In the United States, between 700,000 and 1,000,000 patients experience a fall while hospitalized each year. These incidents are classified as adverse events, representing a significant patient safety issue that can lead to serious injury or death. Beyond the patient harm, these falls impose a substantial financial toll on the US healthcare system. This burden requires examining the total cost at a national level and the specific expenses generated by a single fall incident.
The Annual National Financial Burden
The total cost of falls across the United States is measured in the tens of billions of dollars annually. While this figure encompasses falls in all settings, the portion directly attributable to hospitalized patients contributes significantly to the overall economic strain. Recent data estimates that the total healthcare spending for non-fatal falls among older adults alone reached approximately $80.0 billion in 2020.
This national figure includes both the direct medical costs and the broader financial implications for the health system. Direct costs cover immediate treatment, such as emergency department visits, hospital stays, and surgery. Annual acute treatment costs for fall injuries among older adults alone are estimated to be nearly $20 billion.
The remaining costs include indirect expenditures, such as rehabilitation, lost productivity, and resources dedicated to fall prevention programs in hospitals. The sheer volume of falls drives this high aggregate cost, with up to 35% of in-hospital falls resulting in some form of injury. These injuries often require extended care, exponentially increasing the financial load on the system.
Deconstructing the Cost of a Single Fall Incident
The high national burden is a direct consequence of the expense associated with treating a single fall that results in injury. An injurious fall can add more than six days to a patient’s hospital stay, significantly inflating the overall bill. On average, the cost of a fall with injury is estimated to be over $14,000 per patient.
The severity of the injury directly affects the cost, with serious episodes ranging from approximately $19,000 to over $32,000. These expenses cover necessary medical services following the incident. This includes immediate diagnostic testing, such as X-rays or CT scans, to assess for fractures or internal bleeding.
A single fall may necessitate specialist consultations, particularly from orthopedic surgeons for fractures or neurologists for head trauma. The need for surgical intervention, post-acute care, and extensive rehabilitation services adds substantial costs to the patient’s record. Even without a physical injury, a fall increases the demand for costly resources, such as nursing care hours, specialized patient monitoring, and one-on-one sitters.
Payer Accountability for Fall-Related Injuries
A policy implemented by the Centers for Medicare & Medicaid Services (CMS) makes the costs of hospital-acquired falls particularly burdensome for hospitals. CMS classifies certain injuries resulting from falls and trauma that occur during a hospital stay as Hospital-Acquired Conditions (HACs). Because HACs are considered reasonably preventable, CMS will not provide additional reimbursement to the hospital for treating them if the condition was not present upon admission.
This policy, which began in October 2008, means that if a Medicare patient falls and sustains a fracture while hospitalized, the hospital must absorb the entire cost of treating that fracture. The case is paid as if the secondary diagnosis—the fall-related injury—never occurred, eliminating the higher-paying Diagnosis-Related Group (DRG) assignment. Unreimbursed costs for treating such an injury can range from $7,000 to $30,000 per incident, depending on the severity.
Because Medicare is the largest single payer for hospital services, this policy creates a strong financial disincentive for hospitals to have patient falls. The policy effectively shifts the financial burden of treating a preventable injury from the taxpayer and the payer directly onto the hospital’s operational budget. This mechanism forces hospitals to treat the fall injury at a loss, making prevention a financial priority as well as a patient safety concern.