INTRODUCTION: Tympanostomy tube (TT) placement is the most common ambulatory surgery performed on children in the US. Tube otorrhea is a common post-surgical sequelae requiring physician follow-up. However, it is known that some patients seek care in the emergency department (ED) rather than the physician office, significantly increasing the cost of care.
OBJECTIVE: To evaluate rates of post-TT ED visits, both all-cause and otorrhea-related, among Medicaid-enrolled and commercially insured pediatric populations.
METHODS: Medical and pharmacy insurance claims data from the Truven MarketScan 11-State Medicaid and Commercial Claims and Encounters databases were used. Patients less than or equal to 17 years old undergoing TT placement between 1/1/09 and 12/31/13 were selected for inclusion. The main endpoint was ED encounters within 30 days post-TT placement, both all-cause and with a primary diagnosis code for otorrhea.
RESULTS: 128,472 Medicaid-enrolled and 240,375 commercially insured patients met all study inclusion criteria. Within 30 days following tube placement, the rate of all-cause ED visits was twice as high in the Medicaid-enrolled when compared to the commercially insured population (8.0% vs. 3.9%, p less than 0.0001). Otorrhea-related ED visits were nearly four-fold higher (p less than 0.0001) in Medicaid-enrollees.
CONCLUSIONS: The rate of ED visits within 30 days following tube placement was significantly greater among Medicaid-enrolled pediatric patients than those with commercial insurance, both all-cause and otorrhea-related. Providers should consider these findings when considering treatment choices for Medicaid enrollees and educating patients/caregivers on appropriate follow-up care which may help decrease the utilization of ED for non-emergency encounters.
