Online Program

Impact of c. difficile infections on inpatient hospital reimbursement

Tuesday, November 5, 2013 : 1:15 p.m. - 1:30 p.m.

Robert Freeman, PhD, Department of Pharmacy Practice & Administration, University of Maryland Eastern Shore School of Pharmacy, Princess Anne, MD
Background: The CDC (2009) estimates that hospital-acquired Clostridium difficile-associated diarrhea (CDAD) episodes result in $1.6 billion in annual hospital costs. In addition, the number of CDAD discharges has more than doubled in recent years. Recurrent CDAD episodes affect 20–30% of inpatients at an attributable cost of $13,926 per recurrent inpatient episode. The objective of this study was to determine the financial impact of hospital-acquired CAD on inpatient treatment costs and DRG reimbursement. Methods: A retrospective cohort (CDAD group matched with non-CDAD group) analysis was conducted using the 2009 California Office of Statewide Planning and Development Hospital Discharge Public Database, which contains data on approximately four million patients, including diagnosis-related groups (DRGs); International Classification of Diseases, 9th Revision (ICD-9) codes; hospital charges; source of payment; and length of stay (LOS). To understand cost differences between CDAD and non-CDAD cases, a multiple regression model was developed to study the relationship between inpatient CDAD hospital costs and LOS (dependent variables) and a set of independent or explanatory patient and diagnostic variables, including secondary diagnosis of CDAD, age, sex, race, and the top four secondary diagnoses of each DRG (a measure of case-mix complexity). Thirty-three thousand CDAD patient records were identified using ICD-9 code 008.45 (C. difficile). Results: CDAD was found to significantly increase average LOS and average cost for DRGs for which CDAD was listed as a secondary diagnosis (p<0.0001). As examples, chemotherapy DRG 847 (chemotherapy without leukemia) was found to have a non-CDAD LOS of 3.8 vs. 9.7 days for chemotherapy with CDAD; costs were $12,157 vs. $27,370, respectively. Pneumonia (DRG 924) was associated with an LOS of 4.8 days without CDAD vs. 6.7 with CDAD; associated costs were $9,225 vs. $16,979, respectively. Medicare reimbursement rates for DRGs included in the study were significantly lower than unadjusted hospital costs for both primary ($8,847 vs. $14,068 respectively) and secondary CDAD diagnoses ($15,715 vs. $40,724 respectively). Medicare was the primary payment source (64%) for CDAD treatment, followed by private coverage (18%), Medi-Cal (14%) and other (4%). Conclusions: Inpatient treatment costs and LOS associated with CDAD are significantly higher than a matched cohort of non-CDAD patients, resulting in costs exceeding DRG reimbursement.

Learning Areas:

Biostatistics, economics
Protection of the public in relation to communicable diseases including prevention or control
Public health or related laws, regulations, standards, or guidelines

Learning Objectives:
Assess the impact of hospital-acquired C. difficile infections on DRG-based reimbursement, treatment costs and length of stay Demonstrate the use of a computerized, state-wide data base as a resource to estimate the financial impact of a hospital-acquired infection

Keyword(s): Infectious Diseases, Hospitals

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have conducted independent and collaborative health economic and outcomes research for over 35 years across numerous disease and therapeutic areas including, but not limited to, infectious disease, cancer, mental health, cardiovascular disease and auto-immune disease.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4238.0: Health economics and costs