Inpatient Hospital Costs Increasing Due to Increases in Intensity of Services

Inpatient hospital costs are on the rise due primarily to a change in the intensity of services for patients, according to a new statistical brief released by the Healthcare Cost and Utilization Project (HCUP).

The brief examines inpatient community hospital costs from 1997 to 2009, using data from the HCUP and supplemental sources, for nonelderly and elderly patients receiving care. In addition to assessing the aggregate inflation-adjusted costs for inpatient stays, the brief also examines the procedures that are associated with the most significant increases in stays per population or increases in cost per day.

Community hospitals were defined in the brief as short-term, non-Federal, and general, and did not include hospital units of other institutions.

In 2009, the brief’s authors found that there was a total of 39.4 million inpatient stays in community hospitals in the United States, accounting for aggregate costs of $361.5 billion. The average stay was shorter than in 1997 (4.6 days vs 4.9 days); however, the cost per stay for the average inpatient had increased ($9200 vs $6600).

Overall, the aggregate inflation adjusted costs for inpatient community hospital stays increased by 3.9% between 1997 and 2009. This growth was primarily attributed to changes in the cost per day, average length of stay, number of stays per population, and population size.

When the costs were further assessed based on elderly or nonelderly patient populations, they found that in 2009, nonelderly patients who were <65 years of age accounted for $207.6 billion in hospital stay costs.

There was a 4.4% annual growth increase in the aggregate cost for stays for nonelderly patients, which was reportedly driven by a growth in the intensity of services or cost per day.

They also reported that the aggregate hospital costs were the highest for nonelderly stays, during which the primary procedures were respiratory intubation ($11.9 billion), spinal fusion ($7.9 billion), and Cesarean section ($7.4 billion).

Hospital stays for elderly patients cost $153.9 billion in 2009. This segment of the population also saw an annual growth increase in the aggregate cost for hospital stays, although at an annual growth of 3.1%, this increase was less than the nonelderly patients.

When the data were analyzed, the brief's authors noted that the aggregate hospital costs were highest for elderly patients who had respiratory intubation and mechanical ventilation ($7.9 billion), insertion, revision, replacement or removal of a cardiac pacemaker or cardioverter/defibrillator ($5.8 billion), and knee arthroplasty ($5.8 billion) as the principal procedure.

The brief also assessed the role procedures played in increasing stays per population and intensity of services, or cost per day, for both the elderly and nonelderly populations. They found that for nonelderly patients, rapid increases in stays per population were associated with spinal infusion, knee arthroplasty, cardiac pacemaker or cardioverter/defibrillator procedures, hip replacement, and cesarean section.

Those principal procedures that were associated with increases in the intensity of services or cost per day for the nonelderly group were colorectal resection, appendectomy, percutaneous transluminal coronary angioplasty (PTCA), cholecystectomy, and hysterectomy.

When the data were examined for elderly patients, the brief's authors reported that rapid increases in stays per population for spinal fusion, blood transfusion, hemodialysis, and respiratory intubation all contributed to the growth in costs for inpatient stays.

In addition, principal procedures that increased the intensity of service for elderly patients during their hospital stays included cardiac pacemaker or cardioverter/defibrillator procedures, PTCA, hip replacement, and echocardiogram.