Upcoding emergency admissions for non-life-threatening injuries to children.

OBJECTIVES To assess the influence of investor owned for-profit (IOFP) status on upcoding pediatric inpatient admissions for inconsequential injuries as emergency when urgent or elective would be more suitable. STUDY DESIGN Using Florida inpatient discharge data for children 15 years and younger during 2001 to 2010, we examined injuries originating from the emergency departments (EDs) resulting in 1 overnight stay. Only non-life-threatening injuries were included. We assessed the probability of emergency categorization (vs urgent/elective) of admissions at IOFP hospitals compared with other types of hospitals (public, not for profit). METHODS Logistic regression was used to explore the probability that hospital admission following non-life-threatening injury to a child was classified as an emergency on the billing claim. The model controlled for age, race, sex, Hispanic ethnicity, trauma center status, insurance type and status, number of injuries, and market competition conditions. RESULTS For those patients satisfying the inclusion criteria (n = 8694), about 68% of the time hospitals classified the admissions as emergent. The model provides strong statistical evidence that IOFP hospitals had a higher probability (odds ratio = 1.1) of reporting emergency priorities for children admitted to the hospital from the ED, holding all other variables constant. CONCLUSIONS Upcoding by IOFP hospitals may be a consequence of payer payment practices, utilization management policies, and local market dynamics. Florida Medicaid regulators and managed care organizations should examine their policies to identify inefficiencies associated with pediatric patients admitted for non-life-threatening injuries.