“Snake bites can be life-threatening, and the most appropriate treatment may be an expensive endeavor. Our analysis tells us that it may be time to reevaluate a billing system that often doesn't reflect the resources committed to treating these patients,” said Evan Fieldston, M.D., MBA, a pediatrician and health services researcher at The Children’s Hospital of Philadelphia’s PolicyLab. Fieldston led the study, published in the current issue of Hospital Pediatrics.
Nationally, the American Association of Poison Control Centers reported over 6,600 cases of snake bites and exposures to venom in 2011, with more than one-third of the events occurring in those under age 20. The Poison Control Center at The Children’s Hospital of Philadelphia has already provided expertise to the care of numerous snake bites this summer including those from native venomous snakes such as copperheads and timber rattlesnakes, as well as exotic snakes such as the African Puff Adder. Dr. Kevin Osterhoudt, study collaborator and medical director of The Poison Control Center, notes that the clinical decision-making regarding the appropriate use of antivenom is challenging, and that studies such as this one help to inform the process. His recent blog explores a case study to illustrate the challenges and costs.
The current research was a retrospective resource-utilization study of health information for 2,755 children and adolescents treated for the toxic effects of venom at 33 U.S. children’s hospitals in 2009. Some patients were poisoned by animals other than snakes, such as spiders, scorpions, lizards, marine animals and ticks.
In addition, not all of the patients with snake bites suffered reactions severe enough to require antivenom. The study team analyzed a subset of 107 patients who received antivenom treatment. These patients were drawn from a total of 335 who were hospitalized: 211 as inpatients and 124 under “observation status.”
“Observation status,” as specified by the federal Centers for Medicare & Medicaid Services, refers to patients not officially admitted to a hospital, but receiving care while the hospital decides whether to admit them or discharge them. Their care is considered outpatient care, and reimbursed by insurers at a lower rate than for inpatients.
Only 24 observation-status patients in the study received antivenom, but their costs stood out. “We found that patients receiving antivenom under observation status were high-cost outliers,” said Fieldston. “Their mean costs were $17,665, compared to mean costs of $3,001 for patients in observation status for other diagnoses.”
The 84 inpatients in the study who received antivenom incurred mean costs of $20,502 over a mean length of stay of 2.2 days. Although antivenom therapy was the same for both inpatients and observation-status patients, reimbursement practices can place a heavier burden of the cost on patients in observation status. Hospitals may also receive lower reimbursements for care provided to observation-status patients.
“Given the financial consequences for both patients and hospitals when antivenom treatment is provided under observation status, we suggest that observation status may not be an appropriate classification for this group of patients. I do not think that a patient who was treated with antivenom for a potentially fatal snake bite and hospitalized for ongoing evaluation and management meets the spirit criteria that CMS specifies for observation status,” said Fieldston.
In addition to his CHOP position, Fieldston also is on the faculty of the Perelman School of Medicine at the University of Pennsylvania.
“Resource Utilization of Pediatric Patients Exposed to Venom,” Hospital Pediatrics Vol. 4 No. 5 September 1, 2014, pp. 276 -282(doi: 10.1542/hpeds.2014-0010) .
About PolicyLab: PolicyLab at The Children’s Hospital of Philadelphia develops evidence-based solutions for the most challenging health-related issues affecting children. PolicyLab engages in research that is both responsive to community needs and relevant to policy priorities, partnering with practitioners, policymakers, and families throughout the research process. Through its work, PolicyLab identifies the programs, practices, and policies that support the best outcomes for children and their families, disseminating its findings beyond research and academic communities as part of its commitment to transform evidence to action. www.research.chop.edu/PolicyLab
About The Children’s Hospital of Philadelphia: The Children’s Hospital of Philadelphia was founded in 1855 as the nation’s first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children’s Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program receives the highest amount of National Institutes of Health funding among all U.S. children’s hospitals. In addition, its unique family-centered care and public service programs have brought the 535-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu.
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