Top 5 Costly Inpatient Conditions for Hospitals

By Megan Brooks
WebMD Health News

Reviewed by Arefa Cassoobhoy, MD, MPH

June 15, 2016 -- Sepsis, a life-threatening illness when an infection spreads through the body, was the most expensive condition treated in U.S. hospitals in 2013. Then came:

That's all according to a brief from the Agency for Healthcare Research and Quality.

Hospital costs for 35.6 million hospital stays totaled $381.4 billion in 2013, the report says. The five most expensive conditions accounted for 20.5% of total hospital costs.

The expenses represent each hospital's costs to produce the services, not the amount they were paid for these services by Medicare, Medicaid, private insurance, or patients. They also don't include doctor fees associated with the hospitalization, the agency notes.

Sepsis accounted for $23.7 billion (6.2%) of the total costs, followed by osteoarthritis at $16.5 billion (4.3%), newborn care at $13.3 billion (3.5%), complication of device, implant, or graft at $12.4 billion (3.3%), and heart attacks at $12.1 billion (3.2%).

Rounding out the top 20 most expensive inpatient conditions (in order) were:

Together, the 20 most expensive conditions accounted for nearly half (47.7%) of total hospital costs. They accounted for 43.7% of all hospital stays.

The primary payer shares of total hospital costs were 63% for Medicare and Medicaid, 28% for private insurance, and 5% for uninsured hospitalizations, according to the brief.

With regard to payer, osteoarthritis and back problems were the most expensive conditions for Medicare and private insurance. Pregnancy and childbirth were the most costly for Medicaid and private insurance, and skin infections were the most costly for Medicaid and the uninsured.

Nine of the 20 most expensive conditions for hospital stays billed to Medicare involved the cardiovascular or respiratory system, as did seven of the 20 most expensive conditions billed to Medicaid.

The report notes that although only 7.2% of the U.S. population had a hospital inpatient stay in 2012, the average expense per stay associated with those hospitalizations was more than $18,000, making hospitalization one of the most expensive types of health care treatment.

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SOURCE: Healthcare Cost and Utilization Project, Statistical Brief 204.

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