National Trends in Medicare Charges and Reimbursement for Inpatient Neurologic Care, 2013-2023

OBJECTIVES: National trends in hospital charges and Medicare reimbursement for inpatient neurologic care are poorly characterized. We evaluated longitudinal changes in utilization, charges, and reimbursement for neurologic hospitalizations among Medicare beneficiaries, focusing on the evolving financial structure of inpatient care. METHODS: We conducted a retrospective analysis of Medicare fee-for-service Part A inpatient claims from 2013 to 2023. Neurologic hospitalizations were identified using diagnosis-related groups and categorized into 11 disease categories. Outcomes included hospitalization volume; hospital-submitted charges; Medicare reimbursements; total payments, reimbursement-to-charge ratios; and payment deficit ratios. Financial measures were inflation-adjusted using the Consumer Price Index for Medical Care, and temporal trends were assessed using linear regression. RESULTS: A total of 6,681,481 neurologic hospitalizations were identified. Hospitalization volume declined by 31.5%, while inflation-adjusted charges per hospitalization increased by 60.6% ($48,046 to $77,178). By contrast, inflation-adjusted Medicare reimbursement per hospitalization increased by 25.0% ($10,238 to $12,802). The payment deficit ratio increased from 0.742 to 0.798, with similar patterns across neurologic disease groups. Metropolitan hospitals had slightly lower payment deficit ratios than nonmetropolitan hospitals (adjusted difference -0.296 percentage points; 95% CI -0.312 to -0.279). DISCUSSION: These findings demonstrate a widening gap between inpatient neurologic care charges and Medicare reimbursement, suggesting increasing financial strain despite declining hospitalization volume. This work highlights structural misalignment in payment models and supports further research into reimbursement strategies that better reflect contemporary care complexity.