sábado, 5 de julio de 2014

Preventing Chronic Disease | State-Based Medicaid Costs for Pediatric Asthma Emergency Department Visits - CDC

full-text ►

Preventing Chronic Disease | State-Based Medicaid Costs for Pediatric Asthma Emergency Department Visits - CDC

PCD Logo

State-Based Medicaid Costs for Pediatric Asthma Emergency Department Visits

William S. Pearson, PhD, MHA; Scott A. Goates, PhD; Samantha D. Harrykissoon, JD, MPH; Scott A. Miller, MPA

Suggested citation for this article: Pearson WS, Goates SA, Harrykissoon SD, Miller SA. State-Based Medicaid Costs for Pediatric Asthma Emergency Department Visits. Prev Chronic Dis 2014;11:140139. DOI: http://dx.doi.org/10.5888/pcd11.140139External Web Site Icon.


The prevalence of childhood asthma in the United States increased from 8.7% in 2001 to 9.5% in 2011. This increased prevalence adds to the costs incurred by state Medicaid programs. We provide state-based cost estimates of pediatric asthma emergency department (ED) visits and highlight an opportunity for states to reduce these costs through a recently changed Centers for Medicare and Medicaid Services (CMS) regulation.
We used a cross-sectional design across multiple data sets to produce state-based cost estimates for asthma-related ED visits among children younger than 18, where Medicaid/CHIP (Children’s Health Insurance Program) was the primary payer.
There were approximately 629,000 ED visits for pediatric asthma for Medicaid/CHIP enrollees, which cost $272 million in 2010. The average cost per visit was $433. Costs ranged from $282,000 in Alaska to more than $25 million in California.
Costs to states for pediatric asthma ED visits vary widely. Effective January 1, 2014, the CMS rule expanded which type of providers can be reimbursed for providing preventive services to Medicaid/CHIP beneficiaries. This rule change, in combination with existing flexibility for states to define practice setting, allows state Medicaid programs to reimburse for asthma interventions that use nontraditional providers (such as community health workers or certified asthma educators) in a nonclinical setting, as long as the service was initially recommended by a physician or other licensed practitioner. The rule change may help states reduce Medicaid costs of asthma treatment and the severity of pediatric asthma.


All work was conducted by employees of CDC and no outside funding was received for this work.

Author Information

Corresponding Author: William S. Pearson, PhD, Office of the Associate Director for Policy, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E-02, Atlanta, GA 30329. Telephone: 404-639-6459. E-mail: Wpearson@cdc.gov.
Author Affiliations: Scott A. Goates, Samantha D. Harrykissoon, Scott A. Miller, Centers for Disease Control and Prevention, Atlanta, Georgia.


  1. National Heart Lung and Blood Institute, National Institutes of Health. Expert Panel Report 3: guidelines for the diagnosis and management of asthma. National Asthma Education and Prevention Program. NIH publication no. 07-4051. https://www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.pdf. Accessed November 17, 2013.
  2. Akinbami LJ, Moorman JE, Bailey C, Zaharan HS, King M, Johnson CA, et al. Trends in asthma prevalence, health care use, and mortality in the United States, 2001–2010. NCHS data brief 2012;(94):1-8. PubMedExternal Web Site Icon
  3. Barnett SB, Nurmagambetov TA. Costs of asthma in the United States: 2002–2007. J Allergy Clin Immunol 2011;127(1):145–52. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  4. Centers for Disease Control and Prevention. Asthma’s impact on the nation. http://www.cdc.gov/asthma/impacts_nation/asthmafactsheet.pdf. Accessed September 30, 2013.
  5. Centers for Disease Control and Prevention. National Center for Health Statistics, National Hospital Discharge Survey, 1995–2010. Analysis by the American Lung Association Research and Health Education Division using SPSS software. http://www.lung.org/lung-disease/asthma/resources/facts-and-figures/asthma-children-fact-sheet.html#4. Accessed November 5, 2013.
  6. Finkelstein JA, Barton MB, Donahue JG, Algatt-Bergstrom P, Markson LE, Platt R. Comparing asthma care for Medicaid and non‐Medicaid children in a health maintenance organization. Arch Pediatr Adolesc Med 2000;154(6):563–8. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  7. Centers for Disease Control and Prevention. Vital signs: asthma prevalence, disease characteristics, and self-management education: United States, 2001–2009. MMWR Morb Mortal Wkly Rep 2011;60(17):547–62. PubMedExternal Web Site Icon
  8. Clark N, LaChance L, Milanovich A, Stoll S, Awad DF. Characteristics of successful asthma programs. Public Health Rep 2009;124(6):797–805.PubMedExternal Web Site Icon
  9. Brown AS, Disler S, Burns L, Carlson A, Davis A, Kurian C, et al. Family and home asthma services across the Controlling Asthma in American Cities Project. J Urban Health 2011;88(Suppl 1):100–12. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  10. The Community Guide for Preventive Services. Asthma: home-based, multi-trigger, multicomponent environmental interventions. http://www.thecommunityguide.org/asthma/multicomponent.html. Accessed September 30, 2013.
  11. Centers for Disease Control and Prevention. NAMCS/NHAMCS — about the Ambulatory Health Care Surveys. http://www.cdc.gov/nchs/ahcd.htm. Accessed August 15, 2013.
  12. National Survey of Children’s Health: Data Resource Center for Child and Adolescent Health. http://www.childhealthdata.org/learn/NSCH. Accessed September 20, 2013.
  13. Kaiser Family Foundation — Health Policy Research. Analysis, polling, facts, data and journalism. State category, Medicaid and CHIP, The Henry J. Kaiser Family Foundation. http://kff.org/other/state-indicator/trends-in-monthly-chip-enrollment-june/ and http://kff.org/medicaid/state-indicator/distribution-by-enrollment-group/. Accessed September 20, 2013.
  14. Truven Health Analytics. Marketscan Research Databases. http://truvenhealth.com/Portals/0/assets/ACRS_11223_0912_MarketScanResearch_SS_Web.pdf. Accessed August 1, 2013.
  15. Centers for Disease Control and Prevention and RTI International. Chronic disease cost calculator version 2. http://www.cdc.gov/chronicdisease/resources/calculator/. Accessed December 5, 2013.
  16. Nurmagambetov TA, Barnett SBL, Jacob V, Chattopadhyay SK, Hopkins DP, Crocker DD, et al. Economic value of home-based, multi-trigger, multicomponent interventions with an environmental focus for reducing asthma morbidity: a Community Guide systematic review. Am J Prev Med 2011;41(2S1):S33–S47. PubMedExternal Web Site Icon
  17. Woods ER, Bhaumik U, Sommer SJ, Ziniel SI, Kessler AJ, Chan E, et al. Community asthma initiative: evaluation of a quality improvement program for comprehensive asthma care. Pediatrics 2012;129(3):465–72. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  18. Bhaumik U, Norris K, Charron G, Walker SP, Sommer SJ, Chan E, et al. A cost analysis for a community-based case management intervention program for pediatric asthma. J Asthma 2013;50(3):310–7. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  19. Center for Medicare & Medicaid Innovation. Health Care Innovation Awards: project profiles. http://innovation.cms.gov/initiatives/participant/Health-Care-Innovation-Awards/Health-Resources-In-Action.html. Accessed December 1, 2013.
  20. Diagnostic, Screening, Preventive, and Rehabilitative Services, Final Rule. Fed Regist 2013;78:42226–8. http://www.law.cornell.edu/cfr/text/42/440.130. Accessed April 17, 2014.
  21. Medicaid: use of claims data for analysis of provider payment rates. Washington (DC): United States Government Accountability Office; 2014. http://www.gao.gov/products/GAO-14-56R. Accessed April 17, 2014.
  22. New York State Asthma Surveillance Summary Report. New York (NY): New York State Department of Health; 2009. http://www.health.ny.gov/statistics/ny_asthma/pdf/2009_asthma_surveillance_summary_report.pdf. Accessed March 4, 2014.

No hay comentarios: