A Case Study

Hospital Avoidance in Patient with Recurring MRSA Cellulitis and Abscesses

40-year-old female with known history of sarcoidosis treated with the immunomodulator therapy, Remicade®. In March 2019, she developed painful lesions on her chin, armpit, and nose, was diagnosed with MRSA cellulitis and abscesses (ICD L02.91, A49.02), and was hospitalized. Since that time, she has suffered multiple recurrent infections and has been treated with various oral antibiotics. Ultimately, she was referred to an infectious disease specialist, Nod Specialists, who evaluated her via televideo September 2019 and referred her to an for weekly labs and 3 weeks’ treatment with Daptomycin 500 mg IV qd via existing central venous port. In mid-November 2019, the infection recurred, Nod Specialists evaluated her via televideo and referred the patient to a Home IV Infusion Company for another 3 week course of daptomycin 500 mg IV qd and weekly labs. Additionally, the patient developed nausea that was refractory to oral anti-emetics and Nod Specialists prescribed ondansetron 4 mg IV q8h prn. Her rheumatologist also placed her Remicade on hold and plans to transition her to Rituxan® with Home IV Infusion Company upon completion of daptomycin therapy.

Outcome

Resolution of MRSA lesions and Nod Specialists continues to closely follow for potential recurrence due to this patient’s susceptibility related to impending immunosuppressive therapy with Rituxan®.

Estimated cost of two avoided hospitalizations1

(estimated 3-day length of stay)

Hospitalization

$15,8462

Nod Hospital Services

$1,200

Nod Post-discharge Services

$255

Home Infusion Services x 20 days post hospital discharge

$8,2953

Total Charges

$25,596

Actual cost of combined Nod and Home IV services

Nod Services

$1,0654

Home Infusion Services x 24 days – Payor A

$9,6785

Total Charges

$10,743

Saved $14,853

Estimated Cost Savings $14,853 (difference between estimated cost of two avoided hospitalizations and combined Nod Specialists and Home Infusion charges for two courses of treatment)

1- Centers for Disease Control: National Health Statistics Reports, number 29; National Hospital Discharge Survey, 2007 Summary; Average length of stay for diagnosis of cellulitis and abcess 4.5 days;
https://www.cdc.gov/nchs/data/nhsr/nhsr029.pdf
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