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Health care reform: pediatric elective surgery payer mix and utilization under Tenncare managed competition.
Tenn Med. 2008 Oct; 101(10):39-43.TM

Abstract

Managed care decreases reimbursement for surgical referral care and may decrease access for elective procedures. This study seeks to determine the impact of Medicaid managed competition on elective pediatric otolaryngology surgery.

DESIGN AND SETTING

Payer mix was analyzed for tonsillectomy and adenoidectomy (T&A) and bilateral myringotomy with ventilation tube insertion (BM&VT) charges for an eight-year period surrounding TennCare implementation. The payer mix for hospital gross charges was analyzed for the same period as a control.

RESULTS

After TennCare implementation, hospital gross charges shifted toward increased TennCare/Medicaid and decreased commercial insurance, whereas charges for the two elective procedures shifted toward increased commercial insurance and decreased TennCare/Medicaid.

CONCLUSION

Otolaryngologists avoided impending losses under TennCare through indirect cost shifting. Numbers of T&A and BM&VT procedures performed on Tenncare/Medicaid patients remained constant, while numbers of these procedures performed on commercially-insured patients increased.

Authors+Show Affiliations

Department of Otolaryngology, University of Tennessee Health Science Center, Memphis 38163, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19009832

Citation

Hall, Christopher J., et al. "Health Care Reform: Pediatric Elective Surgery Payer Mix and Utilization Under Tenncare Managed Competition." Tennessee Medicine : Journal of the Tennessee Medical Association, vol. 101, no. 10, 2008, pp. 39-43.
Hall CJ, Thompson JW, Bailey J. Health care reform: pediatric elective surgery payer mix and utilization under Tenncare managed competition. Tenn Med. 2008;101(10):39-43.
Hall, C. J., Thompson, J. W., & Bailey, J. (2008). Health care reform: pediatric elective surgery payer mix and utilization under Tenncare managed competition. Tennessee Medicine : Journal of the Tennessee Medical Association, 101(10), 39-43.
Hall CJ, Thompson JW, Bailey J. Health Care Reform: Pediatric Elective Surgery Payer Mix and Utilization Under Tenncare Managed Competition. Tenn Med. 2008;101(10):39-43. PubMed PMID: 19009832.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Health care reform: pediatric elective surgery payer mix and utilization under Tenncare managed competition. AU - Hall,Christopher J, AU - Thompson,Jerome W, AU - Bailey,James, PY - 2008/11/18/pubmed PY - 2008/12/17/medline PY - 2008/11/18/entrez SP - 39 EP - 43 JF - Tennessee medicine : journal of the Tennessee Medical Association JO - Tenn Med VL - 101 IS - 10 N2 - UNLABELLED: Managed care decreases reimbursement for surgical referral care and may decrease access for elective procedures. This study seeks to determine the impact of Medicaid managed competition on elective pediatric otolaryngology surgery. DESIGN AND SETTING: Payer mix was analyzed for tonsillectomy and adenoidectomy (T&A) and bilateral myringotomy with ventilation tube insertion (BM&VT) charges for an eight-year period surrounding TennCare implementation. The payer mix for hospital gross charges was analyzed for the same period as a control. RESULTS: After TennCare implementation, hospital gross charges shifted toward increased TennCare/Medicaid and decreased commercial insurance, whereas charges for the two elective procedures shifted toward increased commercial insurance and decreased TennCare/Medicaid. CONCLUSION: Otolaryngologists avoided impending losses under TennCare through indirect cost shifting. Numbers of T&A and BM&VT procedures performed on Tenncare/Medicaid patients remained constant, while numbers of these procedures performed on commercially-insured patients increased. SN - 1088-6222 UR - https://www.unboundmedicine.com/medline/citation/19009832/Health_care_reform:_pediatric_elective_surgery_payer_mix_and_utilization_under_Tenncare_managed_competition_ L2 - https://medlineplus.gov/managedcare.html DB - PRIME DP - Unbound Medicine ER -