Urgent Care and Emergency Department Visits in the Pediatric Medicaid Population

Montalbano, Amanda; Rodean, Jonathan; Kangas, Juhi; Lee, Brian; Hall, Matt

doi:10.1542/peds.2015-3100

Cited by 71 publications

(57 citation statements)

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“…Frequent utilization of emergency department (ED) services places considerable burden on medical resources [Pearson et al, 2017] and is more costly than treatment provided through primary and urgent care settings [Montalbano, Rodean, Kangas, Lee, & Hall, 2016;Soril, Leggett, Lorenzetti, Noseworthy, & Clement, 2015]. In addition to high cost of care, individuals who frequently use the ED, particularly for low acuity or chronic conditions, have poorer health-related quality of life than those who do not [Guilbert et al, 2011;Rodday et al, 2017].…”

Section: Introductionmentioning

confidence: 99%

Emergency department utilization and monetary charges in adolescents with autism spectrum disorder, intellectual disability, and a population comparison group

et al. 2019

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Adolescents with autism spectrum disorder (ASD) and/or intellectual disability (ID) may utilize the emergency department (ED) more frequently than individuals in the general population. This study compared ED utilization and charges during adolescence among four groups of individuals: ASD‐only, ASD + ID, ID‐only, and a population comparison (PC) group. ED visits occurring during age 12–17 years were examined to identify non, low, and high utilizers. Logistic regression was used to compare groups on the odds of having at least one ED visit during adolescence. Generalized linear models were used to compare groups on number of ED visits and total charges, stratified by low and high ED utilization. Descriptive examination of presenting diagnoses was performed. Individuals with ID, with or without co‐occurring ASD, were significantly more likely to have at least one ED visit during adolescence. Among high ED utilizers, the ID‐only group had the most frequent ED visits but had significantly lower charges than the ASD‐only group. Individuals with ASD‐only and ASD + ID differed from the ID‐only and PC groups in presenting diagnoses. No differences between groups in number of ED visits or charges were observed among low utilizers. ID, with or without ASD, increased the odds of visiting the ED during adolescence. Adolescents with ID‐only had the most frequent ED visits, but individuals with ASD‐only had the highest ED charges and tended to be seen for psychiatric concerns. Further research is warranted to better characterize and meet the healthcare needs of individuals with ASD and/or ID during adolescence. Autism Res 2019, 12: 1129–1138. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary Frequent emergency department (ED) visits strain medical resources and are costlier than primary and urgent care. Our findings show that adolescents with intellectual disability (ID) may use the ED frequently for nonurgent conditions. Adolescents with autism spectrum disorder, without ID, use the ED less frequently but incur higher charges. Further research is needed to understand how to meet the unique needs of these populations in primary care to prevent overuse of the ED.

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Section: Introductionmentioning

confidence: 99%

Emergency department utilization and monetary charges in adolescents with autism spectrum disorder, intellectual disability, and a population comparison group

et al. 2019

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“…Since UC offers cost-savings compared to similar ED visits, secondary cost-containment strategies may focus on shifting low acuity ED visits to UC. (20) The largest portion of acute care visits by children in capitated plans occurred at the PCP, and the smallest portion of acute care visits were to UC. This underscores the important role of PCPs in serving as the hub of the medical neighborhood, for children with acute or chronic illnesses.…”

Section: Discussionmentioning

confidence: 99%

“…(18,19) UC visits are one example of possible healthcare cost savings, as they are significantly less expensive than ED visits for comparable illnesses, and are an increasingly used venue for low acuity conditions. (18,20) What remains unknown is the association of current payment models on outpatient care-seeking behavior in children, after the major healthcare policy changes associated with the ACA in 2010 and the 2014 Medicaid expansion. This study aims to describe the association of current Medicaid payment models with children's utilization of outpatient care.…”

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confidence: 99%

Pediatric Outpatient Utilization by Differing Medicaid Payment Models in the United States

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Friedman

Rodean

et al. 2020

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Background In the United States (US), medicaid capitated managed care costs are controlled by optimizing patients’ healthcare utilization. Adults in capitated plans utilize primary care providers (PCP) more than emergency departments (ED), compared to fee-for-service (FFS). Pediatric data are lacking. We aim to determine the association between US capitated and FFS Medicaid payment models and children’s outpatient utilization. Methods This retrospective cohort compared outpatient utilization between two payment models of Medicaid enrollees aged 1-18 years using Truven’s 2014 Marketscan Medicaid database. Children enrolled >11 months were included, and were excluded for eligibility due to disability/complex chronic condition, lack of outpatient utilization, or provider capitation penetration rate <5% or >95%. Negative binomial and logistic regression assessed relationships between payment model and number of visits or odds of utilization, respectively. Results Of 711,008 children, 66,980(9.4%) had FFS and 644,028(90.6%) had capitated plans. Children in capitated plans had greater odds of visits to urgent care, PCP-acute, and PCP-well-child care (aOR 1.21[95%CI 1.15-1.26]; aOR 2.07[95%CI 2.03-2.13]; aOR 1.86 [95%CI 1.82-1.91], respectively), and had lower odds of visits to EDs and specialty care (aOR 0.82 [95%CI 0.8-0.83]; aOR 0.61 [95%CI 0.59-0.62], respectively), compared to FFS. Conclusions The majority of children in this US Medicaid population had capitated plans associated with higher utilization of acute care, but increased proportion of lower-cost sites, such as PCP-acute visits and UC. Policies that improve healthcare coverage of children and programs that encourage capitated payment models with care coordination may improve access to timely acute care in lower-cost settings for non-chronically ill children.

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“…We used standardized expenditures per unit of service to (1) remove the high interstate variation in Medicaid payments, (2) remove the influence of changing Medicaid payment over time, and (3) mitigate the impact of services reported under capitated payment arrangements (often reported as a value of $0). 19,20 PMPY spending was calculated each month during the study period as the total standardized expenditures divided by number of enrollee years represented in a specified cohort of CMC (eg, enrolled versus eligible). Details on payment standardization can be found in the Supplemental Information.…”

Section: Outcome Measuresmentioning

confidence: 99%

Costs and Use for Children With Medical Complexity in a Care Management Program

et al. 2020

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made substantial contributions to design, analysis, and interpretation of the data and also participated in drafting and revising the article critically for important intellectual content; Dr Richardson designed the data collection instruments, coordinated data collection, made substantial contributions to design, analysis, and interpretation of the data, and also participated in drafting and revising the article critically for important intellectual content; Mr Rodean made substantial contributions to design, analysis, and interpretation of the data and also participated in revising the article critically for important intellectual content; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work

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Urgent Care and Emergency Department Visits in the Pediatric Medicaid Population

Abstract: BACKGROUND: Urgent care (UC) is one of the fastest growing venues of health care delivery. We compared clinical and cost attributes of pediatric UC and emergency department (ED) visits that did not result in admission.

Cited by 71 publications

References 9 publications

Emergency department utilization and monetary charges in adolescents with autism spectrum disorder, intellectual disability, and a population comparison group

Emergency department utilization and monetary charges in adolescents with autism spectrum disorder, intellectual disability, and a population comparison group

Pediatric Outpatient Utilization by Differing Medicaid Payment Models in the United States

Costs and Use for Children With Medical Complexity in a Care Management Program

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