Inpatient Care versus Subacute Care for Long Term Intravenous Antibiotics Cost from the Patient Perspective
Background: Treatment of osteomyelitis often requires antibiotics over an extended period. Underinsured patients are often kept in an acute care setting for the duration of treatment rather than a subacute care facility or at home for antibiotic administration due to difficulties with placement in lower level care settings. This provides a significant financial burden on both the hospitalized patient and the hospital system. This report highlights the wide discrepancy between costs to the patient between care settings. Methods: A theoretical patient scenario based on a current patient scenario was described to billing officers at a large tertiary care center with affiliated extended care facilities and home healthcare services. Costs to the patient for antibiotics, as well as room and board were obtained. Findings: Six weeks of inpatient care with dual therapy broad spectrum antibiotics and basic nursing care costs $50,980. Similar care at an extended care facility costs $31,072, while similar services provided by home health nursing costs $12,307. Conclusions: The uninsured patient population is placed with a large financial burden when undergoing long term antibiotic treatment. Practitioners and care coordinators should evaluate the proper setting for treatment for patients on an individual basis and strive to find appropriate placement amidst financial challenges. Charitable care that provides medications and potentially other medical needs at a reduced rate for patients with limited financial resources and no insurance should be considered. These efforts will reduce the cost of treatment to the patient and in turn reduce the burden on the hospital system.