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Upcoding emergency admissions for non-life-threatening injuries to children
Zachary Pruitt, Etinne Pracht1
1University of South Florida, Health Policy and Management, 13201 Bruce B. Downs Blvd, MDC56, Tampa, FL 33612.
Insights
Investor-owned for-profit hospitals are more likely to upcode pediatric emergency admissions for non-life-threatening injuries. This practice may stem from payment policies and market dynamics, warranting review by Florida Medicaid regulators.
Area of Science:
- Health Services Research
- Healthcare Economics
- Pediatric Healthcare
Background:
- Investor-owned for-profit (IOFP) hospitals may engage in financial practices that affect patient care classification.
- Upcoding of pediatric inpatient admissions for non-life-threatening injuries could lead to increased healthcare costs.
Purpose of the Study:
- To determine if investor-owned for-profit (IOFP) hospital status influences the upcoding of pediatric inpatient admissions for non-life-threatening injuries.
- To compare the likelihood of emergency categorization for pediatric admissions at IOFP hospitals versus other hospital types.
Main Methods:
- Analysis of Florida inpatient discharge data (2001-2010) for children aged 15 and younger with non-life-threatening injuries admitted from emergency departments.
- Logistic regression modeling to assess the probability of emergency categorization, controlling for patient and hospital characteristics.
Main Results:
- Approximately 68% of included pediatric admissions for non-life-threatening injuries were classified as emergent.
- IOFP hospitals demonstrated a statistically significant higher probability (OR=1.1) of classifying these admissions as emergent compared to other hospital types.
Conclusions:
- Investor-owned for-profit hospitals may upcode pediatric admissions due to payer practices and market dynamics.
- Florida Medicaid and managed care organizations should investigate policies related to pediatric non-life-threatening injury admissions to identify potential inefficiencies.
Objectives:
To assess the influence of investor owned for-profit (IOFP) status on upcoding pediatric inpatient admissions for inconsequential injuries as emergency when urgent or elective would be more suitable.
Study Design:
Using Florida inpatient discharge data for children 15 years and younger during 2001 to 2010, we examined injuries originating from the emergency departments (EDs) resulting in 1 overnight stay. Only non-life-threatening injuries were included. We assessed the probability of emergency categorization (vs urgent/elective) of admissions at IOFP hospitals compared with other types of hospitals (public, not for profit).
Methods:
Logistic regression was used to explore the probability that hospital admission following non-life-threatening injury to a child was classified as an emergency on the billing claim. The model controlled for age, race, sex, Hispanic ethnicity, trauma center status, insurance type and status, number of injuries, and market competition conditions.
Results:
For those patients satisfying the inclusion criteria (n = 8694), about 68% of the time hospitals classified the admissions as emergent. The model provides strong statistical evidence that IOFP hospitals had a higher probability (odds ratio = 1.1) of reporting emergency priorities for children admitted to the hospital from the ED, holding all other variables constant.
Conclusions:
Upcoding by IOFP hospitals may be a consequence of payer payment practices, utilization management policies, and local market dynamics. Florida Medicaid regulators and managed care organizations should examine their policies to identify inefficiencies associated with pediatric patients admitted for non-life-threatening injuries.
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