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Introduction: Acute pancreatitis (AP) was found in the discharge records of 461,302 patients in 2010 according to the National Inpatient Sample (NIS). This illness was concurrently present in 288,597 discharges as the primary diagnosis. The financial ramifications of the disease have increased dramatically over the last decade, exceeding $9 billion in total aggregate charges. This reflects the "national bill" for AP treatments. $3 billion in costs were directly related to discharges coded for primary AP in 2010. This study will explore the financial aspects of inpatient AP diagnosis over time and characterize these observations at the National level.
Methods: The NIS database and cost-charge ratio (CCR) files were utilized in conjunction with SAS 9.3 for all analyses. The weighted group averages (GAPIIC) include both operating and capital-related costs and were used to calculate charges and costs from the total charge records. Independent means and standard errors were generated from the costs and charges columns for each discharge in the years 2001 and 2009. Results were tabulated and relative changes over the time period and their associated statistical significances were calculated using the NIS Z-test calculator.
Results: The number of discharges for all diagnoses of AP (ICD-9 Code 5770) increased 34% from 330,664 to 441,455 from the year 2001 to 2009 (p<.001). Primary diagnosis of AP represented 221,664 and 274,119, respectively, a 24% increase thereof (p<.001). Lengths of stay for primary AP diagnoses in this same time period decreased from 6.1 to 5.1 days (-16%, p<.001). Gender distribution was found to be equivocal. GAPIIC average fell 5.2 percent from 2001 to 2009 (p<.001). Total average charges for all adult AP diagnoses increased 73%, $25,073 to $43,410 (p<.001), while average costs increased 31% from $11,257 to $14,769 (p<.001). The difference between hospital charges and service costs increased 107%, from $13,815 to $28,641 (p<.001). Aggregate charges for primary AP diagnosis increased from $4,279,659,980 to $8,581,512,698, a 101% change (p<.001).
Conclusion: This study finds an increasing gap between hospital costs and charges for treatment of AP. Although costs appear to be managed, charges are dramatically inflated. The inherent power of the NIS has provided evidence that healthcare providers have controlled the treatment costs of AP in the last decade. Increased transparency and movement towards accountability in medical care demands further clarification. Continued investigations may reveal that the fiscal cliff which confronts the healthcare industry is not a matter of care generated cost, but may reflect an intrinsic lack of efficiency in insurance premiums, administration, and overhead.