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Ann Surg. 2018 Feb;267(2):392-400. doi: 10.1097/SLA.0000000000002061.

Practice Style Variation in Medicaid and Non-Medicaid Children With Complex Chronic Conditions Undergoing Surgery.

Author information

1
Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA.
2
The Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, PA.
3
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA.
4
Department of Health Care Management, The Wharton School, The University of Pennsylvania, Philadelphia, PA.
5
The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA.
6
Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA.

Abstract

OBJECTIVES:

With differential payment between Medicaid and Non-Medicaid services, we asked whether style-of-practice differs between similar Medicaid and Non-Medicaid children with complex chronic conditions (CCCs) undergoing surgery.

SUMMARY OF BACKGROUND DATA:

Surgery in children with CCCs accounts for a disproportionately large percentage of resource utilization at major children's hospitals.

METHODS:

A matched cohort design, studying 23,582 pairs of children with CCCs undergoing surgery (Medicaid matched to Non-Medicaid within the same hospital) from 2009 to 2013 in 41 Children's Hospitals. Patients were matched on age, sex, principal procedure, CCCs, and other characteristics.

RESULTS:

Median cost in Medicaid patients was $21,547 versus $20,527 in Non-Medicaid patients (5.0% higher, P < 0.001). Median paired difference in cost (Medicaid minus Non-Medicaid) was $320 [95% confidence interval (CI): $208, $445], (1.6% higher, P < 0.001). 90th percentile costs were $133,640 versus $127,523, (4.8% higher, P < 0.001). Mean paired difference in length of stay (LOS) was 0.50 days (95% CI: 0.36, 0.65), (P < 0.001). ICU utilization was 2.8% higher (36.7% vs 35.7%, P < 0.001). Finally, in-hospital mortality pooled across all pairs was higher in Medicaid patients (0.38% vs 0.22%, P = 0.002). After adjusting for multiple testing, no individual hospital displayed significant differences in cost between groups, only 1 hospital displayed significant differences in LOS and 1 in ICU utilization.

CONCLUSIONS:

Treatment style differences between Medicaid and Non-Medicaid children were small, suggesting little disparity with in-hospital surgical care for patients with CCCs operated on within Children's Hospitals. However, in-hospital mortality, although rare, was slightly higher in Medicaid patients and merits further investigation.

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