hip fracture admissions among medicare beneficiaries 2010 2015 rising hospital costs and falling reimbursements

1. Abstract

1.1. Background: This paper reports trends in care and costs associated with hip fracture admissions among Medicare Beneficiaries (MB).

1.2. Methods: This retrospective study identified 1,558,428 primary hip fracture admissions using the Medicare Provider Analysis and Review Files from fiscal years 2010 through fiscal year 2015.

1.3. Results: The total number of admissions rose from 246,825 to 276,659; however, rate per 1000 MB was 4.96 in 2010 and 4.98 in 2015. In all years, the patients were mostly female, Caucasian, and over age 80. Patient complexity increased as evidenced by greater comorbidity reporting.  Most patients received an Open Reduction and Internal Fixation (ORIF) or partial hip arthroplasty, although there was a slight decline in partial hip arthroplasty and concurrent rise in total hip replacement. The cost per patient rose from $12,363 to $14093 (p<0.0001) despite a fall in average LOS from 5.8 to 5.42 days (p<0.0001) and a fall in in-hospital mortality from 2.6% to 2.2%. Reimbursements fell $1,118 from $10,304 in 2010 to $9,186 in 2015.

1.4. Conclusions: Average hospital cost per beneficiary rose during our study period while inflation-adjusted reimbursements fell. We found lower average LOS and postop mortality. Rates of AKI on presentation and co-morbid infection have risen. The number of patients receiving THA has risen but the most common treatment is femur repair.