Characteristics of children enrolled in Medicaid using respiratory equipment and supplies
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BACKGROUND: Emerging evidence suggests that the population of children assisted with respiratory medical equipment and supplies (RMES) is increasing in size and is having a substantial impact on families, providers, and the health system. Little is known on a population level about children who use RMES to compensate for a deficit in the ability to breathe. This study addressed these gaps by assessing (1) the characteristics of children in Medicaid using RMES and (2) how the use of RMES influences healthcare utilization and spending across the care continuum. METHODS: A retrospective cohort analysis of 11,306 children using and 21,192 children not using RMES [propensity matched by age and complex chronic conditions (CCC)] who were age 0-to-21 years and continuously enrolled in Medicaid in 2013 from 10 states in the Truven Health Medicaid MarketScan Database. RMES use at home (not counting acute use in a clinic, emergency department, or hospital) was identified with Healthcare Common Procedure Coding System (HCPCS), billed by medical supply companies, and International Classification of Diseases (ICD9) codes, billed by clinicians and hospitals. RMES included oxygen, suctioning, apnea monitor, CPAP/BiPAP, tracheostomy, ventilator, cough assist, and vest. We regressed RMES use on total annual per member per year (PMPY) Medicaid payments, adjusting for enrollment reason, gender, age, race/ethnicity, and number of chronic conditions. RESULTS: Of children using RMES at home, 5% were identified with ICD9 only, 80% with HCPCS only, and 15% with ICD9 and HCPCS. Most (87%) children using RMES had a chronic condition (of any complexity); 71% had a complex chronic condition. Neuromuscular (32%) was the most common CCC. RMES usage among children included oxygen (47%), suctioning (28%), apnea monitor (23%), CPAP/BiPAP (22%), tracheostomy (17%), ventilator (8%), cough assist (5%), and vest (4%). PMPY payments in propensity-matched children using vs. not using RMES were $45,892 vs. $15,036, p<0.001. In adjusted analysis, payment increased significantly (p<.001) with use of CPAP/BiPAP (+$1,117), oxygen (+$3,525), cough assist (+$6,342), suctioning (+$8,569), tracheostomy (+$11,977), vest (+$11,999), apnea monitor (+$13,747), and ventilator (+$32,323). Of children using RMES, most payments were for hospitalization (57%), specialty care (24%), and medications (6%); <3% was for RMES or home nursing. CONCLUSION: RMES use can identify additional projected healthcare costs in children beyond consideration of chronic diagnoses. Because most of the cost of using RMES is due to inpatient and specialty care rather than the equipment itself, RMES may indicate – broadly - medical fragility and increased healthcare needs. Population health initiatives of children with medical complexity may benefit from consideration of RMES use in risk assessment for healthcare cost.