The Five Most Expensive Conditions in Hospitals

The Five Most Expensive Conditions in Hospitals

By Dr. Kenneth Rothaus, M.D.

A recent report by the Agency for HealthCare Research and Quality listed the top 5 most expensive conditions for hospitalization as:

• Septicemia
• Osteoarthritis
• Newborn Infants
• Complication of device, implant or graft
• Acute myocardial infarction (heart attack)

In 2013 the cost of the hospitalization for 35.6 million hospital stays totaled in excess of $380 billion with these 5 conditions representing almost 20% of the total.  Septicemia was the most expensive of the group accounting for almost 24 billion dollars or 6.2 percent of total costs of hospitalizations.

When one evaluates the data by breaking the cost down by payer group or type of insurance (e.g., Medicare, Medicaid, private insurance, and uninsured) one finds that the mix varies somewhat among the insurers as to the most expensive conditions.  There is some overlap.  As expected for all of them, septicemia remained the most expensive condition. Furthermore, there were certain other conditions that appeared in the top 20 most expensive conditions in all 4 groups:

• Complication of device, implant or graft
• Acute myocardial infarction
• Congestive heart failure
• Pneumonia
• Acute cerebrovascular disease
• Respiratory failure

The contribution of each payer group to the total cost of hospitalizations in 2013 was interesting as well:

• Medicare and Medicaid 63 %
• Private Insurance 28 %
• Uninsured 5 %

(Note:  There is a category called missing or incomplete that accounts for the missing 4%),

Several years ago, New York State required tougher measures to ensure the early diagnosis and treatment of sepsis. This measure was to insure the early treatment of sepsis in order to save lives. Clearly, it should positively impact the aggregate cost of health care as well.

Do you think the New York measure should be adopted nationwide? Would you say it’s a good idea? Let us know what you think in the comment area below.