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Just One Breath: Valley fever’s human and financial costs detailed in new study

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Just One Breath: Valley fever’s human and financial costs detailed in new study

Reporting on Health Collaborative
Wednesday, September 25, 2013

The rate of people being hospitalized for valley fever has doubled in California over the past decade.

Not only are more people being diagnosed with the disease but the cases are serious enough that more people are ending up in the hospital.

That should be reason enough to take the disease more seriously. But, for those who think that everything is driven by self-interest, consider that the associated health care costs are going up, too. And you and I are paying the bulk of the bills.

These are some of the findings in Coccidioidomycosis-associated Hospitalizations, California, USA, 2000–2011, published in Emerging Infectious Diseases and authored by a team from the California Department of Public Health: Gail Sondermeyer, Lauren Lee, Debra Gilliss, Farzaneh Tabnak, and Duc Vugia.

I wrote on Sunday about how more media coverage could lead to more journal articles. This article was covered this month by the Associated Press and ran in The Washington Post and other outlets nationwide. And it provides more great discussion points for the valley fever symposium that kicked off yesterday in Bakersfield.

Here’s what Sondermeyer and her colleagues found:

During 2000–2011, there were 25,217 coccidioidomycosis-associated hospitalizations in California; hospitalizations increased from 1,074 in 2000 to 3,197 in 2011. The hospitalization rate per 100,000 population in 2011 was 8.6, a significant increase from the 2000 rate of 3.2/100,000 population (p<0.0001). Of the 25,217 hospitalizations, 15,747 (62%) were initial hospitalizations and 9,470 (38%) were subsequent hospitalizations. Of the initial hospitalizations, 9,568 (61%) were for a primary diagnosis of coccidioidomycosis. The initial hospitalization rate per 100,000 population in 2011 was 5.0, a 2-fold increase from the 2000 rate of 2.3/100,000 population (p<0.0001), and the rate of subsequent hospitalizations in 2011 was 3.6/100,000 population, a >4-fold increase from the 2000 rate of 0.8/100,000 population (p<0.0001).

Pay attention to that rate of subsequent hospitalizations. This means the same people keep coming back to the hospital with valley fever.

You may have heard people talk about the “readmission rate.” In health care, you want readmissions to go down, not up because you want to fix people the first time they are in the hospital. If they come back, it means you didn’t solve the problem or that you actually made the problem worse by giving them a treatment that exacerbated the problem, for example, or exposing them to a hospital-acquired infection like MRSA.

The study found that of the 15,747 patients who were initially hospitalized for valley fever, 1 out of every 4 ended up back in the hospital. And, of those who were readmitted, nearly a third had to go back to the hospital three or more times.

That’s a huge flashing neon sign that what we are doing in health care right now to handle valley fever is not working.

It’s not working, and it is costing us a lot of money. Sondermeyer and colleagues wrote:

During 2000–2011, the total charges for all coccidioidomycosis-associated hospitalizations in California was US $2.2 billion, and the average annual total was US $186 million. After we adjusted for inflation, the annual total charges increased from US $73 million in 2000 to US $308 million in 2011.

That’s a 322% increase over a decade. And who paid that price? The individual valley fever patients? They likely paid a chunk of the bill, for certain. But more than 60% of those costs were billed to government agencies. The authors wrote:

Government payers (defined as Medi-Cal, Medicare, other government, and county indigent payers) were the expected source of payment for 62% of charges. For all government payers combined, the total (US $1.4 billion) and average annual total (US $115 million) of hospital charges were each nearly twice those for private coverage.

Let’s hope the discussions in Bakersfield put the increasing intensity of the disease and the rising costs front and center.

Photo by 401(K) 2013 via Flickr

About This Series

This project results from an innovative reporting venture – the Center for Health Journalism Collaborative – which currently involves the Bakersfield Californian, Radio Bilingüe in Fresno, Valley Public Radio in Fresno and Bakersfield, Vida en el Valle in Fresno, Hanford Sentinel, the Voice of OC in Santa Ana, the Arizona Daily Star in Tucson, La Estrella de Tucsón and the Center for Health Journalism. The collaborative is an initiative of the Center for Health Journalism at the University of Southern California’s Annenberg School for Communication and Journalism.

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