Hospitals' Diversity of Diagnosis Groups and Associated Costs of Care.

2021

2021 Feb 24

1098-4275

<p><strong>BACKGROUND AND OBJECTIVES: </strong>Hospitals treating patients with greater diagnosis diversity may have higher fixed and overhead costs. We assessed the relationship between hospitals' diagnosis diversity and cost per hospitalization for children.</p>

<p><strong>METHODS: </strong>Retrospective analysis of 1 654 869 all-condition hospitalizations for children ages 0 to 21 years from 2816 hospitals in the Kids' Inpatient Database 2016. Mean hospital cost per hospitalization, Winsorized and log-transformed, was assessed for freestanding children's hospitals (FCHs), nonfreestanding children's hospitals (NFCHs), and nonchildren's hospitals (NCHs). Hospital diagnosis diversity index (HDDI) was calculated by using the D-measure of diversity in Shannon-Wiener entropy index from 1254 diagnosis and severity-of-illness groups distinguished with 3M Health's All Patient Refined Diagnosis Related Groups. Log-normal multivariable models were derived to regress hospital type on cost per hospitalization, adjusting for hospital-level HDDI in addition to patient-level demographic (eg, age, race and ethnicity) and clinical (eg, chronic conditions) characteristics and hospital teaching status.</p>

<p><strong>RESULTS: </strong>Admission counts were 383 789 (23.2%) in FCHs, 588 463 (35.6%) in NFCHs, and 682 617 (41.2%) in NCHs. Unadjusted mean cost per hospitalization was $10 757 (95% confidence interval [CI]: $9451 to $12 243) in FCHs, $6264 (95% CI: $5830 to $6729) in NFCHs, and $4192 (95% CI: $4121 to $4265) in NCHs. HDDI was significantly ( &lt; .001) higher in FCHs and NFCHs (median 9.2 and 6.4 times higher, respectively) than NCHs. Across all hospitals, greater HDDI was associated ( = .002) with increased cost. Adjusting for HDDI resulted in a nonsignificant ( = .1) difference in cost across hospital types.</p>

<p><strong>CONCLUSIONS: </strong>Greater diagnosis diversity was associated with increased cost per hospitalization and should be considered when assessing associated costs of inpatient care for pediatric patients.</p>

10.1542/peds.2020-018101

Pediatrics

33627373

Racial Justice and Academic Pediatrics: A Call for Editorial Action and Our Plan to Move Forward.

2020

2020 Aug 10

1876-2867

10.1016/j.acap.2020.08.001

Acad Pediatr

32791317

Hypothetical Network Adequacy Schemes For Children Fail To Ensure Patients' Access To In-Network Children's Hospital.

2018

873-880

2018 Jun

1544-5208

<p>Insurers are increasingly adopting narrow network strategies. Little is known about how these strategies may affect children's access to needed specialty care. We examined the percentage of pediatric specialty hospitalizations that would be beyond existing Medicare Advantage network adequacy distance requirements for adult hospital care and, as a secondary analysis, a pediatric adaptation of the Medicare Advantage requirements. We examined 748,920 hospitalizations at eighty-one children's hospitals that submitted data for the period October 2014-September 2015. Nearly half of specialty hospitalizations were outside the Medicare Advantage distance requirements. Under the pediatric adaptation, there was great variability among the hospitals, with the percent of hospitalizations beyond the distance requirements ranging from less than 1&nbsp;percent to 35&nbsp;percent. Instead of, or in addition to, time and distance standards, policy makers may need to consider more nuanced network definitions, including functional capabilities of the pediatric care network or clear exception policies for essential specialty care services.</p>

10.1377/hlthaff.2017.1339

Health Aff (Millwood)

29863927

Financial Loss for Inpatient Care of Medicaid-Insured Children.

2016

2016 Sep 12

2168-6211

<p><strong>Importance: </strong>Medicaid payments tend to be less than the cost of care. Federal Disproportionate Share Hospital (DSH) payments help hospitals recover such uncompensated costs of Medicaid-insured and uninsured patients. The Patient Protection and Affordable Care Act reduces DSH payments in anticipation of fewer uninsured patients and therefore decreased uncompensated care. However, unlike adults, few hospitalized children are uninsured, while many have Medicaid coverage. Therefore, DSH payment reductions may expose extensive Medicaid financial losses for hospitals serving large absolute numbers of children.</p>

<p><strong>Objectives: </strong>To identify types of hospitals with the highest Medicaid losses from pediatric inpatient care and to estimate the proportion of losses recovered through DSH payments.</p>

<p><strong>Design, Setting, and Participants: </strong>This retrospective cross-sectional analysis evaluated Medicaid-insured hospital discharges of patients 20 years and younger from 23 states in the 2009 Kids' Inpatient Database. The dates of the analysis were March to September 2015. Hospitals were categorized as freestanding children's hospitals (FSCHs), children's hospitals within general hospitals, non-children's hospital teaching hospitals, and non-children's hospital nonteaching hospitals. Financial records of FSCHs in the data set were used to estimate the proportion of Medicaid losses recovered through DSH payments.</p>

<p><strong>Main Outcomes and Measures: </strong>Hospital financial losses from inpatient care of Medicaid-insured children (defined as the reimbursement minus the cost of care) were compared across hospital types. For our subsample of FSCHs, Medicaid-insured inpatient financial losses were calculated with and without each hospital's DSH payment.</p>

<p><strong>Results: </strong>The 2009 Kids' Inpatient Database study population included 1485 hospitals and 843 725 Medicaid-insured discharges. Freestanding children's hospitals had a higher median number of Medicaid-insured discharges (4082; interquartile range [IQR], 3524-5213) vs non-children's hospital teaching hospitals (674; IQR, 258-1414) and non-children's hospital nonteaching hospitals (161; IQR, 41-420). Freestanding children's hospitals had the largest median Medicaid losses from pediatric inpatient care (-$9 722 367; IQR, -$16 248 369 to -$2 137 902). Smaller losses were experienced by non-children's hospital teaching hospitals (-$204 100; IQR, -$1 014 100 to $14 700]) and non-children's hospital nonteaching hospitals (-$28 310; IQR, -$152 370 to $9040]). Disproportionate Share Hospital payments to FSCHs reduced their Medicaid losses by almost half.</p>

<p><strong>Conclusions and Relevance: </strong>Estimated financial losses from pediatric inpatients covered by Medicaid were much larger for FSCHs than for other hospital types. For children's hospitals, small anticipated increases in insured children are unlikely to offset the reductions in DSH payments.</p>

10.1001/jamapediatrics.2016.1639

JAMA Pediatr

27618284

Quantifying parental preferences for interventions designed to improve home food preparation and home food environments during early childhood.

2016

115-24

2016 Mar 1

1095-8304

<p>Though preparing healthy food at home is a critical health promotion habit, few interventions have aimed to improve parental cooking skills and behaviors. We sought to understand parents' preferences and priorities regarding interventions to improve home food preparation practices and home food environments during early childhood. We administered a discrete choice experiment using maximum difference scaling. Eighty English-speaking parents of healthy 1-4 year-old children rated the relative importance of potential attributes of interventions to improve home food preparation practices and home food environments. We performed latent class analysis to identify subgroups of parents with similar preferences and tested for differences between the subgroups. Participants were mostly white or black 21-45 year-old women whose prevalence of overweight/obesity mirrored the general population. Latent class analysis revealed three distinct groups of parental preferences for intervention content: a healthy cooking group, focused on nutrition and cooking healthier food; a child persuasion group, focused on convincing toddlers to eat home-cooked food; and a creative cooking group, focused on cooking without recipes, meal planning, and time-saving strategies. Younger, lower income, 1-parent households comprised the healthy cooking group, while older, higher income, 2-parent households comprised the creative cooking group (p&nbsp;&lt;&nbsp;0.05). The child persuasion group was more varied with regard to age, income, and household structure but cooked dinner regularly, unlike the other two groups (p&nbsp;&lt;&nbsp;0.05). Discrete choice experiments using maximum difference scaling can be employed to design and tailor interventions to change health behaviors. Segmenting a diverse target population by needs and preferences enables the tailoring and optimization of future interventions to improve parental home food preparation practices. Such interventions are important for creating healthier home food environments and preventing obesity starting from early childhood.</p>

10.1016/j.appet.2015.11.007

Appetite

26596704