Inpatient care is the largest portion of health care spending in the United States. A new survey from the Healthcare Cost and Utilization Project, under the auspices of the Agency for Healthcare Research and Quality, estimates that inflation-adjusted hospital costs grew by 24.6 percent to $343 billion from 2001 to 2007.

The report identifies which 10 conditions generated the most rapidly increasing hospital costs during that time period.

During that period mean costs per day grew 17.2 percent, with a 6.3 percent increase in the number of hospital discharges.

The increases varied by payer and stemmed from changes in inpatient costs and hospitalization rates.

For example, although discharges incurred for private insurance had the largest increase in mean cost per stay (20.8 percent), there was a decline in the number of stays incurred for private insurance (2.9 percent). In contrast, the average cost per hospitalization incurred for Medicaid and for the uninsured grew relatively slowly, about 14 percent, but it was coupled with dramatic growth in the number of hospital stays (20.1 and 29.9 percent, respectively).

The report also notes the growth in number of stays and total costs for the top 10 conditions by payer. For all payers, total costs more than doubled for stays attributed to blood infection and acute kidney failure. Degenerative joint disease was the most expensive condition incurred for private insurers ($4.6 billion) with a 120.3 percent increase in total costs.

The report says that Medicare patients accounted for more than half the costs of five of the most expensive conditions. These were acute kidney failure (67.8 percent), blood infection (65.2 percent), respiratory insufficiency, arrest, or failure (62.6 percent), intestinal infection (60.6 percent), and degenerative joint disease (55.1 percent). Degenerative joint disease, more common and debilitating with age, generated the second highest amount of cost for Medicare ($6.5 billion) in 2007.

Private insurance was the primary payer for about half of all stays among women in labor who had a previous C-section (51.3 percent) and showed a 55.7 percent growth in total costs for this diagnosis from 2001 to 2007. Medicaid came up as the second most common payer (41.4 percent) for a previous C-section stay.

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There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.