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Medicaid policy changes and its detrimental effects on neonatal reimbursement and care

Publication ,  Journal Article
Kohler, JA; Goldberg, RN; Tanaka, DT
Published in: Journal of Health Care Finance
September 1, 2015

BACKGROUND: In 2008, North Carolina Medicaid changed the way it classified neonatal care by adopting the Centers for Medicare & Medicaid Services Medicare Severity Diagnosis Related Group (MS-DRG) classification system. By changing the classification system, NC Medicaid merged two very different neonatal populations into one reimbursement class with implications both on hospital reimbursements and the regionalization of neonatal care in the state. METHOD: We analyzed North Carolina Medicaid data to determine DRG weights and associated lengths of stay. RESULTS: Following the adoption of the MS-DRG classification system, NC Medicaid reduced its reimbursement for extremely low birth weight (ELBW) infants but increased its reimbursement for infants with respiratory distress syndrome (RDS). CONCLUSIONS: Large tertiary care NICUs in North Carolina are being poorly reimbursed for the costliest ELBW infants for which they shoulder the greatest responsibility. Meanwhile community special care nurseries are potentially being over compensated for less sick infants. This has led to not only the financial instability of large safety net NICUs which provide care for the sickest and costliest infants, but may also have promoted the decrease in the quality of care for sick neonates. By reducing financial support for the State's sickest infants and most vulnerable citizens, Medicaid may have inadvertently widened the disparity of care as safety net hospitals re-examine their abilities to renovate, let alone expand, neonatal services.

Duke Scholars

Published In

Journal of Health Care Finance

ISSN

1078-6767

Publication Date

September 1, 2015

Volume

42

Issue

2

Related Subject Headings

  • Health Policy & Services
 

Citation

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Kohler, J. A., Goldberg, R. N., & Tanaka, D. T. (2015). Medicaid policy changes and its detrimental effects on neonatal reimbursement and care. Journal of Health Care Finance, 42(2).
Kohler, J. A., R. N. Goldberg, and D. T. Tanaka. “Medicaid policy changes and its detrimental effects on neonatal reimbursement and care.” Journal of Health Care Finance 42, no. 2 (September 1, 2015).
Kohler JA, Goldberg RN, Tanaka DT. Medicaid policy changes and its detrimental effects on neonatal reimbursement and care. Journal of Health Care Finance. 2015 Sep 1;42(2).
Kohler, J. A., et al. “Medicaid policy changes and its detrimental effects on neonatal reimbursement and care.” Journal of Health Care Finance, vol. 42, no. 2, Sept. 2015.
Kohler JA, Goldberg RN, Tanaka DT. Medicaid policy changes and its detrimental effects on neonatal reimbursement and care. Journal of Health Care Finance. 2015 Sep 1;42(2).

Published In

Journal of Health Care Finance

ISSN

1078-6767

Publication Date

September 1, 2015

Volume

42

Issue

2

Related Subject Headings

  • Health Policy & Services