Abstract 112: Unsustainable Hospital Costs in the treatment of Medicare Beneficiaries admitted with Aneurysmal Subarachnoid Hemorrhage

Background: Rising medical expenditures and the discrepancies in Medicare reimbursements have placed restraints on the health care delivery system. The goal of this study is to quantify these differences in the management of Medicare beneficiaries admitted with aneurysmal subarachnoid hemorrhage and to evaluate the sustainability of our current health care reimbursement practices. Material and Methods: Patients entered in the Nationwide Inpatient Sample between 2009 and 2010, with International Classification of Diseases codes for a diagnosis of ruptured aneurysm who underwent either surgical or endovascular treatment of the cerebral aneurysm, were included in the study. Factors associated with higher hospitalization cost were identified and correlations with age, sex, medical co morbidities, and discharge status were examined. Results: In 2009 and 2010, the average hospital charges for the 9,097 Medicare patients admitted with a ruptured aneurysm were $270,937 for patients treated with endovascular and $259,131 for patients treated with surgical treatment. These charges are substantially higher than the 2008 average Medicare (MS-DRG) payment, $36,304 for treatment of patients with co morbidity, and $30,380 without co morbidity. A greater number of endovascular treatments were performed, 6290, compared to 2807 surgical treatments. Of both treatments, women were more frequently treated. 78.4% of surgical treatments and 73.3% of endovascular treatments were for women. A higher percentage of patients treated with endovascular treatment had minimal disability at discharge compared with patients treated with surgical treatment (26.9% vs 16.8%, p = 0.005). However, the re-imbursement of both treatments was equivalent. Conclusions: Hospitalization charges for the care of Medicare beneficiaries who undergo surgical or endovascular treatment of ruptured aneurysms are significantly higher than Medicare reimbursement. Women undergo the majority of treatments and endovascular treatment appears to be associated with less disability at discharge. The current discrepancies in hospital expenses and reimbursement may lead to unsustainable healthcare delivery for these patients.