Submitting/Presenting Author

Jonathan HartleyFollow

Presenter Status

Fellow

Abstract Type

Research

Primary Mentor

Jessica Bettenhausen, MD

Start Date

14-5-2021 12:30 PM

End Date

14-5-2021 12:45 PM

Presentation Type

Oral Presentation

Description

Background: Bronchiolitis is a leading cause of hospitalization for infants and results in over 1.7 billion dollars in yearly hospital charges (Hasegawa). The use of high flow nasal cannula (HFNC) on a general pediatrics floor may reduce hospital costs and length of stay (LOS, Kalburgi). However, the financial impact of HFNC use is not welldescribed.

Objective: The primary objective are the financial outcomes of HFNC utilization on the general pediatric floor. The secondary objective included financial outcomes stratified by All Patients Refined Diagnosis Related Groups (APRDRG) severity of illness (SOI) and payor type. We hypothesize that costs outweigh reimbursement for HFNC for low severity bronchiolitis and in children with Public insurance.

Methods: This retrospective cohort study included children aged 0-24 months with a primary diagnosis of bronchiolitis (APR-DRG 138) between 1/1/2018 – 12/31/2019. We excluded newborns, observation status hospitalizations, children requiring ICU-level care, transfers in, and readmissions. We included eight hospitals that provided clinical information to the Children’s Hospital Association’s (CHA) Pediatric Health Information System database and cost and reimbursement data to the CHA Revenue Management Program. We calculated the ratio of reimbursements to costs (CCR) for children with bronchiolitis and compared the CCR stratified by HFNC and APRDRG SOI groups (minor, moderate, and major/extreme) and payor type.

Results: Of 8,777 children hospitalized for bronchiolitis, nearly one-third (31%) were placed on HFNC (Table 1). The majority of children in all levels of severity did not receive HFNC, but was variable based upon APR-DRG SOI (29.2% of children in APR-DRG SOI mild, 25.7% in moderate, and 44.8% in major/severe). We observed a significant difference between costs and reimbursements based upon HFNC administration for each APR-DRG SOI classification and by payor type (Table 2). A CCR <1.0 represents a financial liability to hospitals (costs exceed reimbursement). A plurality of hospitalizations for publicly insured children with bronchiolitis (83%) had a CCR <1.0 (the exception was a CCR of 1.10 for children with major/severe bronchiolitis requiring HFNC). The CCR for children receiving HFNC was variable and increased linearly by APR-DRG SOI classification. CCR was highest for children with major/severe bronchiolitis but was substantially different based upon payor. For example, the CCR was 1.56 for privately insured children with minor bronchiolitis and HFNC use and 1.71 for major/severe bronchiolitis with HFNC use. In contrast, the CCR for publicly insured children with minor bronchiolitis and HFNC use was 0.68 and 1.10 for major/severe bronchiolitis with HFNC use. The differences for children without HFNC use was much less variable based upon APR-DRG SOI.

Conclusions: The CCR was <1.0 for bronchiolitis hospitalizations among most publicly insured children and was lowest for children with minor bronchiolitis receiving HFNC (CCR 0.68). The CCR varied substantially (a difference of 20% - 30% for privately and publicly insured children, respectively) by APR-DRG SOI for children with HFNC use, but less so among children without HFNC use. To gain further insight into CCR variation for children hospitalized with bronchiolitis, future work should assess billing practices, severity of illness classification, and variation in practice patterns.

Comments

Abstract Only.

Share

COinS
 
May 14th, 12:30 PM May 14th, 12:45 PM

Financial Outcomes of High Flow Nasal Cannula Use for Bronchiolitis on the General Pediatric Floor Across Children's Hospitals

Background: Bronchiolitis is a leading cause of hospitalization for infants and results in over 1.7 billion dollars in yearly hospital charges (Hasegawa). The use of high flow nasal cannula (HFNC) on a general pediatrics floor may reduce hospital costs and length of stay (LOS, Kalburgi). However, the financial impact of HFNC use is not welldescribed.

Objective: The primary objective are the financial outcomes of HFNC utilization on the general pediatric floor. The secondary objective included financial outcomes stratified by All Patients Refined Diagnosis Related Groups (APRDRG) severity of illness (SOI) and payor type. We hypothesize that costs outweigh reimbursement for HFNC for low severity bronchiolitis and in children with Public insurance.

Methods: This retrospective cohort study included children aged 0-24 months with a primary diagnosis of bronchiolitis (APR-DRG 138) between 1/1/2018 – 12/31/2019. We excluded newborns, observation status hospitalizations, children requiring ICU-level care, transfers in, and readmissions. We included eight hospitals that provided clinical information to the Children’s Hospital Association’s (CHA) Pediatric Health Information System database and cost and reimbursement data to the CHA Revenue Management Program. We calculated the ratio of reimbursements to costs (CCR) for children with bronchiolitis and compared the CCR stratified by HFNC and APRDRG SOI groups (minor, moderate, and major/extreme) and payor type.

Results: Of 8,777 children hospitalized for bronchiolitis, nearly one-third (31%) were placed on HFNC (Table 1). The majority of children in all levels of severity did not receive HFNC, but was variable based upon APR-DRG SOI (29.2% of children in APR-DRG SOI mild, 25.7% in moderate, and 44.8% in major/severe). We observed a significant difference between costs and reimbursements based upon HFNC administration for each APR-DRG SOI classification and by payor type (Table 2). A CCR <1.0 represents a financial liability to hospitals (costs exceed reimbursement). A plurality of hospitalizations for publicly insured children with bronchiolitis (83%) had a CCR <1.0 (the exception was a CCR of 1.10 for children with major/severe bronchiolitis requiring HFNC). The CCR for children receiving HFNC was variable and increased linearly by APR-DRG SOI classification. CCR was highest for children with major/severe bronchiolitis but was substantially different based upon payor. For example, the CCR was 1.56 for privately insured children with minor bronchiolitis and HFNC use and 1.71 for major/severe bronchiolitis with HFNC use. In contrast, the CCR for publicly insured children with minor bronchiolitis and HFNC use was 0.68 and 1.10 for major/severe bronchiolitis with HFNC use. The differences for children without HFNC use was much less variable based upon APR-DRG SOI.

Conclusions: The CCR was <1.0 for bronchiolitis hospitalizations among most publicly insured children and was lowest for children with minor bronchiolitis receiving HFNC (CCR 0.68). The CCR varied substantially (a difference of 20% - 30% for privately and publicly insured children, respectively) by APR-DRG SOI for children with HFNC use, but less so among children without HFNC use. To gain further insight into CCR variation for children hospitalized with bronchiolitis, future work should assess billing practices, severity of illness classification, and variation in practice patterns.