The impact of infections on reimbursement in 92 US hospitals, 2015-2018

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 bacte-rial 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 asso-ciated with an approximately two-fold increase in model-estimated LOS (9.2 vs 4.8 d; P < .001) and intensive care unit LOS (5.1 vs 2.8 d; 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. (c) 2021 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Automated summary

The study compared the financial burden of hospital admissions for patients with and without infections, showing that infections led to a significant increase in medical time and costs, with only private insurance payers having a positive margin.