Academic journal article Inquiry

Length of Stay and Inpatient Costs under Medicaid Managed Care in Florida

Academic journal article Inquiry

Length of Stay and Inpatient Costs under Medicaid Managed Care in Florida

Article excerpt

Abstract

This study examines the patterns of length of stay (LOS) and inpatient costs for both Medicaid managed care and nonmanaged care patients using data from Medicaid patients aged 18 to 64 years who were discharged from hospitals in Florida between 2006 and 2012. This study used pooled cross-sectional multilevel modeling. The results show that the type of Medicaid program in which patients were enrolled was significantly related to the hospital LOS and inpatient costs. Medicaid managed care patients had 7% shorter LOSs and a 1.9% lower inpatient cost than did Medicaid fee-for-service (FFS) patients. Medicaid managed care patients had shorter LOSs in the Medicaid managed care market with high competition. High managed care penetration generates a cost-decreasing spillover to Medicaid FFS patients.

Keywords

Medicaid managed care, length of stay, inpatient costs, competition

Introduction

Several scholars have paid attention to the differences in lengths of stay (LOSs) and inpatient costs of patients who are insured under managed care or nonmanaged care plans. However, the results of previous studies were inconsistent. (1-5)

Despite the growing interest in Medicaid managed care in Florida, only a few studies have examined the impact of the managed care program on LOS and inpatient costs for Florida's Medicaid enrollees. (6,7) Furthermore, the literature on the impact of Medicaid managed care in the context of different market structures is scarce. (8) It is still unclear whether and how market-level factors affect LOS and inpatient costs for Medicaid beneficiaries. Furthermore, to my understanding, multilevel modeling has not been applied much in health care studies.

Therefore, this study attempts to fill the gap in the previous literature in 3 ways: First, this study analyzes Medicaid managed care program in Florida. Second, this study analyzes how the market competition and competitive influence of Medicaid managed care penetration differently affect LOS and inpatient costs between Medicaid managed care and Medicaid fee-for-service (FFS) patients. Third, using hierarchical linear modeling (HLM), this study provides more precision in estimating the effects of Medicaid managed care plans and market structure variables on LOS and inpatient costs.

Methods

This study addresses the following research questions:

Research Question 1: Do Medicaid patients in managed care have a shorter LOS and lower inpatient costs than do patients in Medicaid FFS?

Research Question 2: Do Medicaid managed care patients have much shorter LOS and lower inpatient costs as the competition of Medicaid managed care organizations (MCOs) and Medicaid managed care penetration increases?

Research Question 3: Does Medicaid managed care penetration affect LOS and inpatient costs for Medicaid FFS patients?

The databases consisted of the following files: (1) the Florida Agency for Health Care Administration (AHCA) hospital inpatient discharge data file, (2) the Florida Medicaid managed care enrollment report, (3) the hospital Medicare cost report from the Center for Medicare and Medicaid Services (CMS), (4) the CMS inpatient prospective payment system impact file, (5) the Florida Statistical Abstract, and (6) the Urban Influence Code from the US Department of Agriculture.

The study population was comprised of all Medicaid patients aged 18 to 64 years who were discharged from short-term general hospitals in Florida from January 1, 2006, to December 31, 2012. The total study population at the patient level was 1 957 072 over all periods. The number of patients observed in the population varied across analysis models because of different missing patterns and sample extraction strategies. Then, the size of the sample was 684 267 patients in the LOS model and 1 368 146 patients in the inpatient costs model. This study examined 902 short-term general hospitals between 2006 and 2012. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.