Unsustainable hospital charges are incurred in the treatment of Medicare beneficiaries admitted with subarachnoid hemorrhage

Abstract

Introduction: Rising medical care expenditures and the unchanging Medicare reimbursements have placed restraints on the health care delivery system.

Objective: The goal of this study is to identify the magnitude and determinants of discrepancy between hospitalization charges and Medicare re-imbursement observed in the management of Medicare beneficiaries admitted with aneurysmal subarachnoid hemorrhage in the United States.

Methods: Patients entered in the Nationwide Inpatient Sample between 2002 and 2010, with a ruptured intracranial aneurysm who underwent either surgical or endovascular treatment were included in the study. Factors associated with higher discrepancy between hospitalization charges and Medicare re-imbursement were identified.

Results: Discrepancies in hospital charges and Medicare reimbursement associated with endovascular and surgical treatment have increased over the decade. The median discrepancy per patient for Medicare patients aged 65 years and older treated surgically or endovascularly for a ruptured aneurysm from 2009 to 2010 was $177,380. The predictors of higher than median discrepancy(charges versus reimbursement), included Hispanic ethnicity (OR 2.1, 95% CI 1.1-3.9, p = 0.02), urinary tract infection (OR 2.0, 95% CI 1.4-2.8, p = <0.001), pneumonia (OR 3.0, 95% CI 1.8-4.8, p = <0.001), deep vein thrombosis (OR 2.5, 95% CI 1.2-5.2, p = 0.02), and pulmonary embolism (OR 18, 95% CI 2.0-169, pp = 0.01).

Conclusions: There is a growing gap between hospital charges and Medicare reimbursement. If hospitals continue to be reimbursed at significantly lower rates than charges incurred, this current system may be unsustainable due to losses incurred by hospitals.

Abbreviations: AHRQAgency for Healthcare Research and QualityCMSCenters for Medicare and Medicaid servicesNISNationwide Inpatient Sample.

Keywords: Aneurysm; Medicare; charges; endovascular treatment; hospital; reimbursement; subarachnoid hemorrhage; surgical treatment.

Figure 1. Mean discrepancy between hospital charges and Medicare reimbursement among Medicare patients aged 65 years and older admitted with a ruptured aneurysm treated with surgical or endovascular treatment, 2002–2010. Error bars represent the standard error.

Figure 2. Mean discrepancy between hospital charges and Medicare reimbursement among Medicare patients aged 65 years and older admitted with a ruptured aneurysm and either treated with surgical treatment or endovascular treatment, 2002–2010. Error bars represent the 95% confidence interval.