The Impact of Infections on Reimbursement in 92 US Hospitals, 2015-2018

Link to article at PubMed

Am J Infect Control. 2021 Apr 20:S0196-6553(21)00202-9. doi: 10.1016/j.ajic.2021.04.007. Online ahead of print.


BACKGROUND: The diagnosis-related group (DRG) is a payment system introduced to standardize healthcare costs. However, reimbursement for treatment of infections does not always cover costs.

METHODS: We used 2015-2018 data from 92 US hospitals in the Becton Dickinson Insights Research Database to compare the financial burden of hospital admissions within non-infection DRGs for patients with a bacterial infection (INF+) versus those without an infection (INF-). Included patients were adults with a hospital length of stay (LOS) ≥ 3 days and evidence of infection. Multi-variable adjusted analyses via generalized linear mixed models were used to evaluate the impact of an infection on outcomes.

RESULTS: We analyzed data from 133,423 INF+ admissions and 170,531 INF- admissions. Infections were associated with an approximately two-fold increase in model-estimated LOS (9.2 vs 4.8 days; P < .001) and intensive care unit LOS (5.1 vs 2.8 days; P < .001). The average additional hospital cost for INF+ versus INF- admissions was $10,326 per admission (P <.001) and the average loss after reimbursement was $1,067 (P = .006). Only private insurance payers had a positive margin.

CONCLUSIONS: Current reimbursement options for infections result in significant hospital financial burden. Reimbursement models should be reconsidered to enable adoption of costlier diagnostics and antimicrobials.

PMID:33891989 | DOI:10.1016/j.ajic.2021.04.007

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