Abstract WMP95: U.S. Trends in the Cost and Charges for a Hospital Admission for Acute Ischemic Stroke (AIS): Do the Trends Track with the Consumer Price Index (CPI) for Medical Care Services?

Abstract

Introduction Care for AIS patients have improved over the last decade, with increased use of high technology interventions. The use of effective but high cost interventions, as well as the resulting improvement in survival, may affect the costs for a hospital admission. Thus, hospital costs for AIS may be expected to increase more than the average cost of medical care, as measured by the CPI. Furthermore, increases in bad debt for AIS patients may force hospitals to increase charges for AIS admissions to cover the cost of providing care to non-paying cases. Hypothesis Trends in costs for hospital admissions for AIS will increase the same as the CPI, while costs for patients treated with tPA will rise faster. Increased use of tPA and/or mechanical thrombectomy (MT), and improved survival will explain increases in costs, while insurance status will explain changes in charges. Methods A total of 499,661 hospital admissions for AIS were extracted from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP) data for 2005 through 2010. Cost per admission was estimated from total charges using each hospital’s cost-to-charge ratio and were compared with CPI trends in changes in healthcare costs provided by the US Bureau of Labor and Statistics. Use of tPA and/or MT was examined using multiple regression analyses. Number and percent of patients, per year, with tPA therapy and MT were calculated. Results Cost of an acute care admission for AIS increased at a greater rate than the CPI from 2005 through 2008, but appeared to level of in 2009, with tPA admission most closely following the CPI. Utilization of tPA increased in 2005 from 1.84% to 5.47% in 2010. The number of admissions with MT increased from 0.87% to 8.09% over the same time period. Charges for AIS admissions have increased much more rapidly that the CPI observed from 2005 to 2010, with admission receiving tPA having the greatest gain in charges. Conclusions Cost of care for AIS patients who receive tPA follows the CPI trend, while costs for non-tPA patients increase at a greater rate. This disparity could indicate a widening gap between cost and reimbursement for non-tPA admissions, and/or a failure of many hospitals to accurately record the use of tPA for billing purposes.