Health care reform

pediatric elective surgery payer mix and utilization under Tenncare managed competition.

Christopher J. Hall, Jerome W. Thompson, James Bailey

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)39-43
Number of pages5
JournalTennessee medicine : journal of the Tennessee Medical Association
Volume101
Issue number10
StatePublished - Oct 2008

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Managed Competition
Health Care Reform
Medicaid
Pediatrics
Hospital Charges
Insurance
Cost Allocation
Adenoidectomy
Tonsillectomy
Otolaryngology
Managed Care Programs
Ventilation
Referral and Consultation

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Health care reform : pediatric elective surgery payer mix and utilization under Tenncare managed competition. / Hall, Christopher J.; Thompson, Jerome W.; Bailey, James.

In: Tennessee medicine : journal of the Tennessee Medical Association, Vol. 101, No. 10, 10.2008, p. 39-43.

Research output: Contribution to journalArticle

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