Top 5 Most Expensive Inpatient Conditions by Payer

The top five most expensive inpatient conditions in 2011 were septicemia, osteoarthritis, complication of devices, general childbirth and heart attack, but the most expensive conditions change slightly depending on the payer.

In August, the Agency for Healthcare Research and Quality and its Healthcare Cost and Utilization Project released a statistical brief on the total cost of hospital stays. Medicare and Medicaid picked up most of the $387 billion inpatient tab — 63 percent, or $242.9 billion. The five most expensive conditions cost more than 18 percent of all hospitalizations, while the top 20 most expensive represented 47.1 percent of hospitalization costs.

However, some inpatient conditions cost more based on the payer. For example, septicemia was the costliest Medicare hospital condition, but childbirth was the most expensive condition for stays covered by Medicaid and private insurance.

Here are the top five most expensive inpatient conditions from 2011, sorted by payer, according to the AHRQ brief. Note: The figures represent hospitals' cost to produce the services and what they billed — not the amount paid for services by payers — and they do not include the physician fees associated with the hospitalization.

Medicare
1. Septicemia (except in labor) — $12.7 billion
2. Osteoarthritis — $8 billion
3. Congestive heart failure (nonhypertensive) — $7.6 billion
4. Complication of device, implant or graft — $7.5 billion
5. Pneumonia (except caused by tuberculosis and STDs) — $6.7 billion

Medicaid
1. Liveborn (general childbirth) — $5.9 billion
2. Septicemia (except in labor) — $2.7 billion
3. Complication of device, implant or graft — $1.4 billion
4. Mood disorders — $1.4 billion
5. Pneumonia (except caused by tuberculosis and STDs) — $1.3 billion

Private insurance
1. Liveborn (general childbirth) — $5.8 billion
2. Osteoarthritis — $5.7 billion
3. Spondylosis, intervertebral disc disorders and other back problems — $4.7 billion
4. Septicemia (except in labor) — $3.7 billion
5. Complication of device, implant or graft — $3.2 billion

Uninsured
1. Heart attack — $819 million
2. Septicemia (except in labor) — $774 million
3. Acute cerebrovascular disease — $538 million
4. Biliary tract disease — $441 million
5. Diabetes mellitus with complications — $440 million

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