Financial loss for inpatient care of medicaid-insured children

JAMA Pediatrics

Volumn 170, Issue 11, 2016, Pages 1055-1062

  Colvin, Jeffrey D ^a   Hall, Matt ^b   Berry, Jay G ^c,d   Gottlieb, Laura M ^e   Bettenhausen, Jessica L ^a   Shah, Samir S ^f   Fieldston, Evan S ^g   Conway, Patrick H ^h   Chung, Paul J ^i,j,k  

^a UNIVERSITY OF MISSOURI KANSAS CITY SCHOOL OF MEDICINE   (United States)

^b CHILDREN S HOSPITAL ASSOCIATION   (United States)

^c BOSTON CHILDREN S HOSPITAL   (United States)

^d HARVARD MEDICAL SCHOOL   (United States)

^e UNIVERSITY OF CALIFORNIA   (United States)

^f UNIVERSITY OF CINCINNATI COLLEGE OF MEDICINE   (United States)

^g UNIVERSITY OF PENNSYLVANIA   (United States)

^h CENTERS FOR MEDICARE AND MEDICAID SERVICES   (United States)

ⁱ UNIVERSITY OF CALIFORNIA   (United States)

^j RAND CORPORATION   (United States)

^k MATTEL CHILDREN S HOSPITAL   (United States)

more..

Author keywords

[No Author keywords available]

Indexed keywords

ADOLESCENT; ADULT; ARTICLE; CHILD; CROSS-SECTIONAL STUDY; FEMALE; FINANCIAL DEFICIT; HEALTH CARE COST; HEALTH CARE POLICY; HEALTH CARE UTILIZATION; HOSPITAL DISCHARGE; HOSPITAL PATIENT; HOSPITALIZED CHILD; HUMAN; MAJOR CLINICAL STUDY; MALE; MEDICAID; MEDICALLY UNINSURED; OUTCOME ASSESSMENT; PEDIATRIC HOSPITAL; PRIORITY JOURNAL; REIMBURSEMENT; RETROSPECTIVE STUDY; CHILD HEALTH; COMMUNITY CARE; COST BENEFIT ANALYSIS; ECONOMICS; HEALTH ECONOMICS; HOSPITAL; HOSPITAL COST; INFANT; NEWBORN; PRESCHOOL CHILD; PUBLIC HEALTH; STATISTICS AND NUMERICAL DATA; UNITED STATES; YOUNG ADULT;

ADOLESCENT; CHILD; CHILD HEALTH; CHILD, PRESCHOOL; COST-BENEFIT ANALYSIS; CROSS-SECTIONAL STUDIES; ECONOMICS, HOSPITAL; FEMALE; HOSPITAL COSTS; HOSPITALS, PEDIATRIC; HUMANS; INFANT; INFANT, NEWBORN; MALE; MEDICAID; MEDICALLY UNINSURED; PATIENT PROTECTION AND AFFORDABLE CARE ACT; PUBLIC HEALTH; REIMBURSEMENT, DISPROPORTIONATE SHARE; RETROSPECTIVE STUDIES; UNCOMPENSATED CARE; UNITED STATES; YOUNG ADULT;

EID: 84996503875     PISSN: 21686203     EISSN: None     Source Type: Journal    
DOI: 10.1001/jamapediatrics.2016.1639     Document Type: Article

References (33)

1. Coughlin TA, Holahan J, Caswell K, McGrath M. An estimated $84.9 billion in uncompensated care was provided in 2013: ACA payment cuts could challenge providers. Health Aff (Millwood). 2014;33 (5):807-814.
2. American Hospital Association. Underpayment by Medicare and Medicaid fact sheet. http://www.aha.org/content/16/medicaremedicaidunderpmt.pdf. 2016 Update. Accessed July 30, 2016.
3. La Couture B. Primer: The Disproportionate Share Hospital (DSH) program. http://americanactionforum.org/research/primer-The-disproportionate-share-hospital-dsh-program. Published August 21, 2014. Accessed August 3, 2015.
4. Medicare Access and CHIP Reauthorization Act of 2015. Pub L No. 114-10, 87 Stat 162.
5. Henry J. Kaiser Family Foundation. Health insurance coverage of children 0-18. http://kff.org/other/state-indicator/children-0-18/. Timeframe 2014. Accessed May 1, 2015.
6. United States Census Bureau. American Community Survey. http://www.census.gov/hhes/www/hlthins/data/incpovhlth/2013/acs-tables .html. Accessed May 19, 2015.
7. Colvin JD, Hall M, Gottlieb L, et al. Hospitalizations of low-income children and children with severe health conditions: implications of the Patient Protection and Affordable Care Act. JAMA Pediatr. 2016;170(2):176-178.
8. Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Introduction to the HCUP Kids' Inpatient Database (KID) 2009. http://www.hcup-us.ahrq.gov/db/nation/kid/kid-2009-introduction.jsp. Accessed May 4, 2015.
9. Henry J. Kaiser Family Foundation. State health facts: data source: health management associates from state Medicaid enrollment reports: monthly Medicaid enrollment for adults and children (in thousands). http://kff.org/medicaid/state-indicator/monthly-medicaid-enrollment-for-adults-and-children-in-thousands/. Accessed January 6, 2016.
10. Annie E. Casey Foundation. Kids Count Data Center: children without health insurance. http://datacenter.kidscount.org/data/tables/8810-children-without-health-insurance?loc=1&loct =1#detailed/1/any/false/868,38/any/17657,17658. Accessed January 6, 2016.
11. Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. HCUP quality control procedures. https://www.hcup-us.ahrq.gov/db/quality.jsp. Published March 6, 2015. Accessed December 11, 2015.
12. Feudtner C, Feinstein JA, Satchell M, Zhao H, Kang TI. Shifting place of death among children with complex chronic conditions in the United States, 1989-2003. JAMA. 2007;297(24):2725-2732.
13. Feudtner C, Hays RM, Haynes G, Geyer JR, Neff JM, Koepsell TD. Deaths attributed to pediatric complex chronic conditions: national trends and implications for supportive care services. Pediatrics. 2001;107(6):e99. doi:10.1542/peds.107.6.e99.
14. Sabbatini AK, Kocher KE, Basu A, Hsia RY. In-hospital outcomes and costs among patients hospitalized during a return visit to the emergency department. JAMA. 2016;315(7):663-671.
15. Ross MA, Hockenberry JM, Mutter R, Barrett M, WheatleyM, Pitts SR. Protocol-driven emergency department observation units offer savings, shorter stays, and reduced admissions. Health Aff (Millwood). 2013;32(12):2149-2156.
16. Huynh TN, Kleerup EC, Wiley JF, et al. The frequency and cost of treatment perceived to be futile in critical care. JAMA Intern Med. 2013;173 (20):1887-1894.
17. Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Cost-to-charge ratio files: 2009 Kids' Inpatient Database (KID) user guide. https://www.hcup-us.ahrq.gov/db/state/CCR2009KIDUserGuide.pdf. Published June 27, 2011. Accessed December 11, 2015.
18. Levit KR, Friedman B,Wong HS. Estimating inpatient hospital prices from state administrative data and hospital financial reports. Health Serv Res. 2013;48(5):1779-1797.
19. Song X, Friedman B. Calculate cost adjustment factors by APR-DRG and CCS using selected states with detailed charges: report 2008-04. http://www.hcup-us.ahrq.gov/reports/methods.jsp. Published 2008. Accessed May 4, 2016.
20. Barnett PG. An improved set of standards for finding cost for cost-effectiveness analysis. Med Care. 2009;47(7)(suppl 1):S82-S88.
21. Riley GF. Administrative and claims records as sources of health care cost data. Med Care. 2009; 47(7)(suppl 1):S51-S55.
22. Centers for Medicare & Medicaid Services. Disproportionate Share Hospital (DSH) payments. http://www.medicaid.gov/medicaid-chip-program-information/by-topics/financing-and-reimbursement/medicaid-disproportionate-share-hospital-dsh-payments.html. Accessed August 31, 2015.
23. Centers for Medicare & Medicaid Services. Healthcare Cost Report Information System. https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Cost-Reports/?redirect=/CostReports/. Accessed June 9, 2015.
24. National Association of Children's Hospitals and Related Institutions. Membership criteria and categories. https://www.childrenshospitals.org/About-Us/Membership. Accessed May 4, 2016.
25. Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. KID description of data elements. http://www.hcup-us .ahrq.gov/db/vars/hosp-teach/kidnote.jsp. Published September 2008. Accessed June 12, 2014.
26. Cole ES,Walker D, Mora A, Diana ML. Identifying hospitals that may be at most financial risk from Medicaid disproportionate-share hospital payment cuts. Health Aff (Millwood). 2014;33(11): 2025-2033.
27. Neuhausen K, Davis AC, Needleman J, Brook RH, Zingmond D, Roby DH. Disproportionate-share hospital payment reductions may threaten the financial stability of safety-net hospitals. Health Aff (Millwood). 2014;33(6):988-996.
28. Bazzoli GJ, Clement JP. The experiences of Massachusetts hospitals as statewide health insurance reform was implemented. J Health Care Poor Underserved. 2014;25(1)(suppl):63-78.
29. Mohan A, Grant J, Batalden M, McCormick D. The health of safety net hospitals following Massachusetts health care reform: changes in volume, revenue, costs, and operating margins from 2006 to 2009. Int J Health Serv. 2013;43(2): 321-335.
30. Cheng TL, Wise PH, Halfon N. Promise and perils of the Affordable Care Act for children. JAMA. 2014;311(17):1733-1734.
31. Cheng TL, Wise PH, Halfon N. Quality health care for children and the Affordable Care Act: A voltage drop checklist. Pediatrics. 2014;134(4): 794-802.
32. Zuckerman S, Goin D; Urban Institute. How much will Medicaid physician fees for primary care rise in 2013? evidence from a 2012 survey of Medicaid physician fees. https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8398.pdf. Published December 2012. Accessed September 8, 2015.
33. Centers for Medicare & Medicaid Services. Medicaid program: payments for services furnished by certain primary care physicians and charges for vaccine administration under the Vaccines for Children program: final rule. Fed Regist. 2012;77 (215):66669-66701.