Luigi Tesio, Antonio Caronni, Dinesh Kumbhare, Stefano Scarano
Interpreting results from Rasch analysis 1. The "most likely" measures coming from the model
Disability and rehabilitation
medicaid payments tend less cost care federal disproportionate share hospital dsh payments help hospitals recover uncompensated costs medicaidinsured uninsured patients patient protection affordable care act reduces dsh payments anticipation fewer uninsured patients therefore decreased uncompensated care however unlike adults hospitalized children uninsured many medicaid coverage therefore dsh payment reductions may expose extensive medicaid financial losses hospitals serving large absolute numbers children identify types hospitals highest medicaid losses pediatric inpatient care estimate proportion losses recovered dsh payments retrospective crosssectional analysis evaluated medicaidinsured hospital discharges patients 20 years younger 23 states 2009 kids inpatient database dates analysis march september 2015 hospitals categorized freestanding childrens hospitals fschs childrens hospitals within general hospitals nonchildrens hospital teaching hospitals nonchildrens hospital nonteaching hospitals financial records fschs data set used estimate proportion medicaid losses recovered dsh payments hospital financial losses inpatient care medicaidinsured children defined reimbursement minus cost care compared across hospital types subsample fschs medicaidinsured inpatient financial losses calculated without hospitals dsh payment 2009 kids inpatient database study population included 1485 hospitals 843 725 medicaidinsured discharges freestanding childrens hospitals higher median number medicaidinsured discharges 4082 interquartile range iqr 35245213 vs nonchildrens hospital teaching hospitals 674 iqr 2581414 nonchildrens hospital nonteaching hospitals 161 iqr 41420 freestanding childrens hospitals largest median medicaid losses pediatric inpatient care 9 722 367 iqr 16 248 369 2 137 902 smaller losses experienced nonchildrens hospital teaching hospitals 204 100 iqr 1 014 100 14 700 nonchildrens hospital nonteaching hospitals 28 310 iqr 152 370 9040 disproportionate share hospital payments fschs reduced medicaid losses almost half estimated financial losses pediatric inpatients covered medicaid much larger fschs hospital types childrens hospitals small anticipated increases insured children unlikely offset reductions dsh payments