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Association of Children's Hospital Status With Value for Common Surgical Conditions
Mehul V Raval1,2, Audra J Reiter1,2, Ian M McCarthy3
1Department of Surgery and Pediatrics, Surgical Outcomes and Quality Improvement Center, Center for Healthcare Studies, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Insights
Children's hospitals (CH) provide equivalent clinical outcomes for routine pediatric surgeries compared to non-children's hospitals (NCH). However, CH care is more expensive, indicating lower overall value for patients and payers.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Healthcare Economics
Background:
- Children's hospitals (CH) are vital for specialized pediatric care in the US.
- The comparative value of CH versus non-children's hospitals (NCH) for routine pediatric surgeries remains unclear.
Purpose of the Study:
- To evaluate the value of CH for routine pediatric surgical procedures.
- To compare clinical outcomes and payment data between CH and NCH.
Main Methods:
- Retrospective cohort study of pediatric patients undergoing common surgical procedures (2010-2015).
- Utilized administrative data from the Health Care Cost Institute for 368,220 patients.
- Assessed hospital tier (freestanding CH, affiliated CH, NCH), clinical outcomes (complications, readmissions), and payment data.
Main Results:
- Clinical outcomes, including complication and readmission rates at 30, 60, and 90 days, were similar across all hospital types.
- Freestanding children's hospitals (CH-A) had higher mean payments for both inpatient (39% higher) and outpatient (34% higher) procedures compared to NCH.
- Payments at CH-A and CH-B were significantly higher than at NCH, despite similar clinical outcomes.
Conclusions:
- Children undergoing routine surgical procedures at CH experience comparable clinical outcomes to those at NCH.
- Higher costs associated with CH care suggest a lower overall value proposition for patients and payers.
- Further research is needed to identify strategies for improving access, reducing costs, and enhancing value in pediatric surgical care at both CH and NCH.
Importance:
Although children's hospitals (CH) provide a substantial proportion of highly specialized pediatric care in the United States, the value of CH compared with non-children's hospitals (NCH) for routine surgical procedures is unknown.
Objective:
To examine the value of CH for routine surgical procedures by assessing clinical outcomes and payment data.
Design, Setting, And Participants:
This retrospective cohort study examined pediatric patients undergoing 1 of 13 commonly performed surgical procedures between 2010 and 2015 with 90-day follow-up using administrative data from the Health Care Cost Institute. Data analysis was conducted from July 2019 to December 2021.
Exposures:
The primary exposure was tier of CH status, defined using self-reported pediatric services, affiliation with pediatric focused programs, and validated based on proportion of pediatric admissions.
Main Outcomes And Measures:
Payments for common surgical procedures from private insurers and overall complication and readmission rates at 30, 60, and 90 days.
Results:
There were 368 220 pediatric patients who underwent one of the surgical procedures of interest; 220 899 (60.0%) of the patients were male; 118 977 (32.3%) had their procedure at freestanding CH (CH-A), 75 256 (20.4%) at CH attached to an adult hospital (CH-B), and 173 987 (47.3%) at NCH. The mean (SD) payment for all procedures at CH-A was $6533.56 ($6399.97), $5847.50 ($4947.47) at CH-B, and $5034.25 ($4787.07) at NCH. The mean (SD) overall complication rate was 0.004 (0.06) at CH-A, 0.01 (0.07) at CH-B, and 0.003 (0.06) at NCH. Readmission rates at 30, 60, and 90 days were similar across all hospital types. After adjusting for zip code, year, surgery, surgery setting, and observable patient, hospital, and county characteristics, the estimated payments for inpatient common procedures were 39% higher at CH-A than at NCH. Payments for outpatient common procedures were 34% higher at CH-A than at NCH.
Conclusions And Relevance:
In this cohort study, children who underwent common surgical procedures had equivalent clinical outcomes at CH and NCH but the procedures were associated with higher payments and, thus, overall lower value care. To ensure delivery of optimal value to patients and payers, more research is needed to evaluate mechanisms to ensure access, decrease costs, and improve value at both CH and NCH.
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