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Background: Hospitalizations represent a significant driver of healthcare costs for children. Little is known about how payor type and the severity of children cared for on the general pediatric inpatient floor impact a hospital’s financial outcomes. Objective: The primary objective of this study is to compare financial outcomes of pediatric hospitalizations to the general floor across patient severity quartiles. Secondary objectives included financial outcomes stratified by payor type across severity quartiles. Methods: Retrospective cohort study included children aged 0-18 years discharged during calendar year 2019 from hospitals that reported clinical information to the Pediatric Health Information System database and financial data to the Revenue Management Program (Children’s Hospital Association, CHA). We excluded newborns, surgical and OB admissions, children requiring PICU or NICU, and transfers in and out. We calculated the ratio of reimbursements to costs (CCR; CCR <1.0 represents a financial liability to hospitals) and compared the CCR across severity quartiles and by payor type. Severity was determined using the Hospitalization Resource Intensity Score for Kids (H-Risk). Results: This study included 287,658 children within fourteen children’s hospitals. Patients were divided among four quartiles of H-Risk with quartile one being the least severe and quartile four the most. The majority of patients were in quartile one (55.5%) and had a public payor (54.4%). As severity increased the number of children with chronic complex conditions increased (CCC; 19.5% with 1 or greater CCC for quartile one and 88.5% for quartile four) and length of stay increased (a geometric mean of 1.8 days for quartile one and 11.3 days for quartile four). Overall, the CCR was 1.1 across all payors and severity levels representing a slight financial gain. Among private payors the CCR varied from 1.5 to 1.7 across severity quartiles. The median net financial gain ranged from $2,496 in quartile one to $37,257 in quartile four. Among public payors the CCR varied from 0.7 to 0.8 across severity quartiles. The median net financial loss ranged from $1,893 in quartile one to $22,513 in quartile four. Conclusions: Not unexpectedly, the financial gains and losses were higher for patients in higher severity quartiles. However, the net gain or loss varied substantially by payor. Utilizing the CCR in conjunction with the patient severity and payor mix may inform payment models and hospital operations, such as staffing models and patient placement, to ensure financial solvency.
When and Where Presented
Pediatric Hospital Medicine 2022 Conference ; July 28-31, 2022; Lake Buena Vista, Florida
Hartley, Jonathan; Bettenhausen, Jessica L.; Hall, Matt; Synhorst, David C.; Markham, Jessica L.; and Gay, James, "Financial Outcomes by Severity Across Children's Hospitals" (2022). Presentations. 73.