Rising Costs, Falling Coverage: A Decade of Medicare Expenditures and Hospital Charges in Neurologic Care
Ka-Ho Wong1, Marissa Castillo1, L DeWitt2, Tammy Smith3, Trieste Francis4, Yi-Hsuan Huang4, John Rose3, Jonathan Galli4, Yibing Zhang4, Jennifer Majersik4, Jordan King4, Vivek Reddy4, Adam De Havenon5, Stacey Clardy4
1U of U Neurology Clinic, 2Department of Neurology, CNC, 3Imaging and Neurosciences Center, 4University of Utah, 5Yale University
Objective:
To describe national trends in hospital charges and inpatient Medicare expenditures for neurological care between 2013 and 2023.
Background:
Recent studies have reported that the overall rate of inpatient admissions among Medicare beneficiaries has declined by approximately 25% since 2000, whereas spending per admission has increased by 11.4%. However, it remains unclear whether similar trends have occurred in neurological care, even as the burden of neurologic disease continues to rise with an aging population.
Design/Methods:
We conducted a retrospective analysis of all neurologic diseases from 2013–2023 using the Medicare Inpatient Hospitals by Provider and Service dataset, which reports inpatient hospital charges by Medicare Severity Diagnosis-Related Group utilizing the Medicare ICD-10-CM/PCS MS-DRG v42.0 Definitions Manual. Trend analyses evaluated total claims, hospital charges, and Medicare reimbursement, as well as changes in the reimbursement-to-charge ratio across neurology subspecialties, adjusted for healthcare inflation.
Results:
From 2013-2023, inpatient neurologic care admissions totaled 6,681,483, generating $475 billion in hospital charges and $88.5 billion in Medicare reimbursements. Annual admissions declined from 711,671(of 7.49 million total Medicare admissions) in 2013 to 487,324(of 5.01 million) in 2023. Median hospital charges per neurologic admission rose from $56,846 to $104,221($78,466 inflation-adjusted), compared with an increase from $46,655 to $83,225($62,697 inflation-adjusted) across all Medicare inpatient admissions. Median Medicare reimbursement per neurologic admission rose from $11,357 to $17,237($12,974 inflation-adjusted), compared with an increase from $7,386 to $10,487($7,900 inflation-adjusted) overall. Reimbursement-to-charge ratios varied by subspecialty, highest in cognitive neurology(0.302) and lowest in headache(0.246) in 2013, shifting by 2023 to highest in neuroimmunology(0.243) and lowest in neuromuscular disorders(0.192).
Conclusions:
From 2013-2023, inpatient neurologic care admissions declined over 30%, while median charges nearly doubled—rising faster than overall Medicare inpatient costs. Medicare reimbursement grew modestly, widening reimbursement-to-charge gaps across subspecialties. These trends underscore growing cost disparities and the need for value-based payment models to sustain access to specialized neurologic care.
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