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Financial and Health Impacts of Multidisciplinary Aerodigestive Care
Margaret L Skinner1, Seohee K Lee2, Joseph M Collaco3
1Department of Otolaryngology-Head & Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA mskinne7@jhmi.edu.
Insights
Children with aerodigestive conditions saw reduced healthcare costs after joining a specialized care team. This multidisciplinary pediatric aerodigestive care team (MPACT) improved care efficiency, shifting services from inpatient to outpatient settings.
Area of Science:
- Pediatric healthcare
- Aerodigestive disorders
- Healthcare management
Background:
- Aerodigestive conditions in children require complex, multidisciplinary care.
- Evaluating the impact of specialized care teams on patient outcomes and healthcare costs is crucial.
Purpose of the Study:
- To analyze patient activity and healthcare charges before and after enrollment in the Multidisciplinary Pediatric Aerodigestive Care Team (MPACT).
- To identify potential demand for MPACT services using ICD-9 data.
Main Methods:
- Retrospective review of financial claims data for pediatric patients (0-18 years) with at least two aerodigestive diagnostic categories (ADCs).
- Analysis of outpatient and inpatient encounters and charges over fiscal years 2010-2013.
- Evaluation of ICD-9 codes to identify patient cohorts and assess care trends.
Main Results:
- A cohort of 126 pediatric patients experienced a shift from inpatient to outpatient care following MPACT enrollment.
- Overall patient charges decreased by a net $921,848 ($7316 per patient).
- Analysis of ICD-9 data identified an additional 1728 pediatric patients with potential need for MPACT services.
Conclusions:
- MPACT enrollment is associated with a significant reduction in healthcare charges for pediatric patients with aerodigestive diseases.
- The study suggests a potential unmet demand for specialized aerodigestive care services.
- Optimizing care through multidisciplinary teams can lead to improved efficiency and cost savings.
Objectives:
(1) Analyze upstream and downstream activity before and after enrollment with the Multidisciplinary Pediatric Aerodigestive Care Team (MPACT). (2) Identify potential demand for MPACT services with ICD-9 data.
Study Design:
Retrospective review of financial claims data.
Setting:
Tertiary care children's center.
Subjects:
Pediatric patients (0-18 years old) enrolled with MPACT (pediatric otolaryngology, gastroenterology, pulmonary, speech-language pathology).
Methods:
Case mix data from fiscal years (FYs) 2010-2013 were analyzed for primary, secondary, and tertiary ICD-9 codes in 4 aerodigestive diagnostic categories (ADCs): dysphagia, chronic cough, gastroesophageal disease, and chronic pulmonary disease/asthma. Inclusion criteria included patients <18 years old, seen by MPACT, with FY2010-FY2013 case mix data and ≥2 ADCs. Unique outpatient and inpatient encounters and associated charges were evaluated to determine upstream and downstream activity trends.
Results:
Of the 126 patients meeting inclusion criteria, 55 (44%) had ≥3 ADCs, and 11 (9%) had 4. These 126 patients received outpatient care during 3068 unique encounters. Outpatient total charges were $282,102 before and $744,542 after MPACT intervention. Eighty-six (68%) patients received inpatient care during 423 unique encounters. Inpatient charges were $4,257,137 before and $2,872,849 after MPACT enrollment. Overall, a net reduction of $921,848 in total charges, $7316 per MPACT patient, was noted. FY2010-FY2014 data identified an additional 1728 pediatric patients with ≥2 ADCs not enrolled in MPACT.
Conclusion:
A cohort of children with aerodigestive disease experienced a shift from inpatient to outpatient care with an overall 20% reduction in patient charges when the years before and after MPACT enrollment were compared. Available ICD-9 data suggest potential demand for MPACT services.
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