Case Studies

Hospital Inpatient Payor Claims Analysis - Hospital Acquired Infections

Insight

One of the largest device manufacturer companies developing innovative medical technologies requested that analytical research be conducted to understand the frequency with which certain hospital infections are developed as a result of the use of certain medical devices.

Strategy

The Aequitas Group developed a Cost Offset Model that would provide pricing support for hospital decisions to use the client’s medical device based on the prevention of costs associated with post-admission acquisition of ventilator associated pneumonia (VAP).

Execution

Using data from Center of Medicare and Medicaid Services (CMS), lookup tables were created containing the cost-to-charge ratios by institutional class. These tables were then used to adjust the hospital charges, creating true estimates of hospital costs that the client utilized towards the initial launch of their device. The economic evidence also supported the reimbursement and clinical outcome evaluation of the client’s medical device by a broader audience of key stakeholders in the United States and, specifically, CMS, which is a bellwether for most other national stakeholders. The study was developed into a poster presented at the CHEST (official publication of the American College of Chest Physicians) and a manuscript is being submitted for publication.