Hospital admission due to skin and skin structure infections (SSSIs) increased by 17% from 20052011. A paucity of data have been reported regarding the total cost of admissions and reimbursement associated with acute bacterial SSSI (ABSSSI), including patients who are admitted unnecessarily. We assessed cost versus reimbursement for 2014 Medicare ABSSSI admissions, focusing on admissions for patients without comorbidities.
Short-term acute care hospital (STACH) admissions for fee-for-service (FFS) beneficiaries from 2014 were assessed with Medicare as a primary payer using the Medicare Provider Analysis and Review (MedPAR) 2014 file and hospital cost report data in 2013 from the Healthcare Cost Report Information System (HCRIS). Admissions with a primary diagnosis code of erysipelas/cellulitis, abscess, or wound infection (ICD-9 codes 035.xx, 681.xx, 682.xx, 686.xx, 958.3, or 998.5x) were included in the analysis. The top 4 Medicare-Severity Diagnosis-Related Group (MS-DRG) codes were identified, and total costs, total payments, and 17 Charlson Comorbidity Index (CCI) comorbidities (Deyo modification) for each admission were summarized. Hospital specific cost:charge ratios (CCRs) were generated from Medicare cost report data and used to convert charges to costs. A cost:reimbursement analysis was conducted for all admissions, and admissions with no CCI comorbidities, by calculating the margin (percentage of reimbursement remaining after hospital costs were applied).
From 3278 STACHs included in the analysis, 205,258 admissions for ABSSSI were identified in 2014, and 174,567 (85%) admissions were attributed to the top 4 MS-DRG codes (Table 1). The total cost for these admissions ranged from $6618 to $14,391 with negative margins (−6% to −9%). In total, 41,761 (24%) admissions were cases with no CCI comorbidities. Compared to all cases, total costs were lower with modest margins (2% to 6%).
Hospitals are cost-constrained in treating Medicare FFS patients with ABSSSI when total cost to treat ABSSSI is similar to the amount reimbursed. The economic burden of ABSSSI admissions may be alleviated through treatment of appropriate patients with few comorbidities in an outpatient healthcare setting.
K. R. Keyloun,
J. Young, Avalere Health: Employee , Salary
P. Gillard, Allergan, plc: Employee , Salary
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