# Impact of hospital-acquired pneumonia on the Medicare program

## TL;DR

Hospital-acquired pneumonia increases Medicare costs and mortality, highlighting the need for prevention.

## Contribution

Quantifies the impact of HAP on Medicare beneficiaries' mortality and costs in 2019.

## Key findings

- HAP patients had 2.8x higher 90-day mortality than non-HAP patients.
- HAP patients spent 69% more days in the hospital and cost 24% more per episode.
- Findings support prioritizing HAP prevention as a Medicare quality initiative.

## Abstract

Patient safety organizations and researchers describe hospital-acquired pneumonia (HAP) as a largely preventable hospital-acquired infection that affects patient safety and quality of care. We provide evidence regarding the consequences of HAP among 2019 Medicare beneficiaries.

Retrospective case–control study.

Calendar year 2019 Medicare beneficiaries with HAP during an initial hospitalization, defined by International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding on inpatient claims (n = 2,457). Beneficiaries with HAP were matched using diagnosis-related group (DRG) codes with beneficiaries who did not experience HAP (n = 2,457).

The 2019 calendar year Medicare 5% Standard Analytic Files (SAF), for inpatient, outpatient, physician, and all postacute hospital settings. The case group (HAP) and control group (non-HAP) were matched on disease severity, age, sex, and race and were compared for hospital length of stay, costs, and mortality during the initial hospitalization and across settings for 30, 60, and 90 days after discharge. The 2019 fiscal year MedPAR Claims data were used to determine Medicare costs.

Medicare beneficiaries with HAP were 2.8 times more likely to die within 90 days compared with matched beneficiaries who did not develop HAP. Among those who survived, beneficiaries with HAP spent 6.6 more days in the hospital (69%) and cost the Medicare program an average of $14,487 (24%) more per episode of care across initial inpatient and postdischarge services.

The findings of higher mortality and cost among Medicare beneficiaries who develop HAP suggest that HAP prevention should be prioritized as a patient safety and quality initiative for the Medicare program.