Health Economics Program
Issue Brief
2006-02
February 2006
Health Conditions Associated With Minnesotans’
Hospital Use
Health care spending by Minnesota residents accounts
for approximately 12% of the state’s economy and
about twenty percent of total health care spending
goes to purchase hospital inpatient care for state
residents. This issue brief broadly describes the mix of
health conditions that were associated with
Minnesotans’ hospital use in 2003.
Average length of stay ranged from 2.6 days
for conditions related to pregnancy and
childbirth to 7.7 days for those diagnosed
with a mental health condition.
Among the primary findings:
Patients with complicated diagnoses had
longer average lengths of stay than those
without them.
Eight of the 25 major groups of health
conditions, or major diagnostic categories
(MDCs), were associated with 76% of
hospital claims during 2003 and 73% of all
patient days of care provided.
The top five MDCs accounted for 50% of all
2003 patient days of care provided to
Minnesotans:
Diseases and disorders of the
circulatory system were associated with
12% of total patient days;
Mental diseases and disorders were
10%;
Just under 10% of all patient days
were provided to newborns and sick
neonates;
Diseases and disorders of the digestive
system were responsible for 9%;
9% of all patient days were associated
with musculoskeletal problems.
Across all major diagnosis categories, 26% of
the total patient days of care provided were
linked to the presence of complicated or
preexisting comorbid diagnoses.
Methods
For this analysis, we used Minnesota resident
insurance claims billed by 119 hospitals operating in
the state during calendar year 2003.1 Claims were
categorized into major diagnostic categories (MDCs),
which is a way of grouping the discrete ICD9-CM
diagnosis codes used for hospital billing and
utilization analysis that appear upon each claim. The
diagnoses in each MDC generally correspond to a
single major organ system within the human body.2
Health Conditions Responsible for
Hospital Inpatient Utilization
Table 1 ranks the top eight broad medical conditions
(MDCs) associated with the bulk of hospital patient
days of care used by Minnesota residents during
2003. These eight categories were responsible for 76%
of all claims, and 73% of the patient days of care
h ealth e conomics p rog ram
Minnesota Department of Health
provided. The first five condition categories alone were responsible for half of the total patient days. Patients with
complicated and/or comorbid diagnoses3 accounted for 26% of all patient days (Table 2) and stayed in the hospital
longer, on average, than patients without complex conditions, 4.5 versus 3.7 days (Table 3).
Table 1
Number of Inpatient Claims and Patient Days by Major Diagnostic Category, 2003
Major Diagnostic Category
Circulatory System
Mental Diseases & Disorders
Newborns & Neonates with Problems
Digestive System
Musculoskeletal & Connective
Respiratory System
Pregnancy & Childbirth
Nervous System
All Else (17 categories)
Total
Number of Number of
Claims
Days
75,704
27,770
63,537
47,802
54,187
42,854
68,309
27,005
130,295
537,463
% of Total % of Total
Claims
Days
245,480
214,108
201,931
196,305
195,431
184,875
180,367
111,450
564,644
2,094,591
14.1%
5.2%
11.8%
8.9%
10.1%
8.0%
12.7%
5.0%
24.2%
100.0%
11.7%
10.2%
9.6%
9.4%
9.3%
8.8%
8.6%
5.3%
27.0%
100.0%
Source: Minnesota Hospital Discharge Dataset of participating hospitals
CY 2003, Minnesota residents only
Care provided to Minnesota residents with circulatory system conditions accounted for nearly 12% of all patient
days and 14% of all claims during 2003, ranking first in Table 1. Average length of stay for Minnesota patients in
this MDC without complications or comorbidities was 3.1 days compared to 3.7 days to those with them (Table
3). Table 2 shows that patients with complicating diagnoses and/or comorbidities were associated with 24% of the
patient days within this category. Among the numerous surgical services provided within this first ranked MDC
were percutaneous cardiovascular interventions, cardiac device implants, coronary artery bypass surgeries, and valve
replacements, for example. The most prevalent medical condition (non-surgical) within this MDC was a diagnosis
of heart failure and cardiogenic shock, which accounted for 16% of all the circulatory system-related patient days
of care.
Table 2
Share of Inpatient Claims and Patient Days with Complications and/or Comorbidities, 2003
With Complications
and/or Comorbidities
Major Diagnostic Category
Circulatory System
Mental Diseases & Disorders
Newborns & Neonates with Problems
Digestive System
Musculoskeletal & Connective
Respiratory System
Pregnancy & Childbirth
Nervous System
All Else (17 categories)
Total
% of Total
Claims
% of Total
Days
20.5%
n.a*
n.a*
58.6%
18.8%
43.3%
5.5%
25.4%
31.0%
22.9%
23.7%
n.a*
n.a*
74.3%
22.1%
46.2%
9.8%
31.4%
29.3%
26.3%
Source: Minnesota Hospital Discharge Dataset of participating hospitals
CY 2003, Minnesota residents only
* n.a. = not applicable. Some MDCs by definition contain no DRGs with complications and/or comorbidities
2
Table 3
2003 Average Length of Stay (ALOS) by Major Diagnostic Category: Patients With and Without
Complications and/or Comorbidities
Complications
and/or
Comorbidities (CC)
ALOS
Without CC
Major Diagnostic Category
ALOS
With CC
Overall
ALOS
Total
Circulatory System
Mental Diseases & Disorders
Newborns & Neonates with Problems
Digestive System
Musculoskeletal & Connective
Respiratory System
Pregnancy & Childbirth
Nervous System
All Else (17 categories)
3.1
7.7
3.2
2.6
3.5
4.1
2.5
3.8
4.4
3.7
n.a
n.a
5.2
4.2
4.6
4.7
5.1
4.1
3.2
7.7
3.2
4.1
3.6
4.3
2.6
4.1
4.3
Total
3.7
4.5
3.9
Source: Minnesota Hospital Discharge Dataset of participating hospitals
CY 2003, Minnesota residents only
n.a. = not applicable.
Mental diseases and disorders, ranked second in Table 1, were associated with slightly over 10% of the patient days
provided by Minnesota hospitals to state residents in 2003. While the patient day volume was high, this MDC
accounted for only 5% of all claims. The overall average length of stay for the MDC was 7.7 days (Table 3).
Psychoses accounted for nearly 79% of total patient days associated within this MDC and lengths of stay averaged
around 8.7 days (not shown).
Ranking third, Table 1 shows that conditions specific to newborns and neonates with problems were associated
with over 9% of all Minnesota resident patient days and nearly 12% of all claims. This category includes all
newborns, from normal full-term neonates, to full-term neonates with major problems, and premature neonates as
well as those at low birthweight.5 While the number of patient days ranks high in this category due to the large
volume of births within the state, it is also important to recognize that the care provided included some of the
most intensive, high tech, and expensive hospital care available, especially at facilities equipped with neonatal
intensive care units. It is this combination of the number of births and need for neonatal intensive care that
accounts for the patient day volume. Normal newborns accounted for 74% of the claims in this MDC and 49% of
patient days. Neonates with various gestational age, respiratory, or delivery-related problems were associated with
26% of claims and 51% of MDC patient days. The average length of stay for normal newborns was 2.1 days in
2003 versus 6.2 days for neonates with problems (not shown).
Diseases and disorders of the digestive system ranked fourth in Table 1, accounting for slightly more than 9% of
total patient days in 2003, and just under 9% of all claims. Of the patient day total within the category, the largest
shares were for major small and large bowel procedures; followed by treatment of esophagitis, gastroenteritis, and
other miscellaneous digestive disorders; and gastrointestinal hemorrhage with complications and/or comorbidities.
Table 2 shows that cases including complications and/or comorbidities were associated with 74% of the patient
days within the category. Average lengths of stay for Minnesota patients without complex diagnoses in this MDC
were 2.6 days compared to 5.2 days for those with them (Table 3).
3
In fifth rank on Table 1 were diseases and disorders of
the musculoskeletal system and connective tissue.
These conditions were associated with 10% of the
claims Minnesota hospitals filed on behalf of state
residents and 9% of all patient days. Thirty one
percent of the MDC patient day volume was a result
of major joint and limb reattachments of the lower
extremities (in other words, joint replacements, or
revisions, to patients’ hips, knees, and ankles), a share
that was four times higher than the next ranked
DRG, medical back problems. According to Table 3,
average length of stay for patients in this MDC
without complications and/or comorbidities was 3.5
days versus 4.2 days for patients with the complex
conditions. Table 2 shows that only 22% of the MDC
patient days resulted from patients with complicating
diagnoses and/or comorbidities.
complicating diagnosis accounted for nearly 46% of
the patient days in this MDC, followed by C-Sections
at over 22% of the MDC volume. Average length of
stay displayed in Table 3 for noncomplex cases was
2.5 days compared with 4.7 days for women with
complicating diagnoses and/or comorbidities. The
average hospital stay for a normal vaginal delivery
without complicating diagnoses was 2.1 days while
women receiving C-sections without additional
complications and/or comorbidities stayed 3.7 days.
Complicated and/or comorbid diagnoses accounted
for just under 10% of MDC patient days.
Nervous system conditions, which included diagnoses
of stroke, coma, viral meningitis, headache, and
concussion, for example, were ranked eighth in Table
1. They accounted for 5% of the patient days
provided to Minnesota residents during 2003 and 5%
of all claims. Within this MDC, three more specific
conditions were responsible for nearly 39% of the
category’s patient day count. They were: intracranial
hemorrhage and stroke with infarction; craniotomy
for persons over age 17 with complications and
comorbidities; and degenerative nervous system
disorders. The stroke category accounted for 18% of
the MDC’s patient day total. Table 3 reveals that
patients with no complicating diagnoses and/or
comorbidities stayed in the hospital an average of 3.8
days while those with the more complex conditions
remained an average of 5.1 days. Thirty-one percent
of patient days in this category resulted from complex
diagnoses (Table 2).
Nearly 9% of all patient days and 8% of all claims in
2003 were associated with the treatment of respiratory
system conditions, the MDC occupying the sixth
rank on Table 1. Patients without complications
and/or comorbidities in this MDC stayed in the
hospital an average of 4.1 days while those with the
greater clinical complexity remained 4.6 days (Table
3). Patients with more clinical complexity were
responsible for 46% of the patient days consumed
within the MDC (Table 2). Two conditions were
responsible for the largest shares of the hospital stays
in this category. Simple pneumonia and pleurisy
among adults was responsible for 25% of category
patient days, followed by patients suffering from
chronic obstructive pulmonary disease 12%.
Conclusions
Services provided to women during pregnancy,
childbirth, and recovery ranked seventh in patient day
volume during 2003. Table 1 shows that this MDC
was associated with just under 9% of all patient days
and almost 13% of all claims. The claim and patient
day volumes associated with this category are high,
not only due to the large number of pregnancies in
the state, but also due to the care provided women
experiencing high-risk pregnancies, complications of
pregnancy (e.g. gestational diabetes or hypertension),
those receiving Cesarean sections, and assorted
postpartum conditions. Vaginal delivery without a
Overall inpatient hospital utilization and spending are
influenced by several factors:
4
The prevalence of common clinical
conditions;
The length of time patients stay in the
hospital;
The presence or absence of preexisting
comorbid conditions;
Unexpected complications that may occur
during a hospital stay;
The level of technology employed in
treatment.
The combination of all of these factors determines
overall inpatient hospital utilization and spending.
Endnotes
Admissions to these 119 out of 134 acute care hospitals
represent 89% of all patient admissions in the state. Two
subacute hospitals, Bethesda and Valley Hospital at Hidden
Lakes, all federal hospitals (VA and PHS Indian facilities), the
state hospital in St. Peter, state regional treatment centers, and
the Shriners Hospital for Children are excluded from the total
count.
1
A few MDCs, however, depart from this schema to reflect
specific types of injury, multiple significant trauma, burns, HIV
infection, substance abuse, miscellaneous contacts with the
health care system, and categories for invalid diagnosis codes.
2
The Centers for Medicare and Medicaid Services (CMS) define
comorbidity as a preexisting condition, which because of its
presence increases the length of hospital stay by at least one day
in approximately 75% of the cases. A complication is a
condition that occurs during the hospital stay, adding at least
one day in approximately 75% of the cases.
3
All newborns delivered in hospitals are counted as inpatients
from delivery until discharged. Insurance claims are generated
for each infant and include nursery charges, plus any therapies or
procedures performed, such as circumcision or bilirubin light
therapy, for example.
4
5
The Health Economics Program conducts research and applied policy
analysis to monitor changes in the health care marketplace; to
understand factors influencing health care cost, quality and access;
and to provide technical assistance in the development of state health
care policy.
For more information, contact the Health Economics Program at (651)
282-6367. This issue brief, as well as other Health Economics
Program publications, can be found on our website at:
http://www.health.state.mn.us/divs/hpsc/hep/index.html
Minnesota Department of Health
Health Economics Program
85 East Seventh Place, P.O. Box 64882
St. Paul, MN 55164-0882
(651) 282-6367
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