Looking at charges by revenue code, per unit billed, shows a steady and substantial increase in the amount charged and subsequently paid across several categories. Below are the top 5 codes billed, excepting pharmacy and implants which are highly variable.

Note that the per unit charge for Room & Board categories has more than doubled since 2016, while other categories saw similar growth trends. “OR - General” was distorted by a drop in claim volume in 2018 which resulted in a spike in the per unit trend. Outside of that year, the steady increase is more apparent.

The amount charged per bill is much more variable than the per unit charge, but there is a noticeable increasing trend since 2016, as indicated by the regression lines. Again, paids mirror the charges.

The perdiem charges reflect the substantial increase in the rate of charges dramatically, as shown below.

The Stop Loss eligible claims are listed below

Diagnosis Type Service Year PatientContractID Order Charge Paid LOS Paid Per Diem
ABI 2016 125541 1 962330 861467 165 5832
ABI 2018 129775 1 784215 718244 114 6879
ABI 2023 142882 1 831955 774600 199 4181
SCI 2023 142259 1 957934 885320 75 12772
SCI 2024 144551 1 1213578 1125527 120 10113

Below is a summary of data showing average complexity and bill counts for more context:

Diagnosis Type Service Year Avg Complexity Charge Per Bill Paid Per Bill LOS Count
ABI 2016 4.83 219349 200811 48.7 12
ABI 2017 5.25 163965 152900 42.8 8
ABI 2018 5.17 257203 232409 47.2 6
ABI 2019 5.33 213013 193631 39.2 9
ABI 2020 5.33 161217 140764 37.3 3
ABI 2021 5.33 226320 198323 47.4 9
ABI 2022 5.00 114773 105630 27.9 7
ABI 2023 5.60 512886 455391 88.4 5
ABI 2024 5.00 313692 257923 40.7 3
Multiple Trauma 2018 5.00 200349 192303 40.0 1
SCI 2016 5.56 166075 150264 48.8 9
SCI 2017 5.50 220103 198625 48.5 4
SCI 2018 5.60 242330 217526 42.2 5
SCI 2019 5.50 200507 173854 33.8 8
SCI 2020 5.33 353567 322118 79.0 3
SCI 2021 5.40 231181 206668 48.6 10
SCI 2022 5.20 280097 258319 55.6 5
SCI 2023 5.57 286134 257150 34.1 7
SCI 2024 5.50 548832 493279 70.0 4
SCI 2025 5.50 255159 227866 34.5 2