P0532 - Cost Analysis of Pediatric Concurrent Care: Commercial vs Medicaid Payer

I. Original Research

Background: In 2010, Concurrent Care (ConCare) legislation
allowed Medicaid patients under 21-years to receive 'concurrent' curative and hospice
care. States determine local implementation of ConCare. Commerical insurance has
generally followed suit without regulation. The financial implications of ConCare for
hospices remain unknown.

II. Research

Objectives:
• Compare ConCare costs, revenues and difference between Medicaid vs
Commercial payers;
• Develop a standardized analysis template;

III.

Methods: For the calendar year 2018, patient demographics, supply, triage and care
coordination costs, visits by hospice personnel, inpatient/respite care, and financial data
were extracted from the EHR of a large East Coast hospice for all pediatric
patients. Administrative costs were estimated as 30% of direct costs. Revenue for
Medicaid vs Commercial payer was determined and compared with total direct
costs. Descriptive analysis was used.

IV.

Results: 32 children (agemean= 6.6 years) received ConCare. Insurance was
Medicaid (37%)/Commercial (67%). Days in ConCare: Medicaid=124 vs
Commercial=156. 50% of Medicaid patients had cancer vs 10% of Commercially
insured. Medicaid vs Commercial insured patients generally had higher personnel costs
($112/day vs $40/day). Supplies, medications, and DME were lower in Medicaid
($34/day) vs Commercial ($59/day). (See Table Below. Full data available for Congress)

V.

Conclusion: Net loss was equivalent for Medicaid vs Commercial patients (-$14.83
vs -$12.45/day); but patients with Medicaid received more visits while commercially
insured patients had more medication, supply and equipment expenses. Hospice
organizations should feel confident to accept children for concurrent care regardless of
insurer as there is little financial risk to hospices.

VI. Implications for research, policy or practice: We will evaluate regional
differences and whether ConCare reduces acute care hospital utilization for Medicaid vs
Commercially insured patients.