10-Year Trend Cost Analysis of Medicare Payment in Autoimmune Encephalitis Inpatient Hospital Admission
Ka-Ho Wong1, Esther Zeng2, L DeWitt3, Vivek Reddy4, Trieste Francis4, Chloe Stein4, Charles Henderson4, Shaun Thompson4, Tammy Smith5, Adam De Havenon6, Stacey Clardy4
1U of U Neurology Clinic, 2UC Berkeley, 3Department of Neurology, CNC, 4University of Utah, 5Imaging and Neurosciences Center, 6Yale University
Objective:
Describe the 10-year trend in hospital and Medicare Payments for Autoimmune Encephalitis (AE) from 2013 to 2022 at the national level.
Background:
Autoimmune neurologic conditions, including AE, incur significant healthcare costs due to the need for inpatient care, diagnostic studies, and the administration of immunotherapies. As the Centers for Medicare & Medicaid Services bear a substantial portion of these healthcare expenditures, this study aims to examine the hospital and Medicare payments associated with AE.
Design/Methods:
This retrospective analysis focuses on the 2013 to 2022 Medicare Inpatient Hospitals - by Provider and Service Data, which reports inpatient hospital charges based on Medicare Severity Diagnosis Related Group (DRG). The analysis examines explicitly DRGs associated with the current default standard AE ICD-10 diagnosis code (G04.81-other encephalitis, myelitis, and encephalomyelitis). The analysis includes a percentage change in AE admission cost adjusted for healthcare inflation between 2013-14 and 2021-22, weighted for the number of AE-related DRGs.
Results:
From 2013 to 2022, there were 240,498 unique AE-related inpatient claims, totaling $8.91 billion in Medicare payments. In 2013, there were 16,552 admissions with a median hospital payment of $36,384.83 [IQR: $33,973.71-39,353.75] with Medicare covering $32,592.02[IQR: $30,711.26-34,601.59] per admission. By 2022, 18,090 admissions saw a median hospital payment of $42,419.21; when after-adjusted for healthcare inflation, this decreased to $32,673.29 [IQR: $29,539.65-36,902.07] per admission. Medicare payments averaged $27,028.80 [IQR: $24,712.54-31,950.61] per admission after-adjusted for healthcare inflation. The difference between hospital payment and Medicare reimbursement rose from $4,015.13 to $4,876.08 per admission after-adjusted for healthcare inflation.
Conclusions:
Medicare reimbursements for AE-related inpatient claims have decreased by 17% when adjusted for healthcare inflation rates. Further investigation is needed to determine the percentage difference of actual hospital charges compare to payments hospitals receive. Understanding these dynamics can help inform policy adjustments and financial planning in healthcare reimbursement models for rare diseases.
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