Stories about: Medicaid

Embracing the future of pediatric quality measurement

Pediatric quality of care researchWhile studying quality of care in the 1990s, Mark Schuster, MD, PhD found that few studies on pediatric quality had been conducted. The typical explanation that he was given was that the federal government wasn’t funding research into quality measures because children on Medicaid don’t drive federal health-care costs nearly as much as adults on Medicaid and Medicare do.

But Schuster, chief of General Pediatrics at Boston Children’s Hospital and William Berenberg Professor of Pediatrics at Harvard Medical School, believes there have been other challenges in measuring care quality in children. In an acceptance speech upon receiving the 2014 Douglas K. Richardson Award for Perinatal and Pediatric Healthcare Research, published today in the journal Pediatrics (PDF), Schuster points to factors including the relative rarity of many pediatric conditions and that many of the benefits of excellent pediatric care are not observed until adulthood.

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Wise health care spending for children with medical complexity

Spending on children with medical complexityJay Berry, MD, MPH, is a pediatrician and hospitalist in the Complex Care Service at Boston Children’s Hospital.

Growing up, my parents repeatedly reminded me that “money doesn’t grow on trees.” They pleaded with me to spend it wisely. I’ve recently been thinking a lot about my parents and how their advice might apply to health care spending for my patients.

As a general pediatrician with the Complex Care Service at Boston Children’s Hospital, I care for “medically complex” children. These children—numbering an estimated 500,000 in the U.S.— have serious chronic health problems such as severe cerebral palsy and Pompe disease. Many of them rely on medical technology, like feeding and breathing tubes, to help maintain their health.

These children are expensive to take care of. They make frequent health care visits and tend be high utilizers of medications and equipment. Some use the emergency department and the hospital so often that they’ve been dubbed frequent flyers.

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CHIP on the block: Should the Children’s Health Insurance Program continue?

chopping block CHIP
Some believe that ACA's insurance exchanges leave gaps in pediatric protection.
Funding for the federal Children’s Health Insurance Program (CHIP) will run out in 2015. Will this leave many kids without health insurance?

About 8 million children currently receive health insurance through CHIP, created in 1997 to bring coverage to children whose families earn too much to qualify for Medicaid but not enough to buy private insurance. States administer the program and receive federal matching funds to cover costs. In 2009, Congress reauthorized funding for CHIP through 2015.

What will happen to CHIP beyond 2015 is uncertain, not just because of the funding deadline but also because of changes brought on by the 2010 Affordable Care Act (ACA). Many believe that the ACA’s Medicaid enrollment incentives and expanded tax credits will add so many lower-income kids to the insurance rolls that CHIP will become unnecessary and simply go away. Others, however, say that the plans sold through the ACA’s insurance exchanges could produce gaps in coverage for children, making it crucial to keep CHIP funded.

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