Abstract Details

Title National Trends in Inpatient Medicare Reimbursements and Hospital Discharges for Cognitive Impairment, 2013-2023

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) P5 - Poster Session 5 (11:45 AM-12:45 PM)

Poster/Presentation
Number 12-006

Objective To explore national trends and medical expenditures for inpatient cognitive impairment discharges from 2013 to 2023.

Background As the US population ages, Medicare enrollment is projected to rise from the 63 million beneficiaries recorded in 2020 to nearly 77 million by 2030. This growth, alongside escalating healthcare costs, highlights the need to understand utilization and spending patterns. Cognitive impairment affects approximately 9% of Medicare beneficiaries, yet national trends in hospital discharges, charges, and reimbursements remain unclear. This study characterizes these trends over the past decade to identify evolving financial patterns in cognitive care.

Design/Methods This retrospective analysis evaluated trends in cognitive impairment–related discharges from 2013 to 2023 using the Medicare Inpatient Hospitals by Provider and Service dataset. Discharges were defined as MS-DRGs 884, 056, 057 (ICD-10-CM/PCS v37.2). Trend analyses assessed discharges, hospital charges, and Medicare reimbursements over the 11- year period. Percent change analyses quantified shifts in discharge volume and reimbursement-to-charge ratios to evaluate evolving payment gaps.

Results

Between 2013 and 2023, there were 426,432 inpatient discharges associated with cognitive impairment, totaling $20.0 billion in hospital charges and $4.35 billion in Medicare reimbursements. Overall discharges increased by 18.6% during the study period. Discharges for DRGs 884 and 056 rose by 32.7% and 144%, respectively, whereas DRG 057 declined by 7.6%. Medicare reimbursement increased by 118.8%, and hospital charges rose by 153%. Linear regression analysis associated each year with a $26.3 million increase in Medicare reimbursement (β= 26,300,000; p < 0.001) and a $146 million increase in hospital charges (β= 146,000,000; p < 0.001). No significant discharge trend emerged, likely reflecting pandemic-related decline (2020-2022).

Conclusions Over the past decade, inpatient hospital charges have outpaced Medicare reimbursements, despite relatively stable discharge volumes. The widening financial gap underscores the increasing economic pressures on hospitals and the need for payment reform to sustain equitable cognitive care.

Authors/Disclosures
Marissa M. Castillo (U of U Neurology Clinic) PRESENTER	Ms. Castillo has nothing to disclose.
Trieste Francis	Miss Francis has nothing to disclose.
Erin D. Bouldin, PhD	The institution of Dr. Bouldin has received research support from National Institutes of Health. The institution of Dr. Bouldin has received research support from Department of Defense. The institution of Dr. Bouldin has received research support from Department of Veterans Affairs. The institution of Dr. Bouldin has received research support from Elizabeth Dole Foundation. Dr. Bouldin has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant with Alzheimer's Association.
Christine Cliatt Brown, MD (University of Utah)	The institution of Dr. Cliatt Brown has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly.
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.
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.
Ka-Ho Wong (U of U Neurology Clinic)	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.

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