Abstract Details

Title 10-Year Trend Cost Analysis of Medicare Payment in Autoimmune Encephalitis Inpatient Hospital Admission

Topic Autoimmune Neurology

Presentation(s) P9 - Poster Session 9 (11:45 AM-12:45 PM)

Poster/Presentation
Number 8-011

Objective

Describe the 10-year trend in hospital and Medicare Payments for Autoimmune Encephalitis (AE) from 2013 to 2022 at the national level.

Background Autoimmune neurologic conditions, including AE, incur significant healthcare costs due to the need for inpatient care, diagnostic studies, and the administration of immunotherapies. As the Centers for Medicare & Medicaid Services bear a substantial portion of these healthcare expenditures, this study aims to examine the hospital and Medicare payments associated with AE.

Design/Methods This retrospective analysis focuses on the 2013 to 2022 Medicare Inpatient Hospitals - by Provider and Service Data, which reports inpatient hospital charges based on Medicare Severity Diagnosis Related Group (DRG). The analysis examines explicitly DRGs associated with the current default standard AE ICD-10 diagnosis code (G04.81-other encephalitis, myelitis, and encephalomyelitis). The analysis includes a percentage change in AE admission cost adjusted for healthcare inflation between 2013-14 and 2021-22, weighted for the number of AE-related DRGs.

Results From 2013 to 2022, there were 240,498 unique AE-related inpatient claims, totaling $8.91 billion in Medicare payments. In 2013, there were 16,552 admissions with a median hospital payment of $36,384.83 [IQR: $33,973.71-39,353.75] with Medicare covering $32,592.02[IQR: $30,711.26-34,601.59] per admission. By 2022, 18,090 admissions saw a median hospital payment of $42,419.21; when after-adjusted for healthcare inflation, this decreased to $32,673.29 [IQR: $29,539.65-36,902.07] per admission. Medicare payments averaged $27,028.80 [IQR: $24,712.54-31,950.61] per admission after-adjusted for healthcare inflation. The difference between hospital payment and Medicare reimbursement rose from $4,015.13 to $4,876.08 per admission after-adjusted for healthcare inflation.

Conclusions Medicare reimbursements for AE-related inpatient claims have decreased by 17% when adjusted for healthcare inflation rates. Further investigation is needed to determine the percentage difference of actual hospital charges compare to payments hospitals receive. Understanding these dynamics can help inform policy adjustments and financial planning in healthcare reimbursement models for rare diseases.

Authors/Disclosures
Ka-Ho Wong (U of U Neurology Clinic) PRESENTER	The institution of Mr. Wong has received research support from The Sumaira Foundation . The institution of Mr. Wong has received research support from The Siegel Rare Neuroimmune Association.
Esther Zeng	Miss Zeng has nothing to disclose.
L D. DeWitt, MD (Department of Neurology, CNC)	Dr. DeWitt has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen.
Vivek Reddy, MD (University of Utah)	Dr. Reddy has nothing to disclose.
Trieste Francis	Miss Francis has nothing to disclose.
Chloe Stein	Chloe Stein has nothing to disclose.
Charles Henderson (University of Utah)	No disclosure on file
Shaun Thompson (University of Utah)	No disclosure on file
Tammy L. Smith, MD, PhD (Imaging and Neurosciences Center)	Dr. Smith has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. The institution of Dr. Smith has received research support from Alexion/AstraZeneca.
Adam De Havenon, MD, FAAN (Yale University)	Dr. De Havenon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novo Nordisk. Dr. De Havenon has or had stock in Certus.Dr. De Havenon has or had stock in TitinKM. The institution of Dr. De Havenon has received research support from NIH/NINDS. Dr. De Havenon has received publishing royalties from a publication relating to health care.
Stacey Clardy, MD, PhD, FAAN (University of Utah)	Dr. Clardy has received personal compensation for serving as an employee of Veterans Health Administration (VHA). Dr. Clardy has received personal compensation for serving as an employee of University of Utah Health. Dr. Clardy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AstraZeneca/Alexion. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen/Horizon. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Arialys. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kyverna. Dr. Clardy has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology/AAN Publications. The institution of Dr. Clardy has received research support from NIH/NINDS. The institution of Dr. Clardy has received research support from SRNA. The institution of Dr. Clardy has received research support from Alexion/AstraZeneca. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a AAN Summer Meeting CoDirector Travel and Lodging with AAN. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a Grand Rounds Travel/Lodging/Honoraria with U of Iowa, Miami, Stanford, Barrow, Beaumont Health, CCF, Emory, Penn State, Mayo Clinic, Walter Reed.

��ɫ��

��ɫ��