image: This table shows the number of discharges, percent of discharges, total bed days, and percent of bed days for major hospitals* by payor status, United States and California. view more
Credit: Dr. Lisa Chamberlain
TORONTO, May 5, 2018 - Hospitals caring for children with serious, chronic illness are highly dependent on public payers, according to a new study. The research found that proposals to dramatically reduce federal expenditures on Medicaid and Children's Health Insurance Program (CHIP) could destabilize current specialty care referral networks serving all children, including the majority of privately-insured children in greatest need of high quality, specialized, pediatric care. Findings from the research will be presented during the Pediatric Academic Societies (PAS) 2018 Meeting in Toronto.
Although Medicaid and CHIP are directed at providing health services for low-income children, the potential impact of reduced Medicaid and CHIP spending on regionalized systems of hospital care for seriously ill children remains unexplored. The objectives of the study were to assess the role of Medicaid and CHIP in regional hospitals serving large numbers of seriously ill children; to assess the importance of these regional hospitals to privately-insured, seriously ill children; and to assess the characteristics of the hospitals with the highest patient volume and Medicaid and CHIP dependence.
Researchers conducted a retrospective analysis between the 2012 national KID inpatient database and the 2012 California confidential, unmasked Patient Discharge Database from the Office of Statewide Health Planning and Development. Public payers were defined as Medicaid and CHIP, and major pediatric hospitals as those with >500 discharges of children <18 years old with a serious, chronic illness. Serious chronic conditions were defined by validated diagnostic algorithms and excluded asthma and mental health conditions. The most common included conditions were prematurity, congenital heart disease, cancer and neurological/genetic disorders.
Nationally, major pediatric hospitals reported over 50 percent of bed days covered by public payers with the 10 highest volume hospitals ranging from 36 percent to 100 percent. Similarly in California, 69 percent of bed days were covered by public payers with the six highest volume hospitals reporting >50 percent public payers. One in three privately-insured children were discharged from major hospitals with >50 percent public payers.
The characteristics of hospitals in the top quintile of Medicaid bed days and had >50 percent publicly insured discharges were 63 percent urban, most often in the south (36 percent) and least often in the northeast (12 percent), 21 percent urban teaching hospitals, and 70 percent children's hospitals.
Dr. Lisa Chamberlain, one of the authors of the study, will present the abstract, "Dependence of Privately-insured, Chronically Ill Children on Medicaid Reliant Hospitals," during the PAS 2018 Meeting on Monday, May 7 at 3:30 p.m. EDT. Reporters interested in an interview with Dr. Chamberlain should contact PAS2018@piercom.com.
Please note: Only the abstract is being presented at the meeting. In some cases, the researcher may have additional data to share with media.
The PAS 2018 Meeting, taking place in Toronto on May 5-8, 2018, brings together thousands of pediatric scientists and other health care providers to improve the health and well-being of children worldwide. For more information about the PAS 2018 Meeting, please visit http://www.pas-meeting.org.
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About The Pediatric Academic Societies (PAS) Meeting
The Pediatric Academic Societies (PAS) Meeting brings together thousands of pediatricians and other health care providers united by a common mission: improve the health and well-being of children worldwide. This international gathering includes researchers, academics, as well as clinical care providers and community practitioners. Presentations cover issues of interest to generalists as well as topics critical to a wide array of specialty and sub-specialty areas. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit http://www.pas-meeting.org. Follow us on Twitter @PASMeeting and #PAS2018, or like us on Facebook.
PAS Media Contact:
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Abstract: Dependence of Privately-insured, Chronically Ill Children on Medicaid Reliant Hospitals
Background: Although Medicaid/CHIP are directed at providing health services for low-income children, the potential impact of reduced Medicaid/CHIP spending on regionalized systems of hospital care for seriously ill children remains unexplored.
Objective: 1) To assess the role of Medicaid and CHIP in regional hospitals serving large numbers of seriously ill children; 2) to assess the importance of these regional hospitals to privately-insured, seriously ill children; and 3) to assess the characteristics of the hospitals with the highest patient volume and Medicaid/CHIP dependence.
Design/Methods: We conducted a retrospective analysis of two datasets: 1) the 2012 national KID Inpatient Database and 2) the 2012 California confidential, unmasked Patient Discharge Database from the Office of Statewide Health Planning and Development. We defined "public payers" as Medicaid and CHIP and "major pediatric hospitals" as those >500 discharges of children <18 years old with a serious, chronic illness. Serious chronic conditions were defined by validated diagnostic algorithms and excluded asthma and mental health conditions. The most common included conditions were prematurity, congenital heart disease, cancer, and neurological/genetic disorders.
Results: Hospitals caring for children with serious, chronic illness are highly dependent on public payers. (Table 1) Nationally, major pediatric hospitals reported 55 percent of bed days were covered by public payers with the 10 highest volume hospitals ranging from 36 percent to 100 percent.(Figure 1) Similarly in California, 69 percent of bed days were covered by public payers with the 6 highest volume hospitals reporting >50 percent public payers. One in three privately-insured children were discharged from major hospitals with >50 percent public payers. The characteristics of hospitals in the top quintile of Medicaid bed days and had >50 percent publicly insured discharges were 63 percent urban, most often in south(36 percent) and least often in the northeast (12 percent), 21 percent were urban teaching hospitals, 70 percent were children's hospitals.
Conclusion(s): Proposals to dramatically reduce federal expenditures on Medicaid and CHIP could destabilize current specialty care referral networks serving all children, including the majority of privately-insured children in greatest need of high quality, specialized, pediatric care.
Authors: Lisa J. Chamberlain, Olga Saynina, Paul H. Wise