National Trends in Inpatient Medicare Reimbursements and Hospital Discharges for Cognitive Impairment, 2013-2023
Marissa Castillo1, Trieste Francis1, Erin Bouldin1, Christine Cliatt-Brown1, Stacey Clardy1, Adam De Havenon2, Ka-Ho Wong3
1University of Utah, 2Yale University, 3U of U Neurology Clinic
Objective:
To explore national trends and medical expenditures for inpatient cognitive impairment discharges from 2013 to 2023.
Background:
As the US population ages, Medicare enrollment is projected to rise from the 63 million beneficiaries recorded in 2020 to nearly 77 million by 2030. This growth, alongside escalating healthcare costs, highlights the need to understand utilization and spending patterns. Cognitive impairment affects approximately 9% of Medicare beneficiaries, yet national trends in hospital discharges, charges, and reimbursements remain unclear. This study characterizes these trends over the past decade to identify evolving financial patterns in cognitive care.
Design/Methods:
This retrospective analysis evaluated trends in cognitive impairment–related discharges from 2013 to 2023 using the Medicare Inpatient Hospitals by Provider and Service dataset. Discharges were defined as MS-DRGs 884, 056, 057 (ICD-10-CM/PCS v37.2). Trend analyses assessed discharges, hospital charges, and Medicare reimbursements over the 11- year period. Percent change analyses quantified shifts in discharge volume and reimbursement-to-charge ratios to evaluate evolving payment gaps.
Results:
Between 2013 and 2023, there were 426,432 inpatient discharges associated with cognitive impairment, totaling $20.0 billion in hospital charges and $4.35 billion in Medicare reimbursements. Overall discharges increased by 18.6% during the study period. Discharges for DRGs 884 and 056 rose by 32.7% and 144%, respectively, whereas DRG 057 declined by 7.6%. Medicare reimbursement increased by 118.8%, and hospital charges rose by 153%. Linear regression analysis associated each year with a $26.3 million increase in Medicare reimbursement (β= 26,300,000; p < 0.001) and a $146 million increase in hospital charges (β= 146,000,000; p < 0.001). No significant discharge trend emerged, likely reflecting pandemic-related decline (2020-2022).
Conclusions:
Over the past decade, inpatient hospital charges have outpaced Medicare reimbursements, despite relatively stable discharge volumes. The widening financial gap underscores the increasing economic pressures on hospitals and the need for payment reform to sustain equitable cognitive care.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.