HAVE MEDICAID REIMBURSEMENTS BEEN A CREDIBLE MEASURE OF THE COST OF PEDIATRIC CARE

Objective. Despite uncertain validity as a measure of cost, Medicaid r eimbursement may be used to compare the costs of different pediatric i nterventions. We explored the credibility of Medicaid reimbursements a s a measure of the costs of inpatient care associated with two differe nt approaches to follow-up care for high-risk indigent infants. Design . Analysis of Medicaid reimbursements within a randomized trial of pri mary follow-up care. Patients. Infants 1500 g at birth in a large coun ty hospital (Parkland Memorial Hospital). Intervention. Conventional c are after nursery discharge (with well-baby care and care for chronic illnesses provided in our follow-up clinic) or primary care (with care for acute illnesses also provided in the follow-up clinic). Measures to prevent a lapse in Medicaid coverage were included in all clinic vi sits. Outcome-Measures. The completeness, comparability, and plausibil ity of Medicaid reimbursements for inpatient care of the two groups be tween nursery discharge and 1 year adjusted age. Results. A high perce ntage (90% to 91%) of both groups were enrolled in Medicaid. However, with fewer clinic visits in the conventional care group, Medicaid cove rage often lapsed in this group, particularly among the highest risk i nfants. As a result, the proportion of hospital days reimbursed by Med icaid was substantially lower for conventional care than primary care infants (53% [92/174] vs 96% [298/310]). An even larger disparity was observed for pediatric intensive care days (10% [6/61] vs 100% [33/33] ). Implausible Medicaid reimbursements included a lower reimbursement rate per day in the pediatric intensive care unit than on the pediatri c floor (1 infant), a lower reimbursement rate per day for hospital ca re than home care (1 infant), and a mean reimbursement rate per day fo r our private pediatric teaching hospital ($1244/day) that did not exc eed that for the private nonteaching pediatric hospital ($1268/day). T he reimbursement rate for our public teaching hospital was particularl y low ($507/day) despite a high acuity of illness (21% of hospital day s in the pediatric intensive care unit). Conclusions. Without proper v alidation, reimbursements from Medicaid (or any program that replaces it) should not be assumed to provide an unbiased or acceptably accurat e measure of the relative or absolute cost of pediatric health care in terventions.