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Alan I. Fields, MD; Alan Rosenblatt, MBA; Murray M. Pollack, MD; Joanne Kaufman, RN, MS

Am J Dis Child. 1991;145(7):727-728.

Abstract
• We evaluated home care costs and the cost-effectiveness of home care vs alternative institutional care for respiratory technology—dependent children in a Medicaid Model Waiver Program. "Cost-savings" was measured as the difference between the established Medicaid reimbursable charges to enact an individualized care plan at a long-term care institution and the actual Medicaid reimbursements for home care. Ten patients—six dependent on mechanical ventilation and four with a tracheostomy who were receiving oxygen—were included in the analysis. The mean (±SD) annual home care costs were $109 836±$20 781 for ventilator-dependent children and $63 650±12 350 for oxygen-dependent patients with a tracheostomy, representing annual savings of approximately $79 000 per patient and $83 000 per patient, respectively. The largest portion of home care reimbursements was for nursing care, accounting for 69.0% and 59.0% of the two patient groups. The full program (50 patients) has the potential for a savings of $4 million per year.

(AJDC. 1991;145:729-733)

Author Affiliations
From the Coordinating Center for Home and Community Care Inc, Millersville, Md (Dr Fields, Mr Rosenblatt, and Ms Kaufman); the Department of Critical Care Medicine, Children's National Medical Center, Washington, DC (Drs Fields and Pollack); and the Departments of Anesthesiology and Pediatrics (Drs Fields and Pollack), George Washington University School of Medicine, Washington, DC.

Footnotes
Accepted for publication January 24, 1991.

Presented in part at the 18th Annual Society of Critical Care Medicine Educational and Scientific Symposium, New Orleans, La, May 8, 1989.

Reprint requests to the Department of Critical Care Medicine, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC 20010 (Dr Fields).

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