Major Drivers of Increased Cost of Inpatient Stroke Care in the Wake of the COVID-19 Pandemic (P3-7.001)

Abstract

<h3>Objective:</h3> To evaluate the impact of the COVID-19 pandemic on inpatient stroke care costs in a 23 hospital, integrated University Hospitals System Stroke Program (UHSSP). <h3>Background:</h3> Since 2008, the UHSSP implemented system-wide clinical practice guidelines and analytics to optimize high-value stroke care by improving quality and reducing unnecessary costs of care. <h3>Design/Methods:</h3> All stroke hospital discharges for DRGs 64–66 at 12 UHSSP hospitals were analyzed for volume, case mix index (CMI), inpatient total direct costs (TDC) including length of stay (LOS), ICU LOS, diagnostics, imaging, lab, OR, Pharmacy, supply and direct contribution margin (DCM) using EPSi™ and quality using <i>GWTG-</i>Stroke® and STATIT piMD™. The data encompassed three waves: 2017 (baseline), 2019 (2 years into a high-reliability initiative), and through 2q2022 (2 years into the pandemic). <h3>Results:</h3> For all medically managed stroke at the academic hub, the average TDC, CMI and positive DCM all increased (by +15%, +0.07, and +0.5% respectively) in 2019 over baseline in 2017. However, in 2q2002 over 2019, there was a significant increase in TDC, not scaled to the increase in CMI, and associated with a significant reduction in the positive DCM (by +63%, +0.06, and −61% respectively). The increased costs were driven by increased ICU LOS (ratio of ICU LOS vs non-ICU LOS +37%, from 2.05 to 2.8-fold) associated with nursing shortages and shifting step-down care to the ICU, and anticoagulant reversal agents accounting for a growth of 37% to 56% of all pharmacy costs. The same pattern was seen analyzing all hospitals in aggregate. <h3>Conclusions:</h3> The inpatient stroke costs have increased significantly since the pandemic, resulting in many health systems now operating in a deficit. Analyses have focused on pharmacy, labor and supply costs. This report identifies an unanticipated significant cost related to prolonged ICU LOS resulting from nursing staffing shortages. <b>Disclosure:</b> The institution of Dr. Sila has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Syntactx . Dr. Sila has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech . Dr. Sila has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astrazeneca . Colin Beilman has nothing to disclose. Mr. Vincent has nothing to disclose. Dr. De Georgia has nothing to disclose. Dr. Sarraj has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca. Dr. Sarraj has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Stryker Neurovascular. Dr. Sarraj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Stryker Neurovascular. The institution of Dr. Sarraj has received research support from Stryker Neurovascular.