Medicaid patients admitted to hospitals with a larger proportion of private payers received more diagnoses on Medicaid insurance claims than those in hospitals with a lower proportion of private payers, according to a new study. MedTwitter
September 13, 2022
"Provider-level variation in coding intensity has been documented to some degree for Medicare and commercially-insured groups, but little was known about diagnostic coding patterns for Medicaid-insured groups," Dragan said in an interview. Patients first discharged from hospitals in the bottom quartile of privately insured patients received 1.37 more diagnoses when subsequently discharged from hospitals in the top quartile, and those first discharged from hospitals in the top quartile of privately insured patients received 1.67 fewer diagnoses when discharged from hospitals in the bottom quartile .
The study findings were limited by several factors, including the use of only claims through 2014 in the main analysis, and the inability to determine whether patients are selecting into well-resourced hospitals for more complex conditions, the researchers noted. However,"To the extent that diagnoses drive reimbursement and quality scores, this may create a feedback loop that further benefits highly-reimbursed facilities and exacerbates inequity in resources," the authors conclude.
"This is a strong study," said Ryan, a professor of health management at UM who was not involved in the research."The authors found that a higher share of private patients led to greater risk coding for Medicaid patients; they attribute this effect to the fact that hospitals with a greater share of private patients have stronger incentives to code," he said.
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