HCUP: Inpatient hospital stays feed rising medical costs

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Healthcare expenditures in the U.S. are astronomical, and according to a statistical brief by the Healthcare Cost and Utilization Project (HCUP), inpatient hospital costs could be the culprit. In fact, the brief outlined that in 2009 alone there were 39.4 million inpatient stays in U.S. community hospitals, which resulted in a $361.5 billion price tag.

HCUP's "Statistical Brief #123" highlighted the inpatient hospital costs in the U.S. between 1997 and 2009. During this time period, aggregate inflation-adjusted costs of inpatient hospital stays increased 4.4 percent per year, according to Elizabeth Stranges, MS, of Thomson Reuters, and colleagues. The cost of stays for non-elderly patients increased more quickly than costs for elderly patients, 4.4 percent vs. 3.1 percent.

Costs for the non-elderly were propelled by a growth in the cost per day for an inpatient hospital stay. In 1997, the cost per day for elderly patients (over the age of 65) was $1,300; in 2009, this number was $2,100. Costs for non-elderly patients were $1,400 in 1997 and $1,900 in 2009.

Most commonly, elderly patients presented at the hospital with congestive heart failure (19 stays per 1,000 patients), pneumonia (15.5 stays per 1,000 patients) and cardiac arrhythmias (13.7 stays per 1,000 patients). The costs for these elderly patient stays totaled $153.9 billion in 2009. While septicemia accounted for the largest aggregate costs ($8.5 billion), cardiac conditions such as coronary atherosclerosis, congestive heart failure and acute MI accounted for $7.5 billion, $7.3 billion and $6.3 billion, respectively.

As the number of patients placed with cardiac devices rose, so did the number of patients hospitalized due to a complication of the device, implant or graft. In fact, in 1997, the aggregate costs for device complications were $2.9 billion while in 2009 these costs rose to $4.9 billion, according to the brief.

The average length of stay was shorter in 2009 compared with 1997, 4.6 days vs. 4.9 days, respectively. The cost per stay was also less in 2009 compared with 1997, $9,200 vs. $6,600 per stay.

“The largest component of growth was change in the intensity of services (cost per stay), which accounted for 71 percent of the growth in aggregate costs,” the authors summed. “Population growth was the next largest contributor to the increase in aggregate costs, accounting for 24 percent, while an increase in the number of discharges per person was only responsible for 5 percent of the growth in aggregate costs.”

Of the top 20 most common reasons for hospitalization, the three top conditions that led to the rapid growth of aggregate costs for the elderly were the same among the non-elderly: septicemia, spondylosis and osteoarthritis.