title: Unsustainable hospital charges are incurred in the treatment of Medicare beneficiaries admitted with subarachnoid hemorrhage.
abstract: BACKGROUND
  Rising medical care expenditures and the unchanging Medicare reimbursements have placed restraints on the health care delivery system.
  
  
  OBJECTIVE
  The goal of this study is to identify the magnitude and determinants of discrepancy between hospitalization charges and Medicare re-imbursement observed in the management of Medicare beneficiaries admitted with aneurysmal subarachnoid hemorrhage in the United States.
  
  
  METHODS
  Patients entered in the Nationwide Inpatient Sample between 2002 and 2010, with a ruptured intracranial aneurysm who underwent either surgical or endovascular treatment were included in the study. Factors associated with higher discrepancy between hospitalization charges and Medicare re-imbursement were identified.
  
  
  RESULTS
  Discrepancies in hospital charges and Medicare reimbursement associated with endovascular and surgical treatment have increased over the decade. The median discrepancy per patient for Medicare patients aged 65 years and older treated surgically or endovascularly for a ruptured aneurysm from 2009 to 2010 was $177,380. The predictors of higher than median discrepancy(charges versus reimbursement), included Hispanic ethnicity (OR 2.1, 95% CI 1.1-3.9, p = 0.02), urinary tract infection (OR 2.0, 95% CI 1.4-2.8, p = <0.001), pneumonia (OR 3.0, 95% CI 1.8-4.8, p = <0.001), deep vein thrombosis (OR 2.5, 95% CI 1.2-5.2, p = 0.02), and pulmonary embolism (OR 18, 95% CI 2.0-169, pp = 0.01).
  
  
  CONCLUSIONS
  There is a growing gap between hospital charges and Medicare reimbursement. If hospitals continue to be reimbursed at significantly lower rates than charges incurred, this current system may be unsustainable due to losses incurred by hospitals.
  
  
  BACKGROUND
  AHRQAgency for Healthcare Research and QualityCMSCenters for Medicare and Medicaid servicesNISNationwide Inpatient Sample.
authors.affiliation: Zeenat Qureshi Stroke Research Center, Departments of Neurology, Neurosurgery, and Radiology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Daraspreet S
authors.initials: DS
authors.lastname: Kainth
authors.affiliation: Zeenat Qureshi Stroke Research Center, Departments of Neurology, Neurosurgery, and Radiology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Malik M
authors.initials: MM
authors.lastname: Adil
authors.affiliation: Zeenat Qureshi Stroke Research Center, Departments of Neurology, Neurosurgery, and Radiology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Hunar S
authors.initials: HS
authors.lastname: Kainth
authors.affiliation: Zeenat Qureshi Stroke Research Center, Departments of Neurology, Neurosurgery, and Radiology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Jaspreet K
authors.initials: JK
authors.lastname: Dhaliwal
authors.affiliation: Zeenat Qureshi Stroke Research Center, Departments of Neurology, Neurosurgery, and Radiology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
keywords: Aneurysm; Medicare; charges; endovascular treatment; hospital; reimbursement; subarachnoid hemorrhage; surgical treatment