Abstract：
OBJECTIVE: To segregate imaging expenditures from claims data by resource utilization bands (RUBs) and underlying conditions to create an \"expenditure map\" of pediatric imaging costs.
METHODS: A Claims data for children enrolled in a commercial value-based plan were categorized by RUB 0 non-user, 1 healthy user, 2 low morbidity, 3 moderate morbidity, 4 high morbidity, & 5 very high morbidity. The per member per year (PMPY) expense, total imaging spend, and imaging modality with the highest spend were assessed for each RUB. Diagnosis categories associated with high imaging costs were also evaluated.
RESULTS: There were 40,022 pediatric plan members. 14% had imaging-related claims accounting for approximately $2.8 million in expenditures. Member distribution and mean PMPY expenditure RUB was respectively: RUB 0 (3,037, $0), RUB 1 (6,604, $7), RUB 2 - 13,698, $27), RUB 3 - 13,341, $87), RUB 4 (2,810, $268), RUB 5 (532, $841). RUB 3 had the largest total imaging costs at $1,159,523. The imaging modality with the greatest mean PMPY expense varied by RUB with radiography highest in lower RUBs and MRI highest in higher RUBs. The top 3 diagnoses associated with the highest total imaging costs were developmental disorders ($443,980), asthma ($388,797), and congenital heart disease ($294,977) and greatest mean PMPY imaging expenditures malignancy/leukemia ($3,100), transplant ($2,639), and tracheostomy ($1,661).
CONCLUSIONS: Expense mapping using claims data allows for a better understanding of the distribution of imaging costs across a covered pediatric population. This tool may assist organizations in planning effective cost-reduction initiatives and learning how imaging utilization varies by patient complexity in their system.
METHODS: A Claims data for children enrolled in a commercial value-based plan were categorized by RUB 0 non-user, 1 healthy user, 2 low morbidity, 3 moderate morbidity, 4 high morbidity, & 5 very high morbidity. The per member per year (PMPY) expense, total imaging spend, and imaging modality with the highest spend were assessed for each RUB. Diagnosis categories associated with high imaging costs were also evaluated.
RESULTS: There were 40,022 pediatric plan members. 14% had imaging-related claims accounting for approximately $2.8 million in expenditures. Member distribution and mean PMPY expenditure RUB was respectively: RUB 0 (3,037, $0), RUB 1 (6,604, $7), RUB 2 - 13,698, $27), RUB 3 - 13,341, $87), RUB 4 (2,810, $268), RUB 5 (532, $841). RUB 3 had the largest total imaging costs at $1,159,523. The imaging modality with the greatest mean PMPY expense varied by RUB with radiography highest in lower RUBs and MRI highest in higher RUBs. The top 3 diagnoses associated with the highest total imaging costs were developmental disorders ($443,980), asthma ($388,797), and congenital heart disease ($294,977) and greatest mean PMPY imaging expenditures malignancy/leukemia ($3,100), transplant ($2,639), and tracheostomy ($1,661).
CONCLUSIONS: Expense mapping using claims data allows for a better understanding of the distribution of imaging costs across a covered pediatric population. This tool may assist organizations in planning effective cost-reduction initiatives and learning how imaging utilization varies by patient complexity in their system.
摘要：
目的：按资源利用带（RUB）和基本条件将成像支出与索赔数据分开，以创建儿科成像成本的“支出图”。
方法：参加基于商业价值的计划的儿童的索赔数据按RUB0非用户分类，1健康用户,2低发病率，3中度发病率，4高发病率，&5非常高的发病率。每个成员每年(PMPY)的费用，总成像支出，对每个RUB评估了花费最高的成像模式。还评估了与高成像成本相关的诊断类别。
结果：有40,022名儿科计划成员。14%的人有与影像相关的索赔，支出约为280万美元。成员分布和平均PMPY支出RUB分别为：RUB0（3,037，$0），1卢布（6,604，7美元），卢布2-13,698，27美元)，卢布3-13,341，87美元)，4卢布（2,810，268美元），5卢布（532美元，841美元）。RUB3的总成像成本最高，为1,159,523美元。平均PMPY费用最大的成像方式因RUB而异，放射线照相在较低的RUB中最高，而MRI在较高的RUB中最高。与最高总成像费用相关的前3名诊断是发育障碍（$443,980），哮喘（388797美元），和先天性心脏病（294,977美元）和最大平均PMPY成像支出恶性肿瘤/白血病（3,100美元），移植（$2,639），和气管造口术(1661美元)。
结论：使用索赔数据进行费用映射可以更好地了解所覆盖儿科人群的影像学费用分布。该工具可以帮助组织计划有效的成本降低计划，并了解成像利用率如何根据其系统中的患者复杂性而变化。
方法：参加基于商业价值的计划的儿童的索赔数据按RUB0非用户分类，1健康用户,2低发病率，3中度发病率，4高发病率，&5非常高的发病率。每个成员每年(PMPY)的费用，总成像支出，对每个RUB评估了花费最高的成像模式。还评估了与高成像成本相关的诊断类别。
结果：有40,022名儿科计划成员。14%的人有与影像相关的索赔，支出约为280万美元。成员分布和平均PMPY支出RUB分别为：RUB0（3,037，$0），1卢布（6,604，7美元），卢布2-13,698，27美元)，卢布3-13,341，87美元)，4卢布（2,810，268美元），5卢布（532美元，841美元）。RUB3的总成像成本最高，为1,159,523美元。平均PMPY费用最大的成像方式因RUB而异，放射线照相在较低的RUB中最高，而MRI在较高的RUB中最高。与最高总成像费用相关的前3名诊断是发育障碍（$443,980），哮喘（388797美元），和先天性心脏病（294,977美元）和最大平均PMPY成像支出恶性肿瘤/白血病（3,100美元），移植（$2,639），和气管造口术(1661美元)。
结论：使用索赔数据进行费用映射可以更好地了解所覆盖儿科人群的影像学费用分布。该工具可以帮助组织计划有效的成本降低计划，并了解成像利用率如何根据其系统中的患者复杂性而变化。
