Abstract Details

Title Rising Costs, Falling Coverage: A Decade of Medicare Expenditures and Hospital Charges in Neurologic Care

Topic General Neurology

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 7-012

Objective To describe national trends in hospital charges and inpatient Medicare expenditures for neurological care between 2013 and 2023.

Background

Recent studies have reported that the overall rate of inpatient admissions among Medicare beneficiaries has declined by approximately 25% since 2000, whereas spending per admission has increased by 11.4%. However, it remains unclear whether similar trends have occurred in neurological care, even as the burden of neurologic disease continues to rise with an aging population.

Design/Methods We conducted a retrospective analysis of all neurologic diseases from 2013–2023 using the Medicare Inpatient Hospitals by Provider and Service dataset, which reports inpatient hospital charges by Medicare Severity Diagnosis-Related Group utilizing the Medicare ICD-10-CM/PCS MS-DRG v42.0 Definitions Manual. Trend analyses evaluated total claims, hospital charges, and Medicare reimbursement, as well as changes in the reimbursement-to-charge ratio across neurology subspecialties, adjusted for healthcare inflation.

Results

From 2013-2023, inpatient neurologic care admissions totaled 6,681,483, generating $475 billion in hospital charges and $88.5 billion in Medicare reimbursements. Annual admissions declined from 711,671(of 7.49 million total Medicare admissions) in 2013 to 487,324(of 5.01 million) in 2023. Median hospital charges per neurologic admission rose from $56,846 to $104,221($78,466 inflation-adjusted), compared with an increase from $46,655 to $83,225($62,697 inflation-adjusted) across all Medicare inpatient admissions. Median Medicare reimbursement per neurologic admission rose from $11,357 to $17,237($12,974 inflation-adjusted), compared with an increase from $7,386 to $10,487($7,900 inflation-adjusted) overall. Reimbursement-to-charge ratios varied by subspecialty, highest in cognitive neurology(0.302) and lowest in headache(0.246) in 2013, shifting by 2023 to highest in neuroimmunology(0.243) and lowest in neuromuscular disorders(0.192).

Conclusions From 2013-2023, inpatient neurologic care admissions declined over 30%, while median charges nearly doubled—rising faster than overall Medicare inpatient costs. Medicare reimbursement grew modestly, widening reimbursement-to-charge gaps across subspecialties. These trends underscore growing cost disparities and the need for value-based payment models to sustain access to specialized neurologic care.

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.
Marissa M. Castillo (U of U Neurology Clinic)	Ms. Castillo 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.
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.
Trieste Francis	Miss Francis has nothing to disclose.
Huapin Huang	Prof. Huang has nothing to disclose.
John W. Rose, MD, FAAN (Imaging and Neurosciences Center)	The institution of Dr. Rose has received research support from National Multiple Sclerosis Society. The institution of Dr. Rose has received research support from Guthy Jackson Charitable Foundation. The institution of Dr. Rose has received research support from NIH . The institution of Dr. Rose has received research support from VA. The institution of Dr. Rose has received research support from Biogen. The institution of Dr. Rose has received research support from Friends of MS. Dr. Rose has received intellectual property interests from a discovery or technology relating to health care.
Jonathan R. Galli, MD (University of Utah)	Dr. Galli has nothing to disclose.
Yibing Zhang, MD	Dr. Zhang has nothing to disclose.
Jennifer J. Majersik, MD, FAAN (University of Utah)	Dr. Majersik 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 Stroke. The institution of Dr. Majersik has received research support from NIH/NINDS. The institution of Dr. Majersik has received research support from NIH/NCATS.
Jordan King (University of Utah)	Jordan King has nothing to disclose.
Vivek Reddy, MD (University of Utah)	Dr. Reddy has nothing to disclose.
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.

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