advanced technological services were not major contributors (4.9 percent).

Conclusions: Payers and policy makers may want to explore hospital stay costs that are rapidly rising to better understand their increases and effectiveness.

Figure 1

Ratio of the Change in Mean Cost for the Top 10 Service Codes with Statistically Significant Change between 2001 and 2006, Congestive Heart Failure versus All Discharges*Note. ^*2001 costs have been inflation adjusted to 2006 dollars. CHF, congestive heart failure.

Figure 2

Ratio of the Change in Mean Cost for the Top 10 Service Codes with Statistically Significant Change between 2001 and 2006, Septicemia versus All Discharges*Note. ^*2001 costs have been inflation adjusted to 2006 dollars.

Figure 3

Ratio of the Change in Mean Cost for the Top 10 Service Codes with Statistically Significant Change between 2001 and 2006, Osteoarthritis versus All Discharges*Note. ^*2001 costs have been inflation adjusted to 2006 dollars.