A Case Study

Hospital Avoidance in a Patient with Complicated Osteomyelitis

A 59-year-old female with a history of left-hand open reduction with internal fixation developed complicated Pseudomonas and Providencia Osteomyelitis (ICD M86.8X4) requiring debridement, followed by multiple courses of failed oral antibiotics over many months. Ultimately, this patient was referred by the ortho service to Nod Specialists infectious diseases (ID) providers for further management. In order to expedite the ID consultation, an ID televideo visit was scheduled. On the day of the scheduled appointment, the patient became extremely anxious and informed Nod Specialists that she was going to the emergency department (ED) for evaluation. Nod’s physician assistant met the patient in the ED and prevented a hospital admission. The patient was then evaluated by the Nod physician via televideo and referred to a Home IV Infusion Company for 6 weeks’ treatment with Cefepime 2 Gms IV q12h to be initiated STAT and weekly labs. The Home Infusion Company arranged for PICC insertion at a local hospital outpatient center and initiated home IV Cefepime via peripheral IV that same evening.

Outcome

This patient’s IV Cefepime was discontinued day 24 due to drug side effects. Despite early discontinuance of treatment, the infection has not recurred and no further treatment has been necessary.

Estimated cost of avoided hospitalization1

(estimated 4-day length of stay)

Hospitalization

$10,5642

Nod Hospital Services

$800

Nod Post-discharge Services

$255

Home Infusion Services x 20 days post hospital discharge

$18,4063

Total Charges

$30,025

Actual cost of combined Nod and Home Infusion services

Nod Services

$3994

Home Infusion Services x 24 days – Payor A

$22,0805

Total Charges

$22,479

Saved $7,546

Estimated Cost Savings $7,546 (difference between estimated hospitalization cost and combined Nod Specialists and Home Infusion charges)

1- Healthcare Cost and Utilization Project 2006; average length of stay 9.3 days for osteomyelitis diagnosis; https://www.hcup-us.ahrq.gov/reports/factsandfigures/figures/2006/2006_4_3.jsp
2- Kaiser Family Foundation 2017; Hospital Adjusted Expenses Per Inpatient Day In Arizona $2,641 https://www.kff.org/health-costs/state-indicator/expenses-per-inpatient-day/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
3- Based on actual total Home Infusion claims billed and paid
4- Based on actual total Infectious Disease Specialist claims billed and paid
5- Based on actual total Home Infusion claims billed and paid